Acute appendicitis in pregnancy mimicking leiomyoma pain

2021 ◽  
Vol 14 (5) ◽  
pp. e238476
Author(s):  
Yuna Kim ◽  
Inchul Hwang
Keyword(s):  
Acute Appendicitis ◽  
Clinical Manifestations ◽  
Second Trimester ◽  
Intravenous Antibiotic ◽  
Laboratory Findings ◽  
Anterolateral Wall ◽  
Fetal Complications ◽  
Hospital Stays ◽  
The Right ◽  
In Pregnancy

Acute appendicitis is the most common nonobstetric condition requiring surgery in pregnancy. However, the diagnosis of acute appendicitis during pregnancy is challenging because of obscure clinical manifestations and laboratory findings. Intravenous antibiotic treatment is not preferred over operation because of the poor outcome. Here, we present a case of a 34-year-old woman in the second trimester of pregnancy who presented with suprapubic pain and an unexpected 3.5 cm-long exophytic intramural myoma on the right anterolateral wall of the uterus rather than prominent appendicitis features; thus, it took 2 days to confirm the diagnosis. Laparoscopic appendectomy was performed, and the patient was discharged without lingering reports on postoperative day 6. Acute appendicitis during pregnancy is common; therefore, attentive clinical suspicion will contribute to shorter hospital stays as well as fewer maternal and fetal complications.

scholarly journals Primary Hyperparathyroidism in Pregnancy: A Two-Case Report and Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
A. D. Herrera-Martínez ◽  
R. Bahamondes-Opazo ◽  
R. Palomares-Ortega ◽  
C. Muñoz-Jiménez ◽  
M. A. Gálvez-Moreno ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Early Diagnosis ◽  
Literature Review ◽  
Primary Hyperparathyroidism ◽  
Serum Levels ◽  
Second Trimester ◽  
Uncommon Disease ◽  
Fetal Complications ◽  
In Pregnancy

Primary hyperparathyroidism (PHPT) in pregnant women is an uncommon disease. It could be easily misdiagnosed because of physiologic changes during pregnancy; in some cases, patients could remain asymptomatic maintaining elevated calcium serum levels, and this situation represents a threat to the health of both mother and fetus. We present two cases of PHPT during pregnancy and their evolution after surgical treatment in the second trimester; there were no observed complications during pregnancy or delivery in our patients. Early diagnosis and medical/surgical treatment in PHPT are necessary for avoiding maternal and fetal complications which could not be predicted based on duration or severity of hypercalcemia. An appropriate management of PHPT during pregnancy is necessary for preserving the health of both the woman and the fetus.

scholarly journals Case Report. Appendiceal Recurrent Colic Due to Enterobius Vermicularis Infection in a 14-Year-Old Female Patient

2016 ◽  
Vol 9 (2) ◽  
pp. 159-162
Author(s):  
Toni I. Stoyanov ◽  
Emilio Corral-Fernadez ◽  
Antonio Melero-Abellan ◽  
Pablo Sarduy-Fernandez ◽  
Paloma Casado-Santamaria ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Young Female ◽  
Lower Abdomen ◽  
Enterobius Vermicularis ◽  
Laboratory Findings ◽  
Rebound Tenderness ◽  
Radiologic Findings ◽  
The Right ◽  
Oral Doses

Summary Acute appendicitis due to Enterobius vermicularis, usually known as pinworm, is very rare and affects mostly children.According to different authors, it is controversial whether pinworms cause inflammation of the appendix or appendiceal colic only.We presentacase ofa14-year-old female with three subsequent hospitalizations in 1 month due to abdominal pain in the right lower abdomen, with rebound tenderness, normal CTscan and laboratory findings. During the last hospitalization, laparoscopic appendectomy was performed. Intraoperatively multiple pinworms were found in the appendix. These were trapped byastercolith in the appendicular base inanoninflamed and histologically normal appendix. Two oral doses of mebendazole were administered postoperatively. Uneventful postoperative period and postoperative follow-up showed lack of symptoms six months after the operation. Despite the widespread idea that acute appendicitis due to Enterobius vermicularis is very rare, it should always be considered in young female patients with repeated abdominal pain in the right lower abdomen with normal laboratory and radiologic findings.

scholarly journals Laparoscopic appendectomy in a second trimester pregnant patient due to acute appendicitis: a case report

2018 ◽  
Vol 7 (8) ◽  
pp. 3373
Author(s):  
Gamaliel Vázquez Estudillo ◽  
Edwin Y. Viveros ◽  
Rodrigo Nuñez Vidales ◽  
Ivanhoe Larracilla Salazar
Keyword(s):  
Emergency Department ◽  
Acute Appendicitis ◽  
Open Surgery ◽  
Diagnostic Laparoscopy ◽  
Pregnant Patient ◽  
Clinical Suspicion ◽  
Second Trimester ◽  
Trimester Pregnancy ◽  
Second Trimester Pregnancy ◽  
Hospital Stays

