Acute Appendicitis Masquerading Distal Intestinal Obstruction Syndrome in Adult Cystic Fibrosis

Overshadowed by Sino-pulmonary infections, Cystic Fibrosis (CF) commonly affects gastrointestinal organs because of secretory and motility dysfunction. Infrequently, these changes result in Distal Intestinal Obstruction Syndrome (DIOS), an increasingly diagnosed gastrointestinal entity in adult Cystic Fibrosis patients. We present a case 22-year-old male who presented to our hospital with right lower quadrant abdominal pain with suspicion of acute appendicitis and was subsequently diagnosed as DIOS. Our case highlights the importance of DIOS as one of the differential diagnosis of right lower quadrant abdominal pain in a patient with a CF, especially for physicians working at community hospitals which may not have a Cystic Fibrosis care program available.

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

Case Reports in Medicine ◽

10.1155/2012/253027 ◽

2012 ◽

Vol 2012 ◽

pp. 1-2 ◽

Cited By ~ 1

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.

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Lavage Treatment of Distal Intestinal Obstruction Syndrome in Children With Cystic Fibrosis

PEDIATRICS ◽

10.1542/peds.83.5.727 ◽

1989 ◽

Vol 83 (5) ◽

pp. 727-733

Author(s):

Sibylle Koletzko ◽

David A. Stringer ◽

Geoffrey J. Cleghorn ◽

Peter R. Durie

Keyword(s):

Cystic Fibrosis ◽

Abdominal Pain ◽

Intestinal Obstruction ◽

Nasogastric Tube ◽

Adverse Reactions ◽

Iliac Fossa ◽

Medical Attention ◽

Patient Reported ◽

Distal Intestinal Obstruction Syndrome ◽

Distal Intestinal Obstruction

The efficacy, adverse reactions, and long-term effects of intestinal lavage treatment with a balanced electrolyte solution (Golytely) was evaluated in patients with cystic fibrosis and distal intestinal obstruction syndrome. Twenty-two patients with cystic fibrosis (mean age 21.8 years, range 14 to 34 years, 15 boys or men) who sought medical attention because of abdominal pain and a mass in the right iliac fossa received Golytely, 5.6 ± 1.9 L (mean ± 1 SD), either orally (n = 14) or via nasogastric tube (n = 8) during 5.6 ± 2.4 hours. No serious side effects occurred. Serum electrolyte values remained within normal limits. Body weight did not change significantly. Minor adverse reactions included bloating (n = 12), nausea (n = 8), vomiting (n = 1), and chills (n = 3). All but one patient reported impressive relief of symptoms and remained pain free for an average of 3 months (range 1 to 19 months). Symptoms of abdominal pain and radiologic signs of fecal impaction assessed before and after lavage both decreased significantly (P < .0001). During follow-up (mean 15.2 months, range 4 to 26 months), 11 patients required a total of 38 (range one to nine) additional doses of Golytely. Seven patients drank the solution at home (21 treatments); only two patients chose a nasogastric tube. In ten patients with symptoms of recurrent distal intestinal obstruction syndrome prior to institution of therapy, duration of hospitalization was significantly reduced by this treatment (5.1 ± 7.6 v 2.3 ± 6.3 hospital days per annum, P < .02). It is concluded that intestinal lavage is a well-accepted, safe, and effective therapy for distal intestinal obstruction syndrome in patients with cystic fibrosis.

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Distal intestinal obstruction syndrome: an important differential diagnosis for abdominal pain in patients with cystic fibrosis

ANZ Journal of Surgery ◽

10.1111/ans.15357 ◽

2019 ◽

Vol 90 (5) ◽

pp. 681-686 ◽

Cited By ~ 3

Author(s):

Amy Hort ◽

Ahmer Hameed ◽

Peter G. Middleton ◽

Henry C. Pleass

Keyword(s):

Cystic Fibrosis ◽

Differential Diagnosis ◽

Abdominal Pain ◽

Intestinal Obstruction ◽

Important Differential Diagnosis ◽

Distal Intestinal Obstruction Syndrome ◽

Distal Intestinal Obstruction

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Correlation between the Duration of Right Lower Quadrant Abdominal Pain and Clinical Stage Of Acute Appendicitis Among Patients Who Underwent Appendectomy at MCU-FDTMF Hospital

Philippine Scientific Journal ◽

10.3860/psj.v43i1.1617 ◽

2010 ◽

Vol 43 (1) ◽

Author(s):

Bonifacio H Batallones

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Clinical Stage ◽

Lower Quadrant ◽

Quadrant Abdominal Pain ◽

Right Lower Quadrant

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Young Patient with Cystic Fibrosis With Right Lower Quadrant Abdominal Pain

Gastroenterology ◽

10.1053/j.gastro.2019.03.065 ◽

2019 ◽

Vol 157 (3) ◽

pp. e6-e7

Author(s):

Carolina González-Olivares ◽

Miguel García ◽

Beatriz Peñas

Keyword(s):

Cystic Fibrosis ◽

Abdominal Pain ◽

Young Patient ◽

Lower Quadrant ◽

Quadrant Abdominal Pain ◽

Right Lower Quadrant

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Abdominal CT Scanning in Reproductive-Age Women with Right Lower Quadrant Abdominal Pain: Does Its Use Reduce Negative Appendectomy Rates and Healthcare Costs?

The American Surgeon ◽

10.1177/000313480707300609 ◽

2007 ◽

Vol 73 (6) ◽

pp. 580-584 ◽

Cited By ~ 4

Author(s):

Bryan C. Morse ◽

Richard H. Roettger ◽

Corey A. Kalbaugh ◽

Dawn W. Blackhurst ◽

William B. Hines

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Ct Scanning ◽

Reproductive Age ◽

Negative Appendectomy ◽

Abdominal Ct ◽

Lower Quadrant ◽

Quadrant Abdominal Pain ◽

Reproductive Age Women ◽

Right Lower Quadrant

Although acute appendicitis is the most frequent cause of the acute abdomen in the United States, its accurate diagnosis in reproductive-age women remains difficult. Problems in making the diagnosis are evidenced by negative appendectomy rates in this group of 20 per cent to 45 per cent. Abdominal CT scanning has been used in diagnosing acute appendicitis, but its reliability and usefulness remains controversial. There is concern that the use of CT scanning to make this diagnosis leads to increased and unwarranted healthcare charges and costs. The purpose of our study is to determine if abdominal CT scanning is an effective test in making the diagnosis of acute appendicitis in reproductive-age women (age, 16–49 years) with right lower quadrant abdominal pain and to determine if its use is cost-effective. From January 2003 to December 2006, 439 patients were identified from our academic surgical database and confirmed by chart review as undergoing an appendectomy with a pre- or postoperative diagnosis of acute appendicitis. Data, including age, presence and results of preoperative abdominal CT scans, operative findings, and pathology reports were reviewed. Comparison of patients receiving a preoperative CT scan with those who did not was performed using chi-squared analysis. In the subgroup of reproductive-age women, there was a significant difference in negative appendectomy rates of 17 per cent in the group that received abdominal CT scans versus 42 per cent in the group that did not ( P < 0.038). After accounting for the patient and insurance company costs, abdominal CT scan savings averaged $1412 per patient. Abdominal CT scanning is a reliable, useful, and cost-effective test for evaluating right lower quadrant abdominal pain and making the diagnosis of acute appendicitis in reproductive-age women.

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