scholarly journals Subhepatic Appendicitis: A diagnostic conundrum

2021 ◽  
Author(s):  
Biji Thomas George ◽  
Youmna Ayman ◽  
Hadi Zafar ◽  
Godfred Menezes
Keyword(s):  
Acute Appendicitis ◽  
Inflammatory Diseases ◽  
Final Diagnosis ◽  
Diagnostic Tools ◽  
Biliary Colic ◽  
Emergency Setting ◽  
Patients At Risk ◽  
Atypical Presentations ◽  
The Right ◽  
High Index Of Suspicion

One of the most common presentations of acute abdominal pain in the emergency setting is appendicitis. Although it can occur in both genders, when it comes to females with appendicitis, reaching a definite diagnosis can be challenging as it can mimic other diseases such as ovarian cysts/torsions, pelvic inflammatory diseases, endometriosis, and urinary tract infection or physiological reasons like menstrual pain which are exclusive to females and can occur as frequently as appendicitis. Therefore, it is crucial to make an accurate diagnosis as early as possible with the right diagnostic tools to reduce morbidity and mortality in females of child-bearing age. This is a summarized case report of an adolescent female who experienced two atypical attacks of appendicitis 1 year apart. Since the patient had mainly right upper flank pain associated with nausea, vomiting, and fever with a largely non-tender abdomen, various diagnoses such as chronic cholecystitis, biliary colic, peptic ulcer, gastroenteritis, mesenteric lymphadenitis, renal colic, mittelschmerz, and torsion of ovarian cyst were considered and treated for. The patient had no relief and underwent numerous investigative procedures in the 2 years she suffered from her illness. The final diagnosis was only obtained when exploratory laparoscopy was performed. This article aims to remind clinicians to have a high index of suspicion for acute appendicitis in all atypical presentations of acute appendicitis. The latest WSES Jerusalem guidelines for the workup for patients at risk of acute appendicitis should be meticulously followed.

scholarly journals Perforated Meckel’s Diverticulitis in a Patient with Unknown Intestinal Malrotation: Clinical Pitfall

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Marie Burgard ◽  
Floryn Cherbanyk ◽  
François Pugin ◽  
Bernhard Egger
Keyword(s):  
Acute Appendicitis ◽  
Clinical Presentation ◽  
Final Diagnosis ◽  
Intestinal Malrotation ◽  
Radiological Imaging ◽  
Atypical Clinical Presentation ◽  
Lower Abdominal Quadrant ◽  
Meckel’S Diverticulitis ◽  
The Right ◽  
Abdominal Quadrant

Symptomatic Meckel’s diverticulum is rare in adults. The most frequent complications are intestinal obstruction and diverticulitis. Diagnosis of Meckel’s diverticulitis can be challenging due to nonspecific clinical manifestation of pain in the right lower abdominal quadrant, mimicking acute appendicitis. If associated with congenital malformation, such as intestinal malrotation, the anomalous anatomy makes the diagnosis even more challenging. In such cases, radiological imaging is essential to guide further management. We present a case of Meckel’s diverticulitis in which physicians were initially misguided because of the atypical clinical presentation. Yet, anamnestic details directed to a potential underlying malformation, leading to supplementary radiological examination and the final diagnosis.

scholarly journals Remote extradural hematoma after supratentorial brain tumor surgery: A rare complication of a routine surgery

2021 ◽  
Vol 18 (3) ◽  
pp. 55-60
Author(s):  
Prashant Punia ◽  
Ashish Chugh ◽  
Sarang Gotecha
Keyword(s):  
Rare Complication ◽  
Tumor Resection ◽  
Final Diagnosis ◽  
Emergency Setting ◽  
Remote Site ◽  
Large Tumor ◽  
Csf Diversion ◽  
High Index Of Suspicion ◽  
A Site ◽  
Age Range

