scholarly journals A Rare Case Od Meckel’s Diverticulum Perforation Caused By a Toothpick Mimicking Acute Appendicitis

2018 ◽  
Vol 7 (1) ◽  
Author(s):  
Aleksandar Resanovic ◽  
Milan Gojgic ◽  
Vladimir Resanovic ◽  
Mazen Arafeh
Keyword(s):  
Acute Appendicitis ◽  
Meckel’S Diverticulum ◽  
Diagnostic Procedures ◽  
Abdominal Ultrasound ◽  
Meckel's Diverticulum ◽  
Imaging Features ◽  
Ileocecal Region ◽  
Lower Quadrant ◽  
Rebound Tenderness ◽  
History Of

<p><em>Meckel’s diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract and is caused by the failure of omphalomesenteric duct to obliterate during embryonal maturation. Most patients are asymptomatic with only 4-16% presenting complications which include hemorrhage, intestinal obstruction, inflamation and occasionally perforation. A preoperative diagnosis of a complicated Meckel’s diverticulum may be challenging because of the overlapping clinical and imaging features of other acute surgical and inflammatory conditions of the abdomen. A 32-year old male was admitted to the emergency department with a 48-hour history of colicky like pain in the lower part of the abdomen, which was gradually increased and was localised in the lower right quadrant, with no history of fever, nausea or vommiting, no urinary symptoms nor altered bowel habits. Laboratory revealed leukocytosis and elevated CRP, while on physical examination guarding and rebound tenderness were found in the right lower quadrant. Abdominal ultrasound  established a distended small bowel with very slow peristalsis in ileocecal region. Complete workup raised suspicion for an acute appendicitis, therefore the patient was operated. Intraoperatively, the perforated Meckel’s diveriticulum was found, caused by a toothpick. Diverticulectomy and appendectomy were done. Postoperative course was uneventful. Regardless of the fact that a variety of diagnostic procedures are at the disposal of surgeons, we feel that the diagnose of a complicated MD remains a challenging task, largely in thanks to the fact that it mimics some other acute abdominal pathology and, often, is misdiagnosed.</em></p>

scholarly journals A féregnyúlvány diverticulosisa, diverticulitise. Esetismertetés és irodalmi áttekintés

2018 ◽  
Vol 159 (19) ◽  
pp. 768-772
Author(s):  
Tamás Vass ◽  
Attila Zaránd ◽  
Dániel Horányi ◽  
László Harsányi
Keyword(s):  
Acute Appendicitis ◽  
Preoperative Diagnosis ◽  
Histopathological Examination ◽  
Iliac Fossa ◽  
Abdominal Ultrasound ◽  
Vermiform Appendix ◽  
Review Of The Literature ◽  
Rebound Tenderness ◽  
History Of ◽  
The Right

Abstract: Diverticulitis of the vermiform appendix is a rare disease with clinical features often similar to conventional acute appendicitis. The importance of appendiceal diverticulosis is the fact that it can lead to an early and a higher incidence of perforation and therefore a higher mortality rate, in contrast to acute appendicitis alone. In this study we present the clinicopathology, diagnosis and therapy of the disease with a review of the literature. A 65-year-old woman presented to the emergency department with a 48-hour history of intermittent pain in the right iliac fossa. Abdominal ultrasound raised the possibility of acute appendicitis but because of the relative asymptomatic state of the patient, the lack of fever and rebound tenderness we started observation. After 2 days with episodic abdominal pain, the patient was taken to the operating theatre for laparoscopic exploration. Intraoperatively, multiple diverticula were noted on the appendix and appendectomy was performed. Histopathological examination revealed diverticulosis and inflammation of the appendiceal wall. Due to the possible complications, the difficult preoperative diagnosis and its frequent association with appendiceal neoplasm, appendiceal diverticulosis requires special attention. For asymptomatic cases, incidentally diagnosed intraoperatively or discovered by radiology prophylactic appendectomy is recommended. Orv Hetil. 2018; 159(19): 768–772.

scholarly journals Sonographic Detection of a Torsed Meckel’s Diverticulum Misinterpreted as Acute Appendicitis

2019 ◽  
Vol 3 (3) ◽  
pp. 278-281
Author(s):  
Justin Choi ◽  
Nicole Dorinzi ◽  
Justine Pagenhardt ◽  
Anthony Steratore ◽  
Melinda Sharon ◽  
...  
Keyword(s):  
Point Of Care ◽  
Meckel’S Diverticulum ◽  
Acute Onset ◽  
Meckel's Diverticulum ◽  
Point Of Care Ultrasound ◽  
Lower Abdomen ◽  
Lower Quadrant ◽  
Rebound Tenderness ◽  
The Right ◽  
Right Lower Quadrant

