Appendicitis: a rare adverse event in colonoscopy

2021 ◽  
Vol 14 (7) ◽  
pp. e242523
Author(s):  
Samer Al-Dury ◽  
Mohammad Khalil ◽  
Riadh Sadik ◽  
Per Hedenström
Keyword(s):  
Emergency Department ◽  
Adverse Event ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Physical Examination ◽  
De Novo ◽  
Perforated Appendicitis ◽  
Lower Quadrant ◽  
The Right ◽  
Right Lower Quadrant

We present a case of a 41-year-old woman who visited the emergency department (ED) with acute abdomen. She was diagnosed with perforated appendicitis and abscess formation on CT. She was treated conservatively with antibiotics and discharged. On control CT 3 months later, the appendix had healed, but signs of thickening of the terminal ileum were noticed and colonoscopy was performed, which was uneventful and showed no signs of inflammation. Twelve hours later, she developed pain in the right lower quadrant, followed by fever, and visited the ED. Physical examination and blood work showed signs consistent with acute appendicitis, and appendectomy was performed laparoscopically 6 hours later. The patient recovered remarkably shortly afterwards. Whether colonoscopy resulted in de novo appendicitis or exacerbated an already existing inflammation remains unknown. However, endoscopists should be aware of this rare, yet serious complication and consider it in the workup of post-colonoscopy abdominal pain.

scholarly journals The use of ultrasonographic and Alvarado scores in evaluating abdominal pain suggestive of acute appendicitis

2017 ◽  
Vol 4 (2) ◽  
pp. 757 ◽  
Author(s):  
Jorge Fernández Álvarez ◽  
José Manuel Gómez López ◽  
Alberto M González Chávez ◽  
Benjamín Valente Acosta ◽  
Diego Abelardo Álvarez Hénandez ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
Alvarado Score ◽  
Lower Quadrant ◽  
Efficient Alternative ◽  
Two Parameters ◽  
The Right ◽  
Right Lower Quadrant

Background: Ultrasonographic scores for appendicitis to determine if, combined with Alvarado scores, they can increase the sensitivity and specificity of the diagnosis of appendicitis.Methods: All cases of abdominal pain suggestive of appendicitis presented between 2013 and 2015 were analysed. An Alvarado score was obtained. All patients underwent ultrasound, and an ultrasonographic score was determined, including the appendicitis classical findings.Results: Two hundred and fifty-one patients with abdominal pain in the right lower quadrant were analysed. Appendicitis was confirmed in 211 (84%) patients. For these patients, the average Alvarado score was 7.95/10 (±1.25) vs. 5.7/10 (± 1.11) for patients who did not have appendicitis (p < 0.001). In patients with confirmed appendicitis, the average ultrasonographic score was 2.48/6 (± 1.06) vs. 0.6/6 (± 0.92) for patients who did not have acute appendicitis (p < 0.001). The ultrasonographic score has a sensitivity of 90% and a specificity of 87% with only two parameters. The combination of the Alvarado and ultrasonographic scores decreased the percentage of negative appendectomies to 2.36% and increased the area under the curve by 0.970.Conclusions: The sum of the Alvarado and ultrasonographic scores provides an efficient alternative for diagnosing abdominal pain suggestive of appendicitis and predicts which patients should undergo surgery with good certainty.

Manifestations of Pediatric Appendicopathia Oxyurica

2013 ◽  
Vol 79 (9) ◽  
pp. 873-874 ◽  
Author(s):  
Mary M. Jordan ◽  
Jennifer E. Sanders ◽  
Christina R. Stallworth ◽  
Scott Russell ◽  
Olivia Titus ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Ex Vivo ◽  
Low Grade ◽  
Enterobius Vermicularis ◽  
Lower Quadrant ◽  
First Case ◽  
Human Digestive Tract ◽  
The Right ◽  
Right Lower Quadrant

Enterobius vermicularis is a parasite that inhabits the human digestive tract. We present two pediatric patients with symptoms mimicking acute appendicitis who were found to have E. vermicularis infection. The first case is a 5-year-old female who presented with flank and abdominal pain associated with low-grade fever and anorexia. She had localized tenderness in the right lower quadrant and a leukocytosis with left shift. Intraoperative findings included a normal-appearing appendix, but ex vivo examination revealed Enterobius vermicularis. The second case is a 7-year-old female who presented with periumbilical abdominal pain, anorexia, and emesis. She had tenderness at McBurney's point, and ultrasound revealed a small echogenic focus within the appendix. Intraoperatively, the distal tip of the appendix appeared inflamed. Again, ex vivo examination revealed E. vermicularis. Enterobius vermicularis infection of the appendix can present with a clinical picture similar to acute appendicitis. In at-risk populations, it should be included in the differential diagnosis for children with right lower quadrant abdominal pain. Complete therapy requires treatment with mebendazole.