Background: Hemorrhages in the surgical cavity post resection of tumor aren’t uncommon and neurosurgeons are well versed with this entity, however occurrence of an Extra Dural Hematoma(EDH), that too at a site remote to the surgical cavity, is rare. The study presents 3 cases of post operative remote site EDH after tumor resection with review of literature  and an attempt to define and discuss the variables which play a role in determining the occurrence, extent and prognosis of the same. Methods: The study investigated 601 patients who underwent tumor resection in the Department of Neurosurgery, Dr D Y Patil Hospital, from January 2017 to December 2019. All patients had a normal coagulation profile preoperatively. Postoperative remote EDH occurred in 3 patients whose data was examined closely in terms of age, sex, location, final diagnosis and treatment. Results: Of the 601 patients who underwent tumor resection from Jan 2017 to Dec 2019, a total of 3 patients in our study were found to have a post-operative remote site EDH. Two of these patients were male and 1 female. The age range was 35 to 46 years with a mean of 41 years. Neither did any of these patients have a pre-existing hydrocephalus nor were they subjected to a CSF diversion procedure preoperatively. All 3 patients developed EDH on the ipsilateral side wherein 2 of our patients had a hematoma in the ipsilateral frontal region anterior to the surgical cavity while 1 patient developed hematoma in ipsilateral parietal region posterior to surgical cavity. Hematomas were unilateral with no extension to opposite side. Two patients had to be re-operated in an emergency setting while one patient was conservatively managed.   Conclusion: In patients with an expected volume loss via large tumor size, excess blood and CSF loss and a large craniotomy, remote EDH may develop and the  neurosurgeon must have a high index of suspicion for this entity

scholarly journals A Rare Case of De Garengeot Hernia: A Challenging Diagnosis and a New Approach

2021 ◽  
pp. 1-3
Author(s):  
Sleiman Marwan Julien ◽  
Sleiman Marwan Julien ◽  
Litchinko Alexis ◽  
Toso Christian ◽  
Ris Frédéric ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Hernia Repair ◽  
Femoral Hernia ◽  
Clinical Presentation ◽  
Emergency Setting ◽  
Rare Presentation ◽  
Hernia Sac ◽  
Double Approach ◽  
The Right ◽  
De Garengeot Hernia

De Garengeot’s hernia is a rare entity in which the appendix is located within a femoral hernia and is almost invariably encountered incarcerated in an emergency setting. The clinical presentation is usually that of an incarcerated femoral hernia and is indistinguishable from other incarcerated femoral hernias. Here, we report on a 48-year-old female patient, known for a post-operative chronic seroma in the right groin since childhood, with a rare clinical presentation of a De Garengeot hernia. An abdominal CT-scan was performed, revealing an appendicitis with a stercolith in a femoral hernia. Generally, an inguinal approach alone (McVay procedure) is chosen and provides access for both appendectomy and hernia repair. In the absence of concomitant acute appendicitis, trans-abdominal pro-peritoneal laparoscopy (TAPP) could also be used as a single approach. In case of a rare presentation of acute appendicitis with probable contamination of the groin, we propose the double approach of laparoscopic appendectomy and hernia repair either with (if hernia sac is not opened during surgery) or without mesh. This approach is not yet described in the literature, and we think it the best technique to perform the appendectomy and hernia repair with little contamination of the groin.

Acute Appendicitis Remains a Great Mimicker – The Pitfalls in the Differential Diagnosis and Tactics - A Case Report

2020 ◽  
Vol 13 (1) ◽  
pp. 54-58
Author(s):  
Georgi I. Popivanov ◽  
Marina N. Konaktchieva ◽  
Vladimir V. Vasilev ◽  
Kirien Ts. Kjossev ◽  
Marin B. Penkov ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Acute Appendicitis ◽  
Neuroendocrine Tumour ◽  
Iliac Fossa ◽  
Femoral Vein ◽  
Vascular Complications ◽  
Final Diagnosis ◽  
Linear Stapler ◽  
Chronic Appendicitis ◽  
The Right