Acute appendicitis is the most frequent surgical procedure of general surgery during pregnancy, which occurs in 0.04 to 0.2% of all pregnancies; this represents 25% of non-obstetric operations performed during pregnancy. A 33-year-old female patient with a second-trimester pregnancy, which goes to the Emergency Department for abdominal pain, when performing the anamnesis and physical examination, the suggestive picture of acute appendicitis is integrated, for which additional laboratory and cabinet studies are carried out, according to the clinical suspicion it is decided to perform diagnostic laparoscopy and management according to findings; cecal erythematosus appendix is evident, so appendectomy is performed, finding proximal appendicolitis. Later with good evolution and satisfactory exit for the binomial. This procedure has been associated with shorter surgery times, shorter hospital stays and fewer complications compared to open surgery.

scholarly journals Surgical Treatment of “Large Uterine Masses” in Pregnancy: A Single-Center Experience

2021 ◽  
Vol 18 (22) ◽  
pp. 12139
Author(s):  
Anna Franca Cavaliere ◽  
Annalisa Vidiri ◽  
Salvatore Gueli Alletti ◽  
Anna Fagotti ◽  
Maria Concetta La Milia ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Uterine Fibroids ◽  
First Trimester ◽  
Second Trimester ◽  
Histologic Diagnosis ◽  
Single Center Experience ◽  
Fetal Complications ◽  
Benign Nature ◽  
The Masses ◽  
In Pregnancy

Uterine myomas or uterine fibroids are the most common benign uterine masses affecting women. The management of large myoma during pregnancy is challenging, and surgical treatment is a possible option. We report nine cases of pregnant women affected by uterine masses larger than 10 cm, who underwent surgical treatment during the second trimester of pregnancy. In all cases, the masses were preconceptionally unknown and diagnosed during the first trimester. In eight cases, no maternal and fetal complications arose during or after surgical treatment and delivery occurred at full term of pregnancy. In one case, spontaneous abortion was recorded. In all cases, histologic diagnosis demonstrated the benign nature. Women affected by large uterine masses diagnosed for the first time in pregnancy could be taken into consideration for surgical treatment in a referral center during the second trimester.

scholarly journals Intestinal Obstruction due to Acute Appendicitis

2020 ◽  
Vol 14 (2) ◽  
pp. 346-353 ◽  
Author(s):  
Pham Hong Duc ◽  
Ngo Minh Xuan ◽  
Nguyen Huu Thuyet ◽  
Huynh Quang Huy
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Acute Appendicitis ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Male Patient ◽  
Bowel Obstruction ◽  
Clinical Manifestations ◽  
Specific Research ◽  
The Right

Acute appendicitis has been proven to be a usual cause of mechanical small bowel obstruction since 1901, but there has been very little specific research on this subject. It usually occurs as an effect of adhesion because of periappendicular inflammation. Although previous studies exist, this presentation of acute appendicitis is not widely identified, which might lead to delays in making the right diagnosis and initiating treatment. We herein report a 17-year-old male patient who presented with the clinical manifestations of intestinal obstruction and fever for 3 days. Preoperative ultrasound and subsequent computed tomography were performed. On laparotomy, an obstructed bowel was seen, and the appendix was recognized to be the cause. We herein report a case of intestinal obstruction due to acute appendicitis and present an overview of the literature.

scholarly journals 236 Omental Fat Torsion Masquerading Clinically as Acute Appendicitis in a Young Male Patient: A Rare Aetiology of Acute Abdomen and The Value of Diagnostic Laparoscopy

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Abuelgasim ◽  
A Baggaley ◽  
E Saad
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Laparoscopy ◽  
Iliac Fossa ◽  
Young Male ◽  
Postoperative Recovery ◽  
Greater Omentum ◽  
Lumbar Region ◽  
Laboratory Findings ◽  
The Right ◽  
Omental Fat

Abstract Acute abdominal pain is a common surgical presentation and acute appendicitis remains the top differential for most young adults. Omental fat torsion has emerged as a rare aetiology of an acute surgical abdomen in the younger population that closely mimics acute appendicitis in its clinical presentation. Preoperative diagnosis is extremely challenging in this age group due to the rarity of the condition and the non-specific nature of its clinical and laboratory findings, and hence most reported diagnoses were made intra-operatively. We report a case of omental fat torsion in a 22-year-old male who presented with clinical features that were highly suggestive of acute appendicitis. However, the diagnostic laparoscopy revealed a normally looking appendix and terminal ileum, with the presence of a twisted segment of the greater omentum in the right lumbar region. A laparoscopic omentectomy and a prophylactic appendectomy to prevent furture acute appendicitis were performed with an uneventful postoperative recovery. Histology confirmed omental fat infarction and a normal appendix. This reported case highlights a rare cause of right iliac fossa pain and demonstrates the value of diagnostic laparoscopy in the context of clinically suspected acute appendicitis in younger male patients. Diagnostic imaging was not deemed necessary in our patient given the strong clinical suspicion of acute appendicitis. Prompt laparoscopy led to definitive diagnosis as well as treatment and avoided the radiation exposure necessitated during a diagnostic computed tomography scan.

