scholarly journals Carcinoma of the appendix – A diagnostic challenge

2015 ◽  
Vol 10 (2) ◽  
pp. 36-40
Author(s):  
S Bhattarai ◽  
BK Yadav ◽  
P Kafle ◽  
N Maharjan ◽  
SJ Shrestha ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Right Hemicolectomy ◽  
Diagnostic Challenge ◽  
Primary Tumors ◽  
Palpable Mass ◽  
Lower Quadrant ◽  
Suspected Appendicitis ◽  
Close Proximity ◽  
Ovarian Pathology ◽  
The Right

INTRODUCTION Primary tumors of the appendix are rare. They are usually diagnosed after pathologic inspection of the appendix removed for suspected appendicitis. The main presentation is that of an acute appendicitis or as a palpable mass, mainly in the right lower quadrant. It mimics ovarian pathology in female because of close proximity to its anatomical structures. CASE PRESENTATION We report a case of 52 years female who presented to us in casualty with complains of pain abdomen and other findings suggestive of acute appendicitis. In spite of extensive preoperative investigations, the diagnosis was confirmed only after opening the abdomen as giant mucocele of appendix demanding right hemicolectomy as a treatment modality. CONCLUSION Although primary tumors of appendix is rare identity in the arena of surgery, it should be in the corner of thought as a possible diagnosis which require extensive surgery when compared to simple Appendicectomy.DOI: http://dx.doi.org/10.3126/jcmsn.v10i2.12953 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 36-40

scholarly journals Laparoscopic Right Hemicolectomy for Appendiceal Mucocele

2021 ◽  
Vol 64 (3) ◽  
pp. 165-169
Author(s):  
Eva Kudelová ◽  
Martin Grajciar ◽  
Marek Smolar ◽  
Michal Kalman ◽  
Ludovit Laca
Keyword(s):  
Surgical Treatment ◽  
Acute Appendicitis ◽  
Right Hemicolectomy ◽  
Cystic Mass ◽  
Lower Quadrant ◽  
Appendiceal Mucocele ◽  
Laparoscopic Right Hemicolectomy ◽  
The Right ◽  
Right Lower Quadrant ◽  
Ct And Mri

Appendiceal mucocele is a rare disease with an incidence of 0.07–0.63% of all appendectomies and was first described in 1842 by Carl von Rokitansky. It is defined as an abnormal intraluminal accumulation of mucin. The clinical picture of AM can vary from asymptomatic mass in the right lower quadrant to symptoms of acute appendicitis. In some cases, AM can be found accidentally on CT performed due to other reasons or during surgery. Diagnosis consists mainly of imaging methods such as ultrasound, CT, and MRI with the finding of encapsulated cystic mass with calcifications. The main goal of surgical treatment is to remove an intact mucocele and prevent spillage of mucin into the peritoneal cavity. We present a case of large mucocele treated with laparoscopic right hemicolectomy.

scholarly journals Solitary Cecal Diverticulitis During Surgery for Acute Appendicitis.

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Rovena Bode ◽  
Eriol Braholli ◽  
Asfloral Haxhiu ◽  
Xheladin Draçini ◽  
Etmont Çeliku
Keyword(s):  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Preoperative Diagnosis ◽  
Acute Diverticulitis ◽  
Right Hemicolectomy ◽  
University Hospital ◽  
Duration Of Symptoms ◽  
Lower Quadrant ◽  
Cecal Diverticulitis ◽  
The Right

