A Critically Ill Child with Gangrenous Appendicitis Masquerading as Hollow Viscous Perforation

Background. Severe complications of acute appendicitis (AA) hitherto well described are less common in clinical practice nowadays. When a septic child is encountered with a short history of abdominal symptoms and disproportionate signs of peritonitis further complicated by radiological findings causing a diagnostic conundrum, management becomes exceedingly demanding. Case Presentation. A 10-year-old previously healthy boy presented to the emergency room with generalized abdominal pain associated with fever and jaundice for a day. Blood workup revealed leucopenia, hyperbilirubinemia, hyponatremia, and elevated CRP. Initial radiological evaluation suggested hollow viscous perforation. He was diagnosed to have hollow viscous perforation peritonitis in severe sepsis. At laparotomy, generalized peritoneal contamination was found, the source of which could be traced down to the gangrenous perforated appendix. Conclusion. Complicated appendicitis, in children, can present with baffling findings. Timely identification of an ill child, adequate workup, prompt resuscitation, and source control are imperative for a successful outcome.

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Superior Mesenteric Venous (SMV) Thrombosis Accompanied with Appendicitis in a Patient with Primary Diagnosis of Typhoid Fever

Infectious Disorders - Drug Targets ◽

10.2174/1871526520666200731180042 ◽

2020 ◽

Vol 20 ◽

Author(s):

Alireza Adibimehr ◽

SeyedAhmad SeyedAlinaghi ◽

Anahid Nourian ◽

Zeinab Mehrabi ◽

Rohollah Moslemi

Keyword(s):

Typhoid Fever ◽

Positive Culture ◽

Primary Diagnosis ◽

Complicated Appendicitis ◽

Contaminated Water ◽

Septic Thrombophlebitis ◽

Rebound Tenderness ◽

Perforated Appendix ◽

History Of ◽

Vague Abdominal Pain

: Septic thrombophlebitis of the Superior Mesenteric Venous (SMV) is rarely accompanied by appendicitis, and symptoms are atypical, so the diagnosis is commonly delayed, resulting in it is associated with high mortality. We report a case of neglected SMV septic thrombophlebitis is caused by appendicitis. The patient represented with fever, vague abdominal pain without rebound tenderness, and history of the consumption of contaminated water. Antibiotic initiated due to suspicious typhoid fever. Then typhoid fever was ruled out. Computed tomography (CT) scans revealed micro-abscess forming complicated appendicitis and the thrombus in SMV. The patient underwent a laparoscopic appendectomy, during which retrocecal gangrened perforated appendix with a 2×2 cm abscess was drained. Based on positive culture with ESBL organism meropenem was initiated. Appendectomy and treatment with broad-spectrum antibiotics and anticoagulation led to a full recovery.

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Ectopic decidua of the appendix: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01204-9 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Manabu Kaneko ◽

Hiroaki Nozawa ◽

Hirofumi Rokutan ◽

Koji Murono ◽

Tetsuo Ushiku ◽

...

Keyword(s):

Differential Diagnosis ◽

Acute Appendicitis ◽

Rare Entity ◽

Lower Quadrant ◽

Case Presentation ◽

Decidual Tissue ◽

Abdominal Symptoms ◽

History Of ◽

Myxoid Degeneration ◽

Right Lower Quadrant

Abstract Background Ectopic decidua is the presence of decidual tissue outside the uterus. Ectopic decidua of the appendix is a rare entity that can present with abdominal symptoms mimicking appendicitis. We report a case of a 39-year-old female patient at 27 weeks gestational age with a 2-day history of right lower quadrant abdominal pain. Case presentation The patient was referred to our hospital with suspicion of either acute appendicitis or threatened rupture of the uterus, the latter of which was considered unlikely following close examination. Therefore, she underwent emergency appendectomy via laparotomy. Microscopic examination revealed decidual tissue with myxoid degeneration in the subserosal layer of the tip side of the appendix, without endometriosis, which was compatible with ectopic decidua (deciduosis). Conclusions Because it is extremely difficult to distinguish ectopic decidua of the appendix from acute appendicitis, even with various imaging modalities, we should be aware that ectopic decidua of the appendix is a differential diagnosis for acute appendicitis in pregnant women.

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Vaginal Bleeding As The Presenting Manifestation of Post-Hepatectomy/-Splenectomy Portal-Mesenteric Venous Thrombosis

10.21203/rs.3.rs-685240/v1 ◽

2021 ◽

Author(s):

Che-Ming Yeh ◽

Jen-Tang Sun ◽

Chieh-Min Fan ◽

Kuang-Chau Tsai ◽

Chih-Jung Chang

Keyword(s):

Venous Thrombosis ◽

Menopausal Woman ◽

Mesenteric Venous Thrombosis ◽

Case Presentation ◽

Delayed Treatment ◽

Abdominal Symptoms ◽

Contrast Enhanced ◽

History Of ◽

Enhanced Computed Tomography ◽

Specific Symptoms

Abstract Background: Portal-mesenteric venous thrombosis is not uncommon after hepatectomy or splenectomy but is under-recognized because of non-specific symptoms and lack of awareness of the clinicians. However, misdiagnosis or delayed treatment may have fatal consequences. Case Presentation: A 57-year-old menopausal woman with the medical history of hepatocellular carcinoma, stage I, underwent laparoscopic partial hepatectomy (S4) and splenectomy 2 months before the presentation of progressive vaginal spotting and vague abdominal pain. Dysfunctional uterine bleeding was suspected initially, but subsequent contrast-enhanced computed tomography due to concern for post-procedure complications revealed thrombosis in the portal vein and superior mesenteric vein. The patient received anticoagulant therapy, and her symptoms gradually resolved. Conclusions: To the best of our knowledge, vaginal variceal bleeding secondary to portal-mesenteric venous thrombosis has never been reported, but it can be the presenting manifestation for this condition. It should be considered in the differential diagnosis of patients who present with vague abdominal symptoms after hepatectomy or splenectomy.

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Subhepatic appendix: an ectopic topography not to be disregarded: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02883-6 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Abdoul Kadir Ibrahim Mamadou ◽

Souleymane Mounkaila ◽

Nouhou Hama Aghali ◽

Mahaman Laouali Harouna Amadou ◽

Ousseini Adakal

Keyword(s):

Elderly Patient ◽

Peptic Ulcer ◽

Abdominal Pain ◽

Case Report ◽

Surgical Intervention ◽

Quadrant Pain ◽

Case Presentation ◽

Perforated Appendix ◽

History Of ◽

The Right

Abstract Introduction Subhepatic appendix is most often due to an anomaly of rotation of the primary intestine occurring during embryogenesis. This ectopic topography associated with advanced age can be a serious diagnosis problem at the stage of appendicitis or appendicular peritonitis. Case presentation We report the case of a 60-year-old melanoderm man, with a history of urinary pathology and peptic ulcer, referred from a health district for abdominal pain of the right hypochondrium evolving for about 5 days, secondarily generalized, in whom we suspected peritonitis, the etiology of which remains to be determined. During the surgical intervention, after preoperative resuscitations measures, a phlegmonous perforated appendix was found under the liver. No postoperative complication was noted, and he was discharged home 8 days after his operation. Conclusion Subhepatic appendicular peritonitis occurring in an elderly patient poses enormous diagnostic problems. When faced with right upper quadrant pain, considering acute ectopic appendicitis would significantly reduce complications.

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