scholarly journals Iatrogenic injury to a vesicourachal diverticulum during laparoscopic appendectomy successfully managed conservatively

2019 ◽  
Vol 2019 (10) ◽  
Author(s):  
Saad Alobaysi ◽  
Saud Alsairi ◽  
Abdullah Aljasser ◽  
Ahmad Alkhaddam ◽  
Abdullah Alshamrani
Keyword(s):  
Laparoscopic Appendectomy ◽  
Urine Output ◽  
Iliac Fossa ◽  
Foley Catheter ◽  
Port Placement ◽  
Right Iliac Fossa Pain ◽  
Laboratory Investigations ◽  
Incomplete Closure ◽  
High Index Of Suspicion ◽  
Ct Cystography

Abstract A vesicourachal diverticulum is a rare congenital anomaly that arises from the incomplete closure of the urachus at the bladder end. We describe a 12-year-old boy who presented with severe persistent right iliac fossa pain associated with subjective fever, nausea, vomiting, and anorexia. A computed tomography (CT) scan of the abdomen and pelvis revealed findings consistent with appendicitis. The patient underwent a laparoscopic appendectomy; however, his postoperative course was remarkable for a low urine output and urine leakage from the suprapubic port site. A CT cystography showed a vesicourachal diverticulum and conservative management was offered. This management consisted of Foley catheter placement, hourly monitoring of the patient’s urine output, antibiotic prophylaxis, daily laboratory investigations and a cystography performed after 7 days. Overall, injury to the vesicourachal diverticulum is rare, and surgeons should be aware of this rare clinical entity and exercise caution during port placement. Surgeons should also have a high index of suspicion to identify these injuries and appropriately manage the condition early.

scholarly journals Pediatric appendicitis score in the diagnosis of childhood appendicitis: a validation study

2017 ◽  
Vol 4 (6) ◽  
pp. 2196 ◽  
Author(s):  
Kambalabettu Zohara Parveen ◽  
K. Shreedhara Avabratha ◽  
Kishan Shetty
Keyword(s):  
Biopsy Specimen ◽  
Laboratory Tests ◽  
Iliac Fossa ◽  
Diagnostic Value ◽  
College Hospital ◽  
Medical College ◽  
Right Iliac Fossa Pain ◽  
Laboratory Investigations ◽  
A Prospective Study ◽  
Appendicitis Score

Background: Pediatric appendicitis score (PAS) is a scoring system which includes symptoms, physical examination and laboratory tests in children suspected to have appendicitis. The objectives of this study were to analyze the diagnostic value of Paediatric Appendicitis Score and to aid early diagnosis of appendicitis.Methods: A prospective study was done in a Medical College hospital, in Mangalore in children aged between 4-16 years, admitted during study period June to December 2016, with right Iliac fossa pain, suspected to have appendicitis. Data from the children including demographic details, clinical features, laboratory investigations and ultrasound done were recorded in proformas after consent from parents. The PAS score was applied to them. If PAS was between 4-6, PAS scoring was repeated after 6 hours. Investigations done were noted. If child was taken up for surgery, histopathology report of the biopsy specimen was collected. The decision to operate or manage conservatively was taken up by the treating pediatric surgeon. PAS score was compared with ultrasound and biopsy report.Results: Sixty children were included in the study. Anorexia, emesis, migration pain, cough tenderness and leukocytosis were the features most consistently seen in appendicitis. Initial PAS were comparable to the repeat scores. Ultrasound showed presence of appendicitis in 88.3% of the children. Ultrasound showed appendicitis in all children with PAS ≥7. Twenty-six children out of 60 underwent surgery. Out of 20 children with PAS ≥7.15 (75%) were taken up for surgery and biopsy showed appendicitis. Biopsy was done in 26 children, of whom 58.1% had PAS ≥ 7. These findings were statistically significant. Conclusions: Paediatric appendicitis score is a valuable tool in diagnosing childhood appendicitis.

scholarly journals Kikuchi- Fujimoto Disease of Mesenteric Lymph Nodes Mimicking Acute Appendicitis

2013 ◽  
Vol 52 (192) ◽  
Author(s):  
Anne Shrestha ◽  
Katie Newton ◽  
Emyr Benbow ◽  
Rajeev Kushwaha
Keyword(s):  
Acute Appendicitis ◽  
Lymph Nodes ◽  
Iliac Fossa ◽  
Abdominal Mass ◽  
Low Grade ◽  
Mesenteric Lymph Nodes ◽  
Surgical Interventions ◽  
Mesenteric Lymph ◽  
Right Iliac Fossa Pain ◽  
High Index Of Suspicion