Background: Caecal diverticulitis is an unusual condition that presents clinically similar to appendicitis. The diagnosis is not always easy and in the majority of cases, it is usually made at laparotomy. The aim of the present study is to retrospectively report our personal experience with solitary caecal diverticulitis, to determine its incidence in patients presenting as an acute abdomen, as well as identify the symptoms and clinical features that may aid in making a pre-operative diagnosis. And to compare this with a review of the literature, focusing on the surgical treatment and also on the indication of appendectomy in the presence of caecal diverticulitis not requiring surgery. Materials and methods: Data was collected in patients hospitalized for acute appendicitis or acute abdomen, in the surgical emergency unit of University Hospital Center "Mother Teresa" of Tirana, in a period of 3 years (2015-2017). Sex, age, duration of symptoms, preoperative diagnosis, management, intraoperative findings, histologic examination, length of hospital stay and complications of allpatients affected by solitary caecal diverticulitis were reviewed. Results: In the study period, 15 patients presented with a solitary caecal diverticulitis. Most of patients had pain in the right iliac fossa, with a duration of 2–6 days. All patients presented with abdominal pain, additional symptoms were nausea, vomiting and fever. The mean white blood cell count was from 8500-19.200/mm3, while the remaining laboratory results were normal. There were no specific findings on abdominal X-ray or ultrasonography. Intraoperative findings ranged from localized /circumscript peritonitis to generalised peritonitis due to acute diverticulitis and a normal appendix. Surgery ranged from diverticulum resection accompanied to appendectomy, to ileocaecal resection, and right hemicolectomy. Conclusions: Cecal diverticulitis should be included in the differen­tial diagnosis of the cases with pain in the right lower quadrant. Preoperative diagnosis of caecal diverticulitis cannot always be made, since the signs and symptoms are similar to acute appendicitis, but is impor­tant in order to decide how to manage this condition.Diverticulectomy and incidental appendectomy are the preferred method of treatment in uncomplicated cases. Right hemicolectomy is a recommended treatment option in complicated patients or those suspicious for tumor during surgery.

Appendicitis: a rare adverse event in colonoscopy

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.

scholarly journals Ileocolic intussusception as a presenting sign of primary lymphoma of the colon

2011 ◽  
Vol 139 (9-10) ◽  
pp. 673-676 ◽  
Author(s):  
Milica Nestorovic ◽  
Goran Stanojevic ◽  
Vesna Brzacki ◽  
Vesna Milojkovic ◽  
Branko Brankovic ◽  
...  
Keyword(s):  
Malignant Neoplasm ◽  
Radical Resection ◽  
Right Hemicolectomy ◽  
Primary Lymphoma ◽  
Ileocolic Intussusception ◽  
Diagnostic Challenge ◽  
Abdominal Ultrasonography ◽  
Atypical Symptoms ◽  
Colorectal Lymphoma ◽  
The Right

Introduction. Intussusception is a rare phenomenon in adults. It is caused mainly by malignant neoplasm. Primary lymphoma of the colon is a rare malignancy of the large intestine. The association of intussusception in adult and primary colorectal lymphoma is a diagnostic challenge, since they occur with a variety of atypical symptoms. Case Outline. We report a case of ileocolic intussusception in a 26-year-old man induced by primary lymphoma of the cecum. He was admitted to our hospital for incomplete intestinal obstruction. After thorough diagnostic work-up (plain abdominal radiography, abdominal ultrasonography, multi-slice computerized tomography, colonoscopy with biopsy), the patient underwent surgery. Intraoperative findings confirmed lymphoma as the cause of intussusception. The right hemicolectomy was carried out with end-to-side ileo-transverse anastomosis. Conclusion. Primary colorectal lymphomas should be considered in differential diagnosis of intussusceptions in adults. The treatment of choice is a radical resection where all oncological standards must be fulfilled.

Diagnostic Performance and Reliability of the Standardized Computed Tomography Reporting System for Acute Appendicitis: Experience in a Tertiary Care Academic Center

2021 ◽  
Vol 104 (7) ◽  
pp. 1102-1108
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Interobserver Agreement ◽  
Reporting System ◽  
Lower Quadrant ◽  
Suspected Appendicitis ◽  
Diagnostic Certainty

Background: Computed tomography (CT) is generally accepted as a modality of choice for imaging workup in patients with suspected appendicitis. A standardized CT reporting system, CT certainty score, has been proposed to improve diagnostic accuracy and to reduce ambiguous CT reports. Objective: To assess the diagnostic performance and the reliability of the standardized CT reporting system for acute appendicitis in Thai adults. Materials and Methods: The present study was a retrospective data review of 421 adult patients who had CT scans of the appendix between January 2016 and December 2017. The clinical and imaging data were extracted and analyzed. The pathological result was used as a standard of reference. The diagnostic performance and interobserver agreement of the standardized CT reporting system were estimated. Results: One hundred sixty-three patients, with a mean age of 41.7 years, had clinical diagnoses of acute appendicitis. Using standardized CT report, radiologists were highly accurate at diagnosing appendicitis [area under curve (AUC) 0.988 (95% CI 0.98 to 1.00); p<0.001]. The estimated sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.1% (95% CI 90.6 to 97.9), 95.7% (95% CI 92.5 to 97.9), 93.4% (95% CI 88.7 to 96.2), 96.9% (95% CI 93.0 to 97.2), 95.5% (95% CI 93.0 to 97.3), respectively. The interobserver agreement was greater than 80% for all binary objective findings and more than 90% agreement on the presence or absence of greater-than-3-mm wall thickness, appendicolith, periappendiceal air, and right lower quadrant fluid collection. The use of CT certainty score had interobserver agreement of 78% (κ=0.69; 95% CI 0.62 to 0.77). Conclusion: Using a standardized CT reporting system yielded a high diagnostic accuracy and high reproducibility of supportive CT findings for appendicitis in at-risk patients. The standardized CT reporting system can improve diagnostic certainty, accuracy, and guide patient management. Keywords: Appendicitis; Certainty score; Computed tomography; Standardized reporting system