Summary Acute appendicitis (AA) is the most common non-traumatic abdominal emergency. Despite the improved knowledge, experience, and technological advance, its diagnosis remains a challenge. Herein we report an example of a difficult diagnosis of acute appendicitis and comment on the possible pitfalls in the differential diagnosis and surgical tactics. We present the case of a 41-year-old man who had been admitted to another hospital with an initial diagnosis of acute appendicitis and changed to Crohn’s disease (CD). Because of a pelvic abscess, percutaneous drainage had been performed. Thrombosis of the right femoral vein had been diagnosed and treated accordingly. In an improved condition, he was referred for elective operation with a final diagnosis of neuroendocrine tumour based on cytology. At laparotomy, the appendix was found densely adherent to the right external iliac vein with a well-demarcated tumour (1 cm) at the base. Appendectomy with partial resection of the caecum with a linear stapler was performed. The histological examination revealed acute to chronic appendicitis with lymphoid follicle hyperplasia at the base. The case illustrates the necessity for broad differential diagnosis in AA and the possibility of severe vascular complications in complicated AA. Taking a detailed history and CT are of paramount importance for an accurate preoperative diagnosis, especially of CD. All emergency surgeons should also be familiar with the scenario of unexpected findings at laparotomy, especially with the management of CD and the algorithms for treatment of appendiceal malignancies. The mini-invasive drainage of right iliac fossa abscess allows for optimizing the patient’s condition and may help to avoid unnecessary extensive resections.

scholarly journals From Clinical Clues to Final Diagnosis: The Return of Detective Work to Clinical Medicine in Cardiac Amyloidosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Hani Sabbour ◽  
Khwaja Yousuf Hasan ◽  
Firas Al Badarin ◽  
Haluk Alibazoglu ◽  
Andrew L. Rivard ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
Clinical Medicine ◽  
Imaging Techniques ◽  
Diagnostic Algorithm ◽  
Signs And Symptoms ◽  
Final Diagnosis ◽  
Diagnostic Tools ◽  
Case Examples ◽  
Non Invasive ◽  
High Index Of Suspicion

Cardiac amyloidosis is frequently misdiagnosed, denying patients the opportunity for timely and appropriate management of the disease. The purpose of this review and case studies is to raise awareness of the diagnostic “red flags” associated with cardiac amyloidosis and the currently available non-invasive strategies for diagnosis. The review focuses on the identification of one of the two main types of cardiac amyloidosis, transthyretin amyloid cardiomyopathy, and non-invasive tools to distinguish this from light-chain amyloidosis. A diagnostic algorithm centered around the use of non-invasive imaging and laboratory analysis is presented. The algorithm generates four differential diagnoses for patients presenting with signs and symptoms consistent with cardiac amyloidosis. Case examples are presented, representing the four potential outcomes of diagnosis using the algorithm. The review provides a guide on how to recognize the often-overlooked presentations of this disease in clinical practice. Non-invasive imaging techniques and diagnostic tools that do not require the involvement of a specialty center have allowed for the improved diagnosis of cardiac amyloidosis. Timely diagnosis of this life-threatening disease is essential for optimal management and it is imperative that clinicians have a high index of suspicion for patients presenting with “red flag” symptoms.

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

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
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.

Acute Appendicitis Masquerading as Acute Scrotum

2011 ◽  
Vol 5 (6) ◽  
pp. 524-527 ◽  
Author(s):  
Paul O. Dienye ◽  
Nze J. Jebbin
Keyword(s):  
Acute Appendicitis ◽  
Acute Scrotum ◽  
Scrotal Pain ◽  
Lower Quadrant ◽  
Diffuse Abdominal Pain ◽  
Close Observation ◽  
Negative Appendicectomy ◽  
Atypical Presentations ◽  
The Right ◽  
Right Lower Quadrant

Acute appendicitis presents typically with periumbilical pain that in a few hours settles at the right lower quadrant of the abdomen. Atypical presentations are common but association with acute scrotum is an extreme rarity. A 30-year-old fisherman presented at a rural medical facility with a 2-day complaint of severe pain at the right hemiscrotum followed about 24 hours later with mild diffuse abdominal pain. There was associated mild fever and nausea but no vomiting. There were no urinary symptoms and no recent sexual exposure. Initial physical examination revealed mild generalized tenderness worse at the right lower quadrant but the scrotum was not remarkable, and cremasteric sign was negative. He was admitted as a case of acute abdomen for close observation. Abdominal and scrotal ultrasound scan were normal. By the second day of admission, pain became marked at the right lower abdomen with associated vomiting. There was also marked tenderness at the right lower quadrant with rebound. A diagnosis of acute appendicitis was thus made and appendicectomy done after proper workup. The abdominal and scrotal pain stopped after surgery and the patient was discharged on the seventh postoperative day. Patients with unusual abdominal and scrotal pain should be admitted and closely observed and evaluated to prevent unnecessary scrotal exploration or negative appendicectomy.

