EP.TU.883Improving diagnosis in all male patients admitted with right iliac fossa pain

Abstract Background Right iliac fossa pain is a common presenting complaint in males. Ultrasound is a cheap non-invasive investigation, yet results can be non-diagnostic. CT is becoming more accessible and available for patient assessment. Aim Our primary aim is to estimate how many unnecessary US scans are gained prior to CT imaging, thereby delaying surgery, increasing cost and increasing length of stay (LOS). Method We conducted a retrospective analysis of all male patients over the age of 16 admitted to a single unit with RIF pain over 12 months. Outcome and length of stay was recorded. Results 162 male patients were admitted to a single University teaching hospital between 2017 and 2018. 33% (n = 53) of patients having an US scan require further imaging, 40% ( n = 21 ) of these had a surgical pathology, 80% (n = 17) of these requiring appendicectomy. Patients (n = 39) who had an initial CT scan subsequently requiring surgery length of LOS 3.6 days compared with US imaging with additional imaging requiring surgery ( n = 17) LOS 5.8 days. Conclusion Evaluation of practice of males over the age of 16 shows that US is frequently non diagnostic, requiring further investigation with CT or MRI. Imaging initially with CT scan aid diagnosis and decrease length of stay. An education steering committee of surgical trainees, consultants and radiographers has been created to adapt practice in our centre through continued education and training.

Download Full-text

Ūminis skausmas dešinėje klubinėje srityje: ar visada tai apendicitas?

Lietuvos chirurgija ◽

10.15388/lietchirur.2010.2.2118 ◽

2010 ◽

Vol 8 (2) ◽

pp. 0-0

Author(s):

Agnius Juška ◽

Ieva Žostautienė ◽

Jonas Pivoriūnas ◽

Jonas Jurgaitis ◽

Marius Paškonis ◽

...

Keyword(s):

Pathological Condition ◽

Iliac Fossa ◽

University Hospital ◽

Lower Quadrant Pain ◽

Lower Quadrant ◽

Right Lower Quadrant Pain ◽

Surgical Trainees ◽

G 21 ◽

Right Iliac Fossa Pain ◽

Vilnius University

Agnius Juška1, Ieva Žostautienė1, Jonas Pivoriūnas1, Jonas Jurgaitis2, Marius Paškonis2, 3, Vytautas Lipnickas2, Kęstutis Strupas21Vilniaus universiteto Medicinos fakultetas,M. K. Čiurlionio g. 21, LT-03101 Vilnius2Gastroenterologijos, urologijos ir abdominalinės chirurgijos klinika, Vilniaus universiteto ligoninė Santariškių klinikos,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Aklosios žarnos pavienis divertikulas – reta patologija ir pagal požymius beveik neatskiriama nuo ūminio apendicito. Aklosios žarnos divertikulitas gali nesukelti simptomų tol, kol nepasireiškia uždegimas, divertikulas neprakiūra ar iš jo neprasideda kraujavimas. Nors atliekami echoskopiniai ir kompiuterinės tomografijos tyrimai, tikslią diagnozę prieš operaciją vis vien sunku nustatyti ir dažniausiai ji paaiškėja operuojant. Nors ši liga reta Vakarų šalyse, ją reikia turėti omenyje diferencijuojant tuomet, kai pacientas skundžiasi skausmu dešinėje klubinėje srityje. Dėl to į šią retą būklę norime atkreipti ne tik chirurgų bet ir kitų gydytojų dėmesį. Reikšminiai žodžiai: pavienis aklosios žarnos divertikulas, divertikulitas dešinėje, skausmas apatiniame dešiniajame kvadrante, įgimtas aklosios žarnos divertikulas. Acute pain in right iliac fossa region – is it always an appendicitis? Agnius Juška1, Ieva Žostautienė1, Jonas Pivoriūnas1, Jonas Jurgaitis2, Marius Paškonis2, 3, Vytautas Lipnickas2, Kęstutis Strupas21Vilnius University Faculty of Medicine,M. K. Čiurlionio str. 21, LT-03101 Vilnius, Lithuania2Clinic of Gastroenterology, Urology and Abdominal Surgery, Vilnius University Hospital Santariškių Clinics,Santariškių Str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Solitary diverticulum of caecum is an uncommon pathological condition almost indistinguishable from acute appendicitis. Caecal diverticulitis can be asymptomatic until it becomes inflamed, perforated or begins to bleed. In spite of routine ultrasonography and computer tomography findings, correct preoperative diagnosis is still difficult and is usually made in the operating theater. Although this condition is very rare in Western countries, it should be considered in the differential diagnosis for patients complaining of right iliac fossa pain. Therefore, the aim of this case report is to improve the awareness of this condition not only among surgical trainees but also among the rest of medical staff. Key words: solitary diverticulum of the caecum, right diverticulitis, right lower quadrant pain, congenital diverticulum of the caecum.