A 38-year-old female presented to the emergency department (ED) with acute-onset right lower quadrant abdominal pain following two days of nausea and vomiting. Physical examination revealed right lower quadrant tenderness to palpation, rebound tenderness, and guarding. Point-of-care ultrasound (POCUS) of the right lower abdomen was performed and interpreted as probable appendicitis. However, upon laparoscopic examination of the abdomen, a benign-appearing appendix was visualized. Further investigation revealed the source of the patient’s pain to be a torsed Meckel’s diverticulum. Although rare, a torsed and inflamed Meckel’s diverticulum can be visualized by POCUS in the ED without the need for further imaging or delay.

scholarly journals Ectopic decidua of the appendix: a case report

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.

Acute Appendicitis: The Reliability of Diagnosis by Clinical Assessment Alone

2005 ◽  
Vol 94 (3) ◽  
pp. 201-206 ◽  
Author(s):  
V. Kalliakmanis ◽  
E. Pikoulis ◽  
I. G. Karavokyros ◽  
E. Felekouras ◽  
P. Morfaki ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Clinical Assessment ◽  
Aged Patients ◽  
Duration Of Symptoms ◽  
Lower Quadrant ◽  
Rebound Tenderness ◽  
Local Rigidity ◽  
Long Duration ◽  
Appendiceal Inflammation ◽  
Loss Of Appetite

Background and Aims: This prospective study aimed to review the trustworthiness of the initial clinical assessment in acute appendicitis without employment of imaging modalities, laparoscopy or any other adjunct diagnostic test. Patients and Methods: 717 patients were operated on for appendicitis by six different surgeons. Initial clinical and laboratory examination were evaluated in relation to the intraoperative and the pathological appreciation of the appendiceal inflammation. Results: 598 patients were found to have appendicitis, 34 a different condition, 41 had both appendicitis and an additional condition and 44 no pathology. 6% of the laparotomies and 11 % of the appendectomies were unnecessary. The severity of the inflammation correlated significantly with periumbilical pain, pain migrating to right lower quadrant, loss of appetite, fever, rebound tenderness, local rigidity, polymorphonuclear predominance on deferential, polymorhonucleosis and leukocytosis. Leukocytosis was less frequent in aged patients. All the six surgeons were found to be equally reliable, although they all underestimated the setting compared to the pathologists. Patients with a long duration of symptoms had milder forms of inflammation and increased percentage of unanticipated abdominal conditions. Conclusions: Appendicitis can be reliably diagnosed clinically without employment of adjunct tests. These can be reserved for equivocal cases.

scholarly journals A RARE CASE OF ILEUS DUE TO MECKEL'S DIVERTICULUM WITH ACUTE APPENDICITIS

2000 ◽  
Vol 61 (9) ◽  
pp. 2372-2376
Author(s):  
Norikazu HANAKI ◽  
Masashi ISHIKAWA ◽  
Masanori NISHIOKA ◽  
Toru KIKUTSUJI ◽  
Yutaka KASHIWAGI ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Rare Case ◽  
Meckel’S Diverticulum ◽  
Meckel's Diverticulum

scholarly journals A Rare Cause of Acute Abdomen: Perforation of Double Meckel’s Diverticulum

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
İlhan Tas ◽  
Serdar Culcu ◽  
Yigit Duzkoylu ◽  
Sadik Eryilmaz ◽  
Mehmet Mehdi Deniz ◽  
...  
Keyword(s):  
Acute Abdomen ◽  
Meckel’S Diverticulum ◽  
Ileocecal Valve ◽  
Rare Condition ◽  
Meckel's Diverticulum ◽  
Rare Entity ◽  
Lower Quadrant ◽  
X Ray ◽  
The Right ◽  
Right Lower Quadrant

Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract. In this report, we aimed to represent a case of intestinal perforation, caused by double Meckel’s diverticulum, which is a very rare entity in surgical practice. The patient was a 20-year-old Caucasian man, admitted to hospital with complaints of abdominal pain, nausea, and vomitting during the last 3 days. Physical examination indicated tenderness, rebound, and guarding in the right lower quadrant of abdomen. Abdominal X-ray revealed a few air-liquid levels in the left upper quadrant. In the operation, 2 Meckel’s diverticula were observed, one at the antimesenteric side, at 70 cm distance to the ileocecal valve, approximately in 3 cm size, and the other between the mesenteric and antimesenteric sides, approximately in 5 cm size. The first one had been perforated at the tip and wrapped with omentum. A 30 cm ileal resection, including both diverticula with end-to-end anastomosis, was performed. The diagnosis of symptomatic Meckel’s diverticulum is considerably hard, especially when it is complicated. Diverticulectomy or segmentary resections are therapeutic options. In patients with acute abdomen clinic, Meckel’s diverticulum and its complications should be kept in mind, and the intestines should be observed for an extra diverticulum for caution although it is a very rare condition.