scholarly journals Complicated acute appendicitis in a child with left atrial isomerism: a case report

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Faysal Tabbara ◽  
Karim Wehby Ataya ◽  
Youssef Annous ◽  
Kawsar Alamiddine ◽  
Ahmad Zaghal
Keyword(s):  
Acute Appendicitis ◽  
Left Atrial ◽  
High Index ◽  
Heterotaxy Syndrome ◽  
Lower Quadrant Pain ◽  
Lower Quadrant ◽  
Trocar Placement ◽  
Atypical Presentations ◽  
Atrial Isomerism ◽  
High Index Of Suspicion

Abstract Background Heterotaxy syndrome is a rare clinical entity that is characterized by abnormal visceral organ arrangement in the chest and abdomen. Left atrial isomerism is a subcategory of heterotaxy syndrome characterized by the presence of multiple spleens with or without cardiac anomalies. Patients may remain asymptomatic their whole lives until they are diagnosed incidentally. Given that patients with left atrial isomerism might demonstrate atypical presentations of acute intrabdominal pathologies, it is important to keep a high index of suspicion when encountering such cases. Case presentation In this report, we present a case of a 9-year-old boy with a known history of left atrial isomersim who presented with left lower quadrant pain and positive McBurney, psoas, and obturator signs on the left side. A computed tomography scan of the abdomen confirmed the diagnosis of perforated acute appendicitis on the left, which prompted an emergent laparoscopic appendectomy. Conclusion Our case highlights the importance of keeping a high index of suspicion for a heterotaxy syndrome that is complicated by acute appendicitis in pediatric patients presenting with vague abdominal pain. Planning the location of trocar placement in patients with situs anomalies is of paramount importance to avoid technical difficulties in laparoscopic procedures.

scholarly journals Ulcerated Giant Dermatofibroma following Routine Childhood Vaccination in a Young Boy

2016 ◽  
Vol 8 (2) ◽  
pp. 210-217 ◽  
Author(s):  
Michelle S.Y. Ng ◽  
Alice Y.W. Foong ◽  
Mark J.A. Koh
Keyword(s):  
Clinical Findings ◽  
Childhood Vaccination ◽  
Diagnostic Challenge ◽  
Vaccination Site ◽  
Common Skin ◽  
Microscopic Features ◽  
Immunohistological Staining ◽  
Atypical Presentations ◽  
The Right ◽  
High Index Of Suspicion

Introduction: The development of cutaneous neoplasms at immunization sites following vaccination is uncommon, and only few have been reported in the literature worldwide. We report an unusual case of an ulcerated giant dermatofibroma that developed as a chronic nonhealing plaque in the immunization scar of a young boy after vaccination. Case Report: A 13-month-old Chinese boy presented with an unusual skin reaction on the vaccination site at the right anterolateral thigh following a routine intramuscular injection of ‘5-in-1’ (diphtheria, tetanus, pertussis, polio and Haemophilus influenzae B) vaccine at 4 months of age. The immunization site developed a slightly raised papule with a central punctum that progressively grew in size, ulcerated and showed occasional bleeding over a span of 9 months. On follow-up, the lesion showed a chronic granulomatous reaction with surrounding induration and a central scarring. The right inguinal lymph node was palpable. Ultrasound of the lesion showed only nonspecific focal skin thickening. An incisional skin biopsy with careful histopathological evaluation revealed microscopic features consistent with an ulcerated giant dermatofibroma. Conclusion: Neoplastic development in immunization scars following vaccination is a rare occurrence and, hence, makes this case a diagnostic challenge. A high index of suspicion is crucial in atypical presentations of a common skin lesion, as typified by this case. Careful history taking and clinicopathological correlation of clinical findings with gross and microscopic findings along with targeted immunohistological staining is often essential to aid early diagnosis.

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