scholarly journals Vyresnio amžiaus žmonių ūminis apendicitas: simptomai, diagnostika ir gydymo rezultatai

2003 ◽  
Vol 1 (3) ◽  
pp. 0-0
Author(s):  
Donatas Venskutonis ◽  
Virmantas Daubaras ◽  
Juozas Kutkevičius
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Elderly Patients ◽  
Hospital Stay ◽  
The Elderly ◽  
Research Data ◽  
Laboratory Research ◽  
Lower Quadrant ◽  
The Right ◽  
Right Lower Quadrant

Donatas Venskutonis, Virmantas Daubaras, Juozas KutkevičiusKauno medicinos universiteto Bendrosios chirurgijos klinika,Kauno 2-oji klinikinė ligoninė,Josvainių g. 2, LT-3021El paštas: [email protected] Įvadas / tikslas Apie 5–10% žmonių ūminiu apendicitu suserga būdami vyresnio amžiaus. Tyrimo tikslas – įvertinti vyresnio amžiaus žmonių, gydytų nuo apendicito, skundus, medicininės apžiūros, laboratorinių, instrumentinių tyrimų duomenis, laiką iki atvykimo į ligoninę ir diagnostinio laikotarpio trukmę, bendrą gulėjimo stacionare trukmę, apendicito patologines formas, komplikacijas ir baigtis, statistiškai įvertinti skirtumus, susijusius su lytimi. Ligoniai ir metodai Retrospektyviai išanalizuotos 158 vyresnio amžiaus žmonių, sirgusių ūminiu apendicitu 1991–2000 metais, ligos istorijos, įvertinti ligonių skundai, medicininės apžiūros, laboratorinių, instrumentinių tyrimų duomenys, laikas iki atvykimo į stacionarą ir diagnostinio laikotarpio trukmė, bendra gulėjimo stacionare trukmė, nustatytos patologinės apendicito formos, įvertintos komplikacijos ir baigtys. Rezultatai Vyrų ir moterų sergamumas ūminiu apendicitu yra panašus, mūsų duomenimis, jis šiek tiek dažniau pasireiškia moterims (55,7%) negu vyrams (44,3%). Ligoniai dažniausiai skundžiasi pilvo skausmu (100%), pykinimu (65,8%), vėmimu (43,7%), kiek rečiau dujų susilaikymu (37,3%), burnos džiūvimu (37,3%). Medicininės apžiūros duomenimis, visiems ligoniams buvo pilvo skausmas (100%), rečiau liežuvio apnašos (72,2%), teigiami Kocherio (44,9%) ir Rovzingo (39,9%) simptomai. Vidutinis nustatytas leukocitų skaičius buvo 11,4×109/l. Laikas, praėjęs nuo simptomų pradžios iki hospitalizavimo, yra gana ilgas (2 paros), o laikas nuo hospitalizavimo iki operacijos – 4,11 val. Išvados Vyresnio amžiaus žmonėms būdingas ilgas ikioperacinis laikotarpis. Dažniausi šių ligonių skundai yra pilvo skausmas, pykinimas, vėmimas. Pilvo skausmingumas nustatomas visiems ligoniams, paprastai dešinėje klubinėje srityje (87,3%). Raumenų tempimas dešinėje klubinėje srityje būdingas 67,7% ligonių, pilvaplėvės dirginimo reiškiniai dešinėje klubinėje srityje – 66,5%. Klinikinių požymių raiškos dažnumo skirtumas vyrų ir moterų statistiškai nereikšmingas. Prasminiai žodžiai: ūminis apendicitas, vyresnio amžiaus ligoniai. Acute appendicitis in the elderly: symptoms, diagnostics and treatment results Donatas Venskutonis, Virmantas Daubaras, Juozas Kutkevičius Background / objective 5–10% of the population fell ill with appendicitis in advanced age. The aim of the current study was to evaluate complaints of the elderly that had been ill with appendicitis: physical, laboratory, instrumental research data, the time before coming to hospital and the duration of the diagnostic period, in-hospital stay, the pathological forms, complications and outcome of appendicitis, to evaluate the statistical difference between males and females. Patients and methods In the course of the study, the charts of 58 senior patients that had been ill in 1991–2000 were analysed for complaints, laboratory, instrumental research data, time before coming to hospital, duration of the diagnostic period, in-hospital stay, as well as pathologic forms, complications and outcome of appendicitis. Results The frequency of acute appendicitis among male and female was found to be similar. Our data show that female morbidity (55.7%) is a little higher than male (44.3%). Most patients complained of abdominal pain (100%), nausea (65.8%), vomiting (43.7%), delay of wind (37.3%), desiccation of mouth (37.3%). The physical research data showed that all patients had abdominal pain (100%), rarely tousled tongue (72.2%), positive Kocher (44.9%) and Rovsing (39.9%) symptoms. Laboratory research data revealed the average leukocytes number to be 11.4. The interval between the patient’s coming to the hospital and the onset of symptoms and hospitalization was rather long (2 days). The average time from hospitalization till operation was 4 hours 11 minutes. Conclusions The interval between the patient’s coming to the hospital and the onset of symptoms and hospitalization is rather long among elderly patients. Most often complaints among elderly people are: abdominal pain, nausea, vomiting. All patients have abdominal pain, the most often pain localization is in the right lower quadrant (87,3%), right lower quadrant tenderness (67,7 %), irritation of the peritoneum in the right lower quadrant (66,5 %). The clinical differences between men and women are not statistically reliable. Keywords: acute appendicitis, elderly patients.

