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

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.

Download Full-text

Omental infarction in an obese 10-year-old boy

Pediatric Reports ◽

10.4081/pr.2011.e22 ◽

2011 ◽

Vol 3 (3) ◽

pp. 22 ◽

Cited By ~ 1

Author(s):

Katerina Kambouri ◽

Stefanos Gardikis ◽

Alexandra Giatromanolaki ◽

Aggelos Tsalkidis ◽

Efthimios Sivridis ◽

...

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Preoperative Diagnosis ◽

Acute Abdominal Pain ◽

Accurate Diagnosis ◽

Lower Abdomen ◽

Omental Infarction ◽

Appropriate Treatment ◽

Low Incidence ◽

The Right

Primary omental infarction (POI) has a low incidence worldwide, with most cases occurring in adults. This condition is rarely considered in the differential diagnosis of acute abdominal pain in childhood. Herein, we present a case of omental infarction in an obese 10-year-old boy who presented with acute abdominal pain in the right lower abdomen. The ultrasound (US) examination did not reveal the appendix but showed secondary signs suggesting acute appendicitis. The child was thus operated on under the preoperative diagnosis of acute appendicitis but the intraoperative finding was omental infarct. Since the omental infarct as etiology of acute abdominal pain is uncommon, we highlight some of the possible etiologies and emphasize the importance of accurate diagnosis and appropriate treatment of omental infarction.

Download Full-text

Torsion of caecal appendices epiploicae: mimicking acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20202858 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2407

Author(s):

A. P. Roshini ◽

Dattaprasad Samant ◽

F. P. Noronha

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Iliac Fossa ◽

Lower Abdominal Pain ◽

Free Fluid ◽

Normal Appendix ◽

Menstrual Cycles ◽

Rebound Tenderness ◽

Appendices Epiploicae ◽

The Right

Acute appendicitis is a common cause for pain in the right iliac fossa, which requires urgent surgical intervention. However, at the time of surgery, if the appendix is normal, the surgeon has to search for other causes of acute abdominal pain including rare etiologies, such as torsion of appendices epiploicae and subsequently its gangrene. We report the case of a 45 years old female who presented with right lower abdominal pain, rebound tenderness and guarding in right iliac fosse, with regular menstrual cycles and no urinary complaints. Investigation revealed leucocytosis and ultra-sonography abdomen was suggestive of an inflamed appendix in the right iliac fossa with free fluid. Intra-operatively, we found a normal appendix with gangrene of the appendices epiploicae which had undergone torsion. She underwent excision off appendices epiploicae with appendicectomy with uneventful post-operative period. Histopathology of the appendices was suggestive of congestion. Preoperative diagnosis of this condition is rarely made.

Download Full-text

Manifestations of Pediatric Appendicopathia Oxyurica

The American Surgeon ◽

10.1177/000313481307900918 ◽

2013 ◽

Vol 79 (9) ◽

pp. 873-874 ◽

Cited By ~ 1

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.

Download Full-text

Caecal Epiploic Appendagitis Masquerading Clinically as an Acute Appendicitis: A Case Report and Brief Literature Review

Case Reports in Surgery ◽

10.1155/2019/6508642 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Tallat Ejaz ◽

Eltaib Saad ◽

Andik Nabil ◽

James Slattery

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Iliac Fossa ◽

Lower Abdominal Pain ◽

Good Health ◽

Final Diagnosis ◽

Epiploic Appendagitis ◽

Rebound Tenderness ◽

History Of ◽

The Right

A 46-year-old female presented to our emergency department (ED) with a 2-day history of right lower abdominal pain which was associated with nausea and anorexia. Abdominal examination revealed tenderness in the right iliac fossa (RIF) with rebound tenderness and a localized guarding. Urine dipstick was normal, and the pregnancy test was negative. Her laboratory investigations were significant only for a CRP of 16.6. A presumptive clinical diagnosis of acute appendicitis was suggested based on the given history and relevant physical signs. However, an abdominal computed tomography (CT) scan revealed an epiploic appendagitis of the caecum with a normal-looking appendix. She was managed conservatively and responded well and was discharged after 2 days in good health. Though being a relatively rare case of acute localized right-sided lower abdominal pain, caecal epiploic appendagitis should be considered as one of the differential diagnoses with the final diagnosis reached usually by the radiological findings due to the nonspecific nature of clinical and laboratory features.

Download Full-text

Idiopathic Omental Infarction, Diagnosed and Managed Laparoscopically: A Case Report

Case Reports in Surgery ◽

10.1155/2013/193546 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Ahmed AbdulAziz ◽

Tamer El Zalabany ◽

Abdul Rahim Al Sayed ◽

Ahmed Al Ansari

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Clinical Finding ◽

Iliac Fossa ◽

Sudden Onset ◽

Free Fluid ◽

Lower Quadrant ◽

Omental Infarction ◽

Rebound Tenderness ◽

The Right

Idiopathic omental infarction is a rare cause of acute abdomen in adults, and the clinical finding can mimic acute appendicitis. Although idiopathic omental infarction is uncommon, the incidence of its detection has become more frequent as a result of advances in radiological technologies. We reported on a 21-year-old man who presented with sudden onset of intermittent right lower quadrant abdominal pain for seven days. The pain became more localized at the right iliac fossa (RIF) at day 2 before admission. A physical examination revealed a fever (38.2∘C), severe RIF tenderness, mass-like fullness, and positive rebound tenderness. A CT of the abdomen showed inflammatory changes and increased fat density mass in the right upper quadrant measuring5×4 cm representing focal panniculitis. However, the appendix was visualized normally and the findings were not in favor of acute appendicitis. Diagnosis was carried on laparoscopically. Serosanguinous free fluid was found in all abdominal quadrants. A6×4 cm gangrenous omental mass was noted. The omental mass was excised and an appendectomy was performed. In summary, omental infarction should be considered as a deferential diagnosis for acute right-sided abdominal pain, especially if the clinical finding does not correspond to appendicitis.