scholarly journals Clinical manifestations of primary and secondary dengue in Paraguay and its relation to virus serotype

2019 ◽  
Vol 13 (12) ◽  
pp. 1127-1134
Author(s):  
Dolores Lovera ◽  
Celia Martínez-Cuellar ◽  
Fernando Galeano ◽  
Sara Amarilla ◽  
Cynthia Vazquez ◽  
...  
Keyword(s):  
Risk Factor ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
Denv Infection ◽  
Laboratory Findings ◽  
Profound Impact ◽  
Hospitalization Period ◽  
Virus Serotype ◽  
The World ◽  
Hospital Stays

Introduction: Dengue virus (DENV) infection is currently a major cause of morbidity in the world, and its incidence has mainly increased during the last years in Latin America, including Paraguay. The objective of this study was to compare the clinical and laboratory findings of dengue and assess whether the serotype is a risk factor for severity. Methodology: We included patients ≤ 15 years old hospitalized with dengue at the Institute of Tropical Medicine, from Paraguay, from 2007 to 2018. Patients were classified according to the 2009 WHO dengue classification guidelines and were stratified by serotype into three groups according to the hospitalization period: the 2007 epidemic (DENV-3), the 2012-2013 epidemic (DENV-2) and the 2016-2018 epidemic (DENV-1). Results: Of 784 children hospitalized for dengue, 50 cases (6.3%) were caused by DENV-3, 471 (60%) by DENV-2, and 263 (33.5%) by DENV-1. Myalgias and headache were associated with DENV-3 cases and abdominal pain was associated with DENV-2 cases. Bleeding was observed mainly in DENV-1 and 2 cases. Patients with DENV-2 infections experienced more severe disease, required fluid expansion more frequently, and exhibited more often shock and admission in the ICU. Secondary cases of dengue were more severe that primary cases. Patients with infection by DENV-2 had longer hospital stays (5.1 ± 2.8 days) when compared to DENV-3 o DENV-1 infection cases (2.9 ± 1.6 days and 4.36 ± 2.7 days, respectively) (p < 0.05). Conclusions: The DENV serotype has a profound impact on the clinical manifestations and severity of dengue. DENV-2 infections were associated more frequently to requirement of fluid expansion, shock, and longer hospital stay.

scholarly journals Curative resection of an aldosteronoma causing primary aldosteronism in the second trimester of pregnancy

2020 ◽  
Vol 2020 ◽  
Author(s):  
Skand Shekhar ◽  
Rasha Haykal ◽  
Crystal Kamilaris ◽  
Constantine A Stratakis ◽  
Fady Hannah-Shmouni
Keyword(s):  
Primary Aldosteronism ◽  
Secondary Hypertension ◽  
Uncontrolled Hypertension ◽  
List Type ◽  
Second Trimester ◽  
Unilateral Adrenalectomy ◽  
Fetal Complications ◽  
Common Etiology ◽  
History Of ◽  
In Pregnancy

Summary A 29-year-old primigravida woman with a known history of primary aldosteronism due to a right aldosteronoma presented with uncontrolled hypertension at 5 weeks of estimated gestation of a spontaneous pregnancy. Her hypertension was inadequately controlled with pharmacotherapy which lead to the consideration of surgical management for her primary aldosteronism. She underwent curative right unilateral adrenalectomy at 19 weeks of estimated gestational age. The procedure was uncomplicated, and her blood pressure normalized post-operatively. She did, however, have a preterm delivery by cesarean section due to intrauterine growth retardation with good neonatal outcome. She is normotensive to date. Learning points: Primary aldosteronism is the most common etiology of secondary hypertension with an estimated prevalence of 5–10% in the hypertensive population. It is important to recognize the subtypes of primary aldosteronism given that certain forms can be treated surgically. Hypertension in pregnancy is associated with significantly higher maternal and fetal complications. Data regarding the treatment of primary aldosteronism in pregnancy are limited. Adrenalectomy can be considered during the second trimester of pregnancy if medical therapy fails to adequately control hypertension from primary aldosteronism.