Download Full-text

Comparison of the use of neutrophil: lymphocyte count ratio (NLCR) to total leukocyte count in diagnosing appendicitis in adults with right iliac fossa pain

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v21i2.24357 ◽

2018 ◽

Vol 21 (2) ◽

pp. 24-27

Author(s):

Rabindra K.C. ◽

Abhishek Bhattarai ◽

Rakshya Joshi ◽

Ashok Kharel ◽

Ishwar Iohani

Keyword(s):

Acute Appendicitis ◽

Lymphocyte Count ◽

Leukocyte Count ◽

Iliac Fossa ◽

Final Diagnosis ◽

University Teaching ◽

Total Leukocyte Count ◽

Count Ratio ◽

Right Iliac Fossa Pain ◽

Laboratory Investigations

Introduction: Diagnosis of acute appendicitis (AA) is purely based on history, examination and few laboratory investigations. However, it is often a perplexing diagnostic problem during the early stages of the disease. Failure to make an early diagnosis is a primary reason for morbidity and mortality. Elevated leukocyte count is one of the indicators of appendiceal inflammation in patients with right iliac fossa pain and most of the patients with acute appendicitis present with leucocytosis. Recently, it has been seen that the neutrophil: lymphocyte count ratio (NLCR) is a more sensitive marker than leukocytosis in patients with acute appendicitis. Method: This is a prospective observational study conducted over a period of one year in the department of surgery at the Tribhuvan University Teaching Hospital, from September 2013 to August 2014. The clinical diagnosis of Acute appendicitis was made by history and clinical examinations and laboratory investigations. Total leukocyte count (TLC) and NLCR of patients diagnosed as AA were measured and recorded in the pro forma. Histological diagnosis was taken as the final diagnosis. Results: A total of 106 patients were included in the study. Two third of the patients were male. Right iliac fossa tenderness was the most common sign. Ultrasound was able to diagnose acute appendicitis in 40.65% of the cases. NLCR> 3.5 was observed in 90.56% of patients with acute appendicitis, whereas 78.3% of patients had leukocytosis only. High NLCR (5.60) is associated with complicated AA. Conclusion: NLCR is a more sensitive laboratory parameter than TLC in patients with RIF pain to diagnose acute appendicitis. A high NLCR ratio has a high likelihood of a complicated AA.

Download Full-text

THE ROLE OF COMPUTED TOMOGRAPHY (CT) IN PATIENTS WITH RIGHT ILIAC FOSSA PAIN IN THE EMERGENCY DEPARTMENT.

Indian Journal of Medical Research and Pharmaceutical Sciences - September-2020 ◽

10.29121/ijmrps.v8.i1.2020.1 ◽

2020 ◽

Vol 8 (1) ◽

pp. 1-9

Keyword(s):

Ct Scan ◽

Medical Center ◽

Iliac Fossa ◽

Non Invasive ◽

Dual Source ◽

Invasive Method ◽

Right Iliac Fossa Pain ◽

The Mean ◽

Contrast Media Administration

Objective To emphasize the accuracy of CT as non-invasive method either to confirm specific diagnosis or suggest an alternative diagnosis for right iliac fossa pain. Material and method A total number of 200 patients who underwent abdomen and pelvic CT, their images were retrospectively reviewed in a period between June 2019 –December 2019 at King Hussein Medical Center. The age of the patients ranges from (14-70 years) with the mean age 42 years. All scans were performed with Siemens definition dual source 64 slice CT scan, abdominal CT scan protocol with or without intravenous (IV) contrast media administration. The results will be analyzed by simple statistical method.