Download Full-text

A Retrospective Analysis of Acute Appendicitis in Children Treated with Laparoscopic Appendectomies at a Single Center in Dubai, UAE

Dubai Medical Journal ◽

10.1159/000518252 ◽

2021 ◽

pp. 1-6

Author(s):

Saad Syed ◽

Hussein Naji

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Ct Scan ◽

Laparoscopic Appendectomy ◽

Pediatric Population ◽

Iliac Fossa ◽

Demographic Data ◽

Free Fluid ◽

Rebound Tenderness ◽

The Right

Background: Appendicitis is one of the most common emergency conditions that occur in the pediatric population. The condition is usually suspected clinically, and the diagnosis is confirmed by radiological investigations such as ultrasound, CT scan, or MRI. This study was conducted to contribute to global databases by presenting data from the Middle East with an objective of identifying the clinical characteristics of children who were diagnosed with acute appendicitis and underwent laparoscopic appendectomy at a single pediatric surgery center in Dubai. Methods: A 2-year hospital-based retrospective cohort study was conducted at Mediclinic Parkview Hospital, Dubai, enrolling all patients younger than 14 years who were diagnosed with acute appendicitis and who underwent laparoscopic appendectomy. Demographic data, clinical presentation, laboratory, radiological and pathology findings, postoperative complications, and readmission rates were analyzed. Results: Fifty-six patients were operated on and enrolled in this study. All patients (56/56) presented with abdominal pain, while an associated fever was present in 44.6% (25/56); 78.5% (44/56) of the patients had nausea but 64.3% (36/56) had vomiting. On examination, all patients had abdominal tenderness, while rebound tenderness in the right iliac fossa (RIF) was found in 92.8% (52/56) of the patients. Laboratory investigations showed elevated leukocyte count in 76.7% (43/56) of patients. Appendicitis was diagnosed on ultrasound in 57.4% (31/54) of the patients, and free fluid was visualized in 40.7% (22/54) of the patients. Appendicitis was diagnosed on CT scan in all 25 patients, and free fluid was visualized in 64% (16/25) of the patients. The number of admission days ranged from 1 to 5 days, with a median of 2 days. And 62.5% (35/56) of patients were discharged in the first 2 days from admission. Major and minor complications after surgery were documented in 4 and 14 patients, respectively. Pathology reports showed features of acute appendicitis in all the resected appendices. Conclusions: Acute appendicitis in children should be suspected in all children with acute abdominal pain. This study can help guide the management of pediatric appendicitis and allow proper and standardized documentation of findings and judicious use of laboratory and radiological investigations.

Download Full-text

Appendicitis: a rare adverse event in colonoscopy

BMJ Case Reports ◽

10.1136/bcr-2021-242523 ◽

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.

Download Full-text

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

International Journal of Health Sciences ◽

10.29332/ijhs.v4n2.440 ◽

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.

Download Full-text

APPENDECTOMY IN CHILDREN WITH ACUTE RHEUMATIC FEVER

PEDIATRICS ◽

10.1542/peds.43.4.573 ◽

1969 ◽

Vol 43 (4) ◽

pp. 573-577

Author(s):

Jer-Shoung Lin ◽

Ramon Rodriguez-Torres

Keyword(s):

Differential Diagnosis ◽

Abdominal Pain ◽

Acute Appendicitis ◽

Rheumatic Fever ◽

Acute Rheumatic Fever ◽

Laboratory Data ◽

Initial Symptom ◽

C Reactive Protein ◽

Reactive Protein ◽

The Right

Clinical and laboratory data on five patients with appendectomy, later proved to have acute rheumatic fever, are presented in detail. The findings indicate that abdominal pain simulating acute appendicitis can be presented as the only initial symptom in acute rheumatic fever. Awareness and knowledge of the presence of clues-high fever, rapid sedimentation rate, prolonged P-R interval, and 4 plus C-reactive protein-usually help to make the differential diagnosis. However, if doubt remains, the right approach is to go ahead with surgery since these patients tolerate anesthesia and laparotomy very well.

Download Full-text

When the Simplest Solution is not the Right one: A Case of a Blunt Occam’s Razor

10.46715/2020.07.1000106 ◽

2020 ◽

Author(s):

Mark Lewis ◽

Pourya Pouryahya

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Young Female ◽

Childbearing Age ◽

Young Females ◽

Occam’S Razor ◽

The Right ◽

Delays In Diagnosis ◽

Histopathological Investigation ◽

Occam's Razor

Abdominal pain in young females of childbearing age can be challenging when presenting to the Emergency department due to the atypical nature of presentation. Delays in diagnosis or misdiagnosis of appendicitis in this group can lead to higher rates of complications. Highlighting these cases will hopefully reduce the incidence of delayed and misdiagnosis and lead to better patient outcomes Here we present a case of a young female of childbearing age who presented with symptoms consistent with gastroenteritis, however ongoing abdominal pain prompted further investigation. The cause of the ongoing pain was confounded by the presence of an existing gynaecological condition and inconsistent presentation. A diagnosis of appendicitis was eventually made, and the patient proceeded to a laparoscopic appendectomy. On histopathological investigation the appendix was found to be gangrenous. The patient made a full recovery and was discharged from the hospital two days after surgery. Keywords:, Abdominal pain; Appendicitis; Emergency department; PID; pelvic pain; Occam’s Razor

Download Full-text