Risk factors Associated in Acute Appendicitis in Pregnancy

2020 ◽  
Vol 16 ◽  
Author(s):  
Mojtaba Ahmadinejad ◽  
Seyed Mozaffar Hashemi ◽  
Mahnaz Jamee
Keyword(s):  
Acute Appendicitis ◽  
Pregnant Women ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Laboratory Findings ◽  
Lower Quadrant ◽  
Rebound Tenderness ◽  
Abnormal Increase ◽  
Clinical Indices ◽  
Wbc Count

Backgrounds:: Acute appendicitis has been considered as the most common non-obstetric indication, that requires surgical intervention in pregnant women. Objective: The aim of this study is to compare clinical manifestations and para-clinical indices between pregnant and non-pregnant patients whom underwent appendectomy. Methods:: In this prospective cohort study, 57 pregnant and non-pregnant women, presenting appendicitis, were compared in terms of diagnostic indicators, histopathological characteristics and laboratory findings. Results:: Periumbilical region was the point of initiation of the pain, however, was more prominent in non-pregnant women. Similarly, tenderness in RLQ (right lower quadrant) of abdomen was more detectable in non-pregnant group and some of the cases has no rebound tenderness. Pregnant women with appendicitis were presented abnormal increase in WBC count. Conclusion:: Pregnancy and appendicitis-related signs and symptoms have similarity among them. Due to pregnancy, physical examination might not present exact diagnosis, therefore, pregnant women, susceptible have appendicitis must undergo complete and careful on-time examination that includes; ultrasound and labs.

scholarly journals Management of primary hyperparathyroidism in pregnancy: a case series

2019 ◽  
Vol 2019 ◽  
Author(s):  
Aisling McCarthy ◽  
Sophie Howarth ◽  
Serena Khoo ◽  
Julia Hale ◽  
Sue Oddy ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Case Series ◽  
Definitive Treatment ◽  
List Type ◽  
Second Trimester ◽  
Management Options ◽  
Neonatal Complications ◽  
Fetal Complications ◽  
In Pregnancy

Summary Primary hyperparathyroidism (PHPT) is characterised by the overproduction of parathyroid hormone (PTH) due to parathyroid hyperplasia, adenoma or carcinoma and results in hypercalcaemia and a raised or inappropriately normal PTH. Symptoms of hypercalcaemia occur in 20% of patients and include fatigue, nausea, constipation, depression, renal impairment and cardiac arrythmias. In the most severe cases, uraemia, coma or cardiac arrest can result. Primary hyperparathyroidism in pregnancy is rare, with a reported incidence of 1%. Maternal and fetal/neonatal complications are estimated to occur in 67 and 80% of untreated cases respectively. Maternal complications include nephrolithiasis, pancreatitis, hyperemesis gravidarum, pre-eclampsia and hypercalcemic crises. Fetal complications include intrauterine growth restriction; preterm delivery and a three to five-fold increased risk of miscarriage. There is a direct relationship between the degree of severity of hypercalcaemia and miscarriage risk, with miscarriage being more common in those patients with a serum calcium greater than 2.85 mmol/L. Neonatal complications include hypocalcemia. Herein, we present a case series of three women who were diagnosed with primary hyperparathyroidism in pregnancy. Case 1 was diagnosed with multiple endocrine neoplasia type 1 (MEN1) in pregnancy and required a bilateral neck exploration and subtotal parathyroidectomy in the second trimester of her pregnancy due to symptomatic severe hypercalcaemia. Both case 2 and case 3 were diagnosed with primary hyperparathyroidism due to a parathyroid adenoma and required a unilateral parathyroidectomy in the second trimester. This case series highlights the work-up and the tailored management approach to patients with primary hyperparathyroidism in pregnancy. Learning points: Primary hyperparathyroidism in pregnancy is associated with a high incidence of associated maternal fetal and neonatal complications directly proportionate to degree of maternal serum calcium levels. Parathyroidectomy is the definitive treatment for primary hyperparathyroidism in pregnancy and was used in the management of all three cases in this series. It is recommended when serum calcium is persistently greater than 2.75 mmol/L and or for the management of maternal or fetal complications of hypercalcaemia. Surgical management, when necessary is ideally performed in the second trimester. Primary hyperparathyroidism is genetically determined in ~10% of cases, where the likelihood is increased in those under 40 years, where there is relevant family history and those with other related endocrinopathies. Genetic testing is a useful diagnostic adjunct and can guide treatment and management options for patients diagnosed with primary hyperparathyroidism in pregnancy, as described in case 1 in this series, who was diagnosed with MEN1 syndrome. Women of reproductive age with primary hyperparathyroidism need to be informed of the risks and complications associated with primary hyperparathyroidism in pregnancy and pregnancy should be deferred and or avoided until curative surgery has been performed and calcium levels have normalised.

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