scholarly journals Intestinal obstruction caused by pericecal internal herniation

2020 ◽  
Vol 2020 (2) ◽  
Author(s):  
Floris B Poelmann ◽  
Ewoud H Jutte ◽  
Jean Pierre E N Pierie
Keyword(s):  
Abdominal Pain ◽  
Intestinal Obstruction ◽  
Acute Abdominal Pain ◽  
Treatment Preference ◽  
Treatment Modalities ◽  
Internal Herniation ◽  
Lower Quadrant ◽  
Surgical History ◽  
The Right ◽  
Right Lower Quadrant

Abstract Intestinal obstruction caused by pericecal internal herniation are rare and only described in a few cases. This case describes an 80-year-old man presented with acute abdominal pain, nausea and vomiting, with no prior surgical history. Computed tomography was performed and showed a closed loop short bowel obstruction in the right lower quadrant and ascites. Laparoscopy revealed pericecal internal hernia. This is a viscous protrusion through a defect in the peritoneal cavity. Current operative treatment modalities include minimally invasive surgery. Laparoscopic repair of internal herniation is possible and feasible in experienced hands. It must be included in the differential diagnoses of every patient who presents with abdominal pain. When diagnosed act quick and thorough and expeditiously. Treatment preference should be a laparoscopic procedure.

scholarly journals Amyand's hernia and acute appendicitis: Case presentation in Basic Hospital of Chone

2020 ◽  
Vol 4 (2) ◽  
pp. 19-23
Author(s):  
Orelvis Rodríguez Palmero ◽  
Liseidy Ordaz Marin ◽  
María Del Rosario Herrera Velázquez ◽  
Agustín Marcos García Andrade
Keyword(s):  
Abdominal Pain ◽  
Inguinal Hernia ◽  
Acute Appendicitis ◽  
Physical Examination ◽  
Iliac Fossa ◽  
Amyand’S Hernia ◽  
Case Presentation ◽  
The North ◽  
History Of ◽  
The Right

Present the case of a 66-year-old male patient, with a history of right inguinal hernia, who was referred to the emergency room at the IESS de Chone Basic Hospital in the north of the Manabí province, Ecuador, with symptoms of Abdominal pain of more than 24 hours of evolution located in the right iliac fossa and inguinal region on the same side, in the physical examination the hernia was impossible to reduce, so he was taken to the operating room, in the intervention the cecal appendix was found swollen within the hernial sac, a condition known as Amyand's hernia.

scholarly journals Isolated intestinal Ganglioneuromatosis: case report and literature review

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Angela Mauro ◽  
Letizia Zenzeri ◽  
Francesco Esposito ◽  
Giovanni Gaglione ◽  
Caterina Strisciuglio ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Polypoid Lesion ◽  
Occult Blood ◽  
Fecal Occult Blood ◽  
Ileal Loop ◽  
Lower Quadrant ◽  
Blood Tests ◽  
Fecal Occult ◽  
The Right ◽  
Right Lower Quadrant