Download Full-text

1176 Paediatric Patients Presented with Right Iliac Fossa Pain: Is the Ultrasound Scan Conducted in A Timely Manner?

British Journal of Surgery ◽

10.1093/bjs/znab259.769 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M Barghash ◽

A Iskandar ◽

S Fawzy ◽

B Ali

Keyword(s):

Length Of Stay ◽

Iliac Fossa ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Ultrasound Scan ◽

Clinical Tool ◽

Paediatric Patients ◽

Computed Tomography Scans ◽

Right Iliac Fossa Pain ◽

The Uk

Abstract Aim Ultrasound scan is a crucial clinical tool in the management of acute appendicitis in children. That is because it can aid in the diagnosis without exposing the patient to potentially harmful ionising radiation from computed tomography scans. In this project, we were assessing whether children presented with right iliac fossa pain receive their scans on time. In addition, we were exploring whether definitive management and hospital length of stay were affected by the scan delay. Method This was a retrospective project in which we assessed case notes of paediatric patients who had an ultrasound scan between September 2019 and September 2020 in one of the district general hospitals in the UK. The project included notes of patients who were below 16, admitted with right iliac fossa pain, and had an inpatient ultrasound scan. Results A total of 33 patients met the inclusion criteria. The waiting time ranged from 1 hour to 89 hours with a mean of around 19.5 hours and a median of 14.5 hours. The hospital length of stay ranged from 1 day to 21 days with a mean of around 2.5 days and a median of 1 day. Conclusions An ultrasound scan should be conducted within the same day of admission for all paediatric patients presented with right iliac fossa pain.

Download Full-text

Lockdown dilemma: ingestion of magnetic beads presenting as right iliac fossa pain and subacute small bowel obstruction

BMJ Case Reports ◽

10.1136/bcr-2020-236429 ◽

2020 ◽

Vol 13 (11) ◽

pp. e236429

Author(s):

Bankole Oyewole ◽

Anu Sandhya ◽

Ian Maheswaran ◽

Timothy Campbell-Smith

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Magnetic Beads ◽

Iliac Fossa ◽

Serous Fluid ◽

Magnetic Resonance Scan ◽

History Of ◽

Right Iliac Fossa Pain ◽

Multiple Episodes ◽

Safety Netting

A 13-year-old girl presented with a 3-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice. She presented again 6 days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment. Intraoperative findings revealed 200 mL of serous fluid in the pelvis, normal-looking appendix, dilated stomach and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetised the laparoscopic instruments. A minilaparotomy was performed with the extraction of 14 magnetic beads and the repair of nine enterotomies. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.

Download Full-text

Giant sigmoid diverticulitis mimicking acute appendicitis

Annals of The Royal College of Surgeons of England ◽

10.1308/147870811x591008 ◽

2011 ◽

Vol 93 (6) ◽

pp. e89-e90 ◽

Cited By ~ 2

Author(s):

M Anderton ◽

B Griffiths ◽

G Ferguson

Keyword(s):

Computed Tomography ◽

Iliac Fossa ◽

Treatment Options ◽

Sigmoid Diverticulitis ◽

Acute Presentation ◽

Rare Manifestation ◽

Giant Sigmoid Diverticulum ◽

Right Iliac Fossa Pain ◽

Colonic Diverticula

Giant colonic diverticula are a rare manifestation of diverticular disease and there are fewer than 150 cases described in the literature. They may have an acute or chronic presentation or may remain asymptomatic and be found incidentally. As the majority (over 80%) of giant diverticula are located in the sigmoid colon, they usually present with left-sided symptoms but due to the variable location of the sigmoid loop, right-sided symptoms are possible. We describe the acute presentation of an inflamed giant sigmoid diverticulum with right iliac fossa pain. We discuss both the treatment options for this interesting condition and also the important role of computed tomography in the diagnosis and management of abdominal pain in elderly patients.

Download Full-text