scholarly journals The use of ultrasonographic and Alvarado scores in evaluating abdominal pain suggestive of acute appendicitis

2017 ◽  
Vol 4 (2) ◽  
pp. 757 ◽  
Author(s):  
Jorge Fernández Álvarez ◽  
José Manuel Gómez López ◽  
Alberto M González Chávez ◽  
Benjamín Valente Acosta ◽  
Diego Abelardo Álvarez Hénandez ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
Alvarado Score ◽  
Lower Quadrant ◽  
Efficient Alternative ◽  
Two Parameters ◽  
The Right ◽  
Right Lower Quadrant

Background: Ultrasonographic scores for appendicitis to determine if, combined with Alvarado scores, they can increase the sensitivity and specificity of the diagnosis of appendicitis.Methods: All cases of abdominal pain suggestive of appendicitis presented between 2013 and 2015 were analysed. An Alvarado score was obtained. All patients underwent ultrasound, and an ultrasonographic score was determined, including the appendicitis classical findings.Results: Two hundred and fifty-one patients with abdominal pain in the right lower quadrant were analysed. Appendicitis was confirmed in 211 (84%) patients. For these patients, the average Alvarado score was 7.95/10 (±1.25) vs. 5.7/10 (± 1.11) for patients who did not have appendicitis (p < 0.001). In patients with confirmed appendicitis, the average ultrasonographic score was 2.48/6 (± 1.06) vs. 0.6/6 (± 0.92) for patients who did not have acute appendicitis (p < 0.001). The ultrasonographic score has a sensitivity of 90% and a specificity of 87% with only two parameters. The combination of the Alvarado and ultrasonographic scores decreased the percentage of negative appendectomies to 2.36% and increased the area under the curve by 0.970.Conclusions: The sum of the Alvarado and ultrasonographic scores provides an efficient alternative for diagnosing abdominal pain suggestive of appendicitis and predicts which patients should undergo surgery with good certainty.

scholarly journals A Case of Valentino's Syndrome Presenting as Possible Appendicitis

2019 ◽  
Vol 104 (11-12) ◽  
pp. 540-541
Author(s):  
Brandon H. Cherry ◽  
Denish Patel ◽  
Joseph E. Ronaghan
Keyword(s):  
Acute Appendicitis ◽  
Signs And Symptoms ◽  
Perforated Peptic Ulcer ◽  
Exploratory Laparotomy ◽  
Good Health ◽  
Lower Quadrant Pain ◽  
Lower Quadrant ◽  
Right Lower Quadrant Pain ◽  
The Right ◽  
Purulent Fluid

Introduction We present a case of a 24-year-old female who presented with the signs and symptoms of acute appendicitis. Case report When computed tomography and ultrasound were not definitive for the diagnosis, the decision was made to perform a laparoscopic appendectomy. The appendix showed no gross signs of inflammation, so intraoperative esophagogastroduodenoscopy was used to examine for a perforated peptic ulcer. When no perforations were found, exploratory laparotomy was performed and revealed purulent fluid in the right colic gutter and a pinhole perforation in the first part of the duodenum. The defect was repaired and the abdominal space was washed thoroughly and closed. The patient recovered well and was discharged from the hospital in good health. Conclusion Valentino's syndrome is an uncommon cause of right lower quadrant pain and symptoms mimicking acute appendicitis.

scholarly journals Left sided acute appendicitis with intestinal malrotation in an adult, a diagnostic challenge

2018 ◽  
Vol 8 (1) ◽  
pp. 68-70
Author(s):  
Rupesh Gautam, ◽  
Deepak Adhikari ◽  
Gemma U. De Lima ◽  
Bhawana Adhikari
Keyword(s):  
Acute Appendicitis ◽  
Ct Scan ◽  
Lower Abdominal Pain ◽  
Sudden Onset ◽  
Intestinal Malrotation ◽  
Diagnostic Challenge ◽  
Diagnostic Modality ◽  
Operative Findings ◽  
The Right ◽  
Ct Features