scholarly journals A Rare Case of Acquired Transthoracic Littre's Hernia

2019 ◽  
Vol 05 (04) ◽  
pp. e150-e153
Author(s):  
Arthur Curmi ◽  
Anthony P. Dimech ◽  
Rebecca Dalli ◽  
Ayman Mostafa ◽  
Joseph Debono
Keyword(s):  
Motor Vehicle ◽  
Meckel’S Diverticulum ◽  
Lower Abdominal Pain ◽  
Rib Fractures ◽  
Meckel's Diverticulum ◽  
First Case ◽  
History Of ◽  
Littre’S Hernia ◽  
The Right ◽  
Littre Hernia

Abstract Introduction The Littre hernia is a rare complication of Meckel's diverticulum. Meckel's diverticulum is vestigial remnant of the omphalomesenteric duct occurring in approximately 2% of the general population with an estimated 4 to 16% risk of complications. Usual sites of the Littre hernia include inguinal (50%), umbilical (20%), and femoral (20%). We report a case of an acquired transthoracic Littre's hernia occurring through the left part of the diaphragm triggered by a history of traumatic rib fractures associated with alcohol abuse. Case Report A 71-year-old man presented with 4-day history of worsening shortness of breath, colicky lower abdominal pain, and inability to open bowels despite passing flatus, without nausea or vomiting. His past medical history was remarkable for multiple traumatic rib fractures caused by falls which were associated with excessive alcohol consumption. A noncontrast computed tomography (CT) scan of the abdomen and pelvis showed distended jejunal loops containing air/fluid levels likely resulting from herniated jejunum between the left chest wall and left diaphragm. An urgent laparotomy was performed which revealed small bowel and omentum herniating through a small defect in the left posterior hemidiaphragm. The contents of the sac were reduced and a Meckel's diverticulum was found inside the sac, characteristic of Littre's hernia. The diaphragmatic defect was closed and the Meckel diverticulum stapled and excised. Discussion Herniation of Meckel's diverticulum through the diaphragm most commonly occurs in the pediatric population. Acquired transthoracic Littre's hernia is rare and may arise following thoracobdominal trauma caused by surgery, motor vehicle accidents, and falls from height. Left-diaphragmatic tears are characteristically more clinically apparent and symptomatic than the right since the liver often has a protective effect on the right part of the diaphragm. Herniation of abdominal contents in the chest cavity causes respiratory distress and requires urgent surgical correction. Diagnosis is often delayed since diaphragmatic hernia tends to present very late after the initial trauma, subjecting the patient to possible life-threatening complications. While it is easier to reduce the herniated contents and repair the diaphragm via a thoracic approach, laparotomy is often preferred in cases of acute trauma associated with intra-abdominal injuries. Repair of Littre's hernia then consists of resection of the diverticulum and herniorraphy. Conclusion Internal Littre's hernia is usually of congenital origin. This is the first case of a transthoracic Littre's hernia caused by traumatic rib fractures. Hence, it is of utter importance that a clinician is aware of such uncommon pathology.

scholarly journals Torsion of vermiform appendix: case report and review of the literature

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Kosuke Endo ◽  
Masahito Sato ◽  
Kenichi Saga ◽  
Atsushi Higashio ◽  
Yoshiaki Yuba ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Rare Disease ◽  
Treatment Plan ◽  
Laboratory Data ◽  
Lower Abdominal Pain ◽  
Emergency Operation ◽  
Abdominal Ultrasound ◽  
Vermiform Appendix ◽  
Ileocecal Region

Abstract Background Torsion of the vermiform appendix is a rare disease with symptoms very similar to those of acute appendicitis. We herein report a case of torsion of the vermiform appendix diagnosed by intraoperative findings. Case presentation A 4-year-old boy presented to our hospital because of abdominal pain and vomiting. Laboratory data revealed a C-reactive protein level of 0.08 mg/dL and white blood cell count of 19,300/μL (neutrophils, 88.9%). Abdominal ultrasound showed a target sign-like finding in the ileocecal region. A computed tomography scan showed swelling of the appendix. We performed an emergency operation under suspicion of acute appendicitis. Laparoscopic examination showed that the appendix had twisted 720° in the clockwise direction. Appendectomy was performed, and the postoperative course was uneventful. Conclusions Although torsion of the vermiform appendix is a very rare disease and difficult to differentiate from appendicitis, an inappropriate treatment plan could lead to necrosis and perforation of the appendix. It is important to consider this disease as a differential diagnosis in patients with right lower abdominal pain.

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