Abstract Background Intestinal Ganglioneuromatosis (IG) is a rare disorder of the enteric nervous system. In pediatric age it is often associated with genetic syndromes such as Neurofibromatosis 1 (NF1), multiple endocrine neoplasia type 2B (MEN2B) and Cowden syndrome (PTEN mutation), and ganglioneuromas (GNs) may be sometimes the first sign of the disease. Isolated GNs are rare and sporadic. Clinical symptom vary and depend on the size and on the location of the GNs. This disorder affects intestinal motility and it, consequently, causes changes in bowel habits, abdominal pain, occlusive symptoms and rarely lower gastrointestinal bleeding secondary to ulceration of the intestinal mucosa. On the other hand, patients can remain asymptomatic for many years. Case presentation We describe a 9-year-old boy referred to our emergency department for right lower quadrant abdominal pain. No familial history for gastrointestinal disorders. No history of fever or weight loss. At physical examination, he had diffused abdominal pain. Abdominal ultrasonography showed a hypoechoic formation measuring 41.8 mm by 35 mm in the right lower quadrant of the abdomen. Routine blood tests were normal, but fecal occult blood test was positive. Abdominal TC confirmed the hypodense formation, of about 5 cm in transverse diameter, in the right hypochondrium that apparently invaginated in the caecum-last ileal loop. Colonoscopy showed in the cecum an invaginated polypoid lesion of the terminal ileal loop. Laparoscopic resection of the polypoid lesion was performed. Histological diagnosis of the large neoplasm observed in the terminal ileum was diffuse ganglioneuromatosis. NF1, RET and PTEN gene tests resulted negative for specific mutations. At the 1 year follow-up, the patient presented good general condition and blood tests, fecal occult blood test, esophagogastroduodenoscopy, colonoscopy and MR-enterography were negative. Conclusions Only few cases are reported in literature of IG in pediatric age. Although rare, the present case suggests that this disorder must be taken in consideration in every patient with GI symptoms such as abdominal pain, constipation, lower intestinal bleeding, in order to avoid a delayed diagnosis.

scholarly journals Right Lower Quadrant Abdominal Pain in a Patient with Prior Ventriculoperitoneal Shunting: Consider the Tip!

2012 ◽  
Vol 2012 ◽  
pp. 1-2 ◽  
Author(s):  
Petros Charalampoudis
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Lower Quadrant ◽  
Vp Shunt ◽  
Quadrant Abdominal Pain ◽  
Ventriculoperitoneal Shunting ◽  
Infection Treatment ◽  
Catheter Tip ◽  
Colicky Pain ◽  
Right Lower Quadrant

Introduction. Ventriculoperitoneal (VP) shunting is the treatment of choice for nonobstructive hydrocephalus. In patients with such a device, right lower quadrant abdominal pain can puzzle the surgeon, posing a differential diagnostic problem among appendicitis, nonsurgical colicky pain, and primary shunt catheter tip infection. Treatment is different in either case.Presentation of Case. We hereby present a case of a young woman with prior ventriculoperitoneal shunt positioning who presented to our department with right lower quadrant abdominal pain. The patient underwent a 24-hour observation including a neurosurgery consult in order to exclude acute appendicitis and VP shunt tip infection. Twenty four hours later, the patient’s symptomatology improved, and she was discharged with the diagnosis of atypical colicky abdominal pain seeking a gastroenterologist consult.Discussion. This case supports that when a patient with prior VP shunting presents with right lower quadrant abdominal pain, differential diagnosis can be tricky for the surgeon.Conclusion. Apart from acute appendicitis, primary or secondary VP catheter tip infection must be considered because the latter can be disastrous.

scholarly journals Adult intestinal malrotation: a case report

2019 ◽  
Vol 7 (12) ◽  
pp. 4807
Author(s):  
Nyoman T. Pradiptha ◽  
Ketut Wiargitha
Keyword(s):  
Abdominal Pain ◽  
X Rays ◽  
Foetal Development ◽  
Lower Quadrant ◽  
Ladder Pattern ◽  
Intestinal Peristalsis ◽  
Ligament Of Treitz ◽  
The Right ◽  
High Index Of Suspicion ◽  
Right Lower Quadrant

Midgut malrotation is an incomplete rotation of the intestine which occurs during foetal development and usually presents in the neonatal period. The bowel is not fixed adequately and is thus held by a precariously narrow-based mesentery. The incidence of malrotation has been estimated at 1 in 6000 live births, it is rare for malrotation to present in adulthood. Author report a 40-year-old man presented to emergency department with generalized abdominal pain. His symptoms began 2 days before admission. The patient really weak and his mental state was somnolence. His abdomen was slightly extended, and intestinal peristalsis was obscure. Abdominal X-rays revealed dilatation of gastric, coiled spring appearance without free air and step ladder pattern. The patient then underwent laparotomy exploration. Upon entering the abdomen, ileum was noted to completely mobilized and founded volvulus segment, a clockwise twisting three times, about 30 cm proximal from ICJ, and soon author released it. The ligament of Treitz misplaced, there was in the right lower quadrant, close by ICJ. Then about 110 cm segment of ileum necrotic, the rest of the small bowel was normal, author found internal hernia in the right lower quadrant and there was Ladd's band. Clinicians should be aware of this serious cause of abdominal pain. The diagnosis of malrotation in adulthood is often delayed. Complete resolution of acute obstruction or chronic abdominal pain is the result of a high index of suspicion for malrotation, appropriate diagnostic studies, and aggressive treatment.

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