A 28-yr-old male presented with sudden onset pain at the epigastric region followed by left lower abdominal pain. CT scan of the abdomen revealed reverse relation of the superior mesenteric artery and superior mesenteric vein with large bowel loops including the cecum on left side and small bowel loops on the right. An inflamed appendix arising from the base of left sided cecum was identified. The intra operative findings were consistent with CT features. This is a rare case of left sided acute appendicitis with intestinal malrotation in an adult patient. CT scan is diagnostic modality of choice and excludes other possible disease presenting with similar clinical features.  

scholarly journals A Pink Herring in the Colon: A Case Report of Eosinophilic Colitis Masking Invasive Adenocarcinoma of the Colon

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
David Malcolm Milne ◽  
Jason Rattan ◽  
Alyssa Muddeen ◽  
Amrit A. Rambhajan
Keyword(s):  
Colon Cancer ◽  
Weight Loss ◽  
Iliac Fossa ◽  
Fluid Collection ◽  
Right Hemicolectomy ◽  
Subsequent Treatment ◽  
Invasive Adenocarcinoma ◽  
Lower Quadrant ◽  
Eosinophilic Colitis ◽  
The Right

Eosinophilic colitis is an inflammatory condition in which the wall of the colon becomes infiltrated by eosinophils which stain densely pink on microscopy. It is an uncommon clinical entity which has a long list of differential diagnoses. We present a case of a patient whose biopsy at colonoscopy revealed eosinophilic colitis which led to a delay in the diagnosis and subsequent treatment of colon cancer. A 35-year-old male presented with a six-week history of right lower quadrant abdominal pain associated with diarrhoea and weight loss. Colonoscopy showed an inflamed cecum; computed tomography revealed a small ascitic fluid collection in the right iliac fossa. Biopsy showed eosinophilic colitis, and he was treated conservatively with albendazole and mesalamine. The patient failed to improve over the following month with continued weight loss. A repeat CT scan showed a right iliac fossa mass. A right hemicolectomy was performed with histopathology from the specimen showing mucinous adenocarcinoma. Eosinophilic colitis can mask colon cancer and should be considered a diagnosis of exclusion.

Evaluation of the Appendicitis Inflammatory Response Score against Alvarado Score in Diagnosis of Acute Appendicitis

2020 ◽  
Vol 18 (2) ◽  
pp. 68-72
Author(s):  
O.B. Karki ◽  
N.K. Hazra
Keyword(s):  
Inflammatory Response ◽  
Acute Appendicitis ◽  
Scoring System ◽  
Receiver Operating Curve ◽  
P Value ◽  
Diagnostic Challenge ◽  
Alvarado Score ◽  
Predictive Values ◽  
Suspected Appendicitis ◽  
Response Score

Background Patients presenting with suspected appendicitis pose a diagnostic challenge. Various scoring systems have been designed to aid in the clinical assessment of these patients. Widely applied was Alvarado score and best performed in validating studies, but was observed with few drawbacks. Appendicitis inflammatory response (AIR) score was designed to overcome the drawbacks associated with the implementation of Alvarado scoring system. Objective The main objective of this study was to evaluate the Appendicitis inflammatory Response Score and compare its performance in predicting risk of appendicitis with the Alvarado score. Method Appendicitis inflammatory response score and Alvarado scores were calculated prospectively on patients suspected of acute appendicitis presenting to Manipal Teaching Hospital, Pokhara, Nepal between July 2017 and June 2019. Diagnostic performance of the two scores was compared. Statistical analysis was done using SPSS 21 and p value < 0.05 was considered significant. Result The study included 217 patients with 109 (50.2%) males and 108 (49.8%) females. The mean age of patients was 25.77±15.54. The results analyzed showed better sensitivity of Appendicitis Inflammatory Response score (96.91%) as compared to 94.30% of Alvarado score. The positive and negative predictive values of Alvarado score were 74.87% and 50%, as compared to 79.70% and 72.20% for AIR score. Furthermore, the area under receiver operating curve of the appendix inflammatory response score was better (0.701) than that of Alvarado score (0.580). Conclusion Appendicitis Inflammatory Response (AIR) scoring performed well and more accurate than Alvarado scoring system with high specificity and high negative predictive value preventing negative appendectomies.

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