Kikuchi-Fujimoto disease, or histiocytic necrotising lymphadenopathy of unknown aetiology, is a rare, benign and self-limiting cause of lymphadenopathy often involving the cervical nodes, and rarely presenting with mesenteric lymphadenopathy. We present a 26-year-old Caucasian male, who presented with right iliac fossa pain and low grade pyrexia, mimicking acute appendicitis. He underwent a laparatomy and an extended right hemi-colectomy for a caecal mass. Histology of the specimen showed lymph nodes with extensive areas of necrosis, with abnormal architecture suggesting Kikuchi-Fujimoto lymphadenopathy. This was further confirmed by immunohistochemistry. In this context maintenance of a high index of suspicion of this condition can avoid major surgical interventions. We describe the management of our case of Kikuchi-Fujimoto’s disease involving the mesenteric nodes and provide an up to date review of the pertinent literature on this subject.  Keywords: abdominal mass; Kikuchi- Fujimoto disease; mesenteric lymphadenopathy; necrotising lymphadenitis.  

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

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.  

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

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.

Abdominal apoplexy during pregnancy

2020 ◽  
Vol 13 (10) ◽  
pp. e235946
Author(s):  
Jasmeet Kumari ◽  
Rosemary Harkin
Keyword(s):  
Iliac Fossa ◽  
Unknown Origin ◽  
Breech Presentation ◽  
Sudden Onset ◽  
Left Iliac Fossa ◽  
Safe Delivery ◽  
Uterine Contractions ◽  
Early Labour ◽  
Increased Risk ◽  
High Index Of Suspicion

We report a case of idiopathic spontaneous intraperitoneal haemorrhage (ISIH) in a 31-year-old patient at 37 weeks gestation in her second pregnancy. The patient presented to the labour ward with abdominal pain and uterine contractions. The initial complain was of sudden onset, severe sharp pain in left iliac fossa. She started having uterine contractions within 30 min of her presentation. Examination confirmed early labour with a footling breech presentation. Urgent caesarean section was performed that confirmed peritoneal bleeding of unknown origin with safe delivery of the baby. Mother and baby were safely discharged on day 5. ‘Abdominal apoplexy’ (ISIH), is a rare obstetric emergency with increased risk of fetal and maternal morbidity and mortality. With various clinical presentations as a possibility, diagnosis is challenging. High index of suspicion with prompt management of suspected cases can be pivotal life saving measure for the fetus and mother.

scholarly journals SARS-CoV-2 infection in an infant with non-respiratory manifestations: a case report

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Muhammad Adel ◽  
Ahmed Magdy
Keyword(s):  
Computed Tomography ◽  
Aplastic Anemia ◽  
Rt Pcr ◽  
Positive Real ◽  
Case Presentation ◽  
Chest Computed Tomography ◽  
High Incidence ◽  
Laboratory Investigations ◽  
High Index Of Suspicion ◽  
Specific Symptoms

Abstract Background Coronavirus disease (COVID-19) presents in children usually with less severe manifestations than in adults. Although fever and cough were reported as the most common symptoms, children can have non-specific symptoms. We describe an infant with aplastic anemia as the main manifestation. Case presentation We describe a case of SARS-CoV-2 infection in an infant without any respiratory symptoms or signs while manifesting principally with pallor and purpura. Pancytopenia with reticulocytopenia was the predominant feature in the initial laboratory investigations, pointing to aplastic anemia. Chest computed tomography surprisingly showed typical findings suggestive of SARS-CoV-2 infection. Infection was later confirmed by positive real-time reverse transcription polymerase chain reaction assay (RT-PCR) for SARS-CoV-2. Conclusions Infants with COVID-19 can have non-specific manifestations and a high index of suspicion should be kept in mind especially in regions with a high incidence of the disease. Chest computed tomography (CT) and testing for SARS-CoV-2 infection by RT-PCR may be considered even in the absence of respiratory manifestations.

scholarly journals Giant sigmoid diverticulitis mimicking acute appendicitis

2011 ◽  
Vol 93 (6) ◽  
pp. e89-e90 ◽  
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.

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