scholarly journals Atypical Presentations of Appendicitis

KYAMC Journal ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 101-106
Author(s):  
ABM Moniruddin ◽  
Salma Chowdhury ◽  
Tanvirul Hasan ◽  
Baikaly Ferdous ◽  
Md Rashed Khan
Keyword(s):  
Primary Care Physicians ◽  
Abdominal Mass ◽  
Vital Signs ◽  
Atypical Symptoms ◽  
Appropriate Treatment ◽  
No Weight Loss ◽  
Skin Erythema ◽  
Bowel Movements ◽  
Atypical Presentations ◽  
The Right

Appendicitis has its acute, subacute, recurrent and chronic forms. Appendicitis is commonly predisposed to and precipitated by a single or a combination of multiple discrete factors like obstruction of lumen, ischemia from thromboembolic episodes, infection or idiopathic etc. Typically, it starts as umbilical or peri-umbilical or midline abdominal dull aching pain that soon gets localized in the right iliac region. Movements worsen the pain. Other typical features include nausea, vomiting, anorexia, pyrexia, preference to lie down with or without curling up, chills, constipation, diarrhea, fever, shaking etc. The atypical symptoms of appendicitis include a dull or sharp pain anywhere in the abdomen, back, rectum, painful urination, bloating, flatulence, generalized abdominal tenderness, distension simulating acute intestinal obstruction, enlarging abdominal mass with or without overlying skin erythema, normal bowel movements, normal vital signs and even with no pain, no nausea, no vomiting no pyrexia or no weight loss. These atypical symptoms very often misguide the primary care physicians and the surgeons resulting in failure of diagnosis putting the patients to the risks of life-endangering complications. Diagnosis of appendicitis in absence of typical features are to be made from pre-occupied knowledge and clinical suspicion with or without the help of biochemical and/or imaging studies. Early and timely diagnosis and appropriate treatment are essential to save the life and to reduce the morbidity as well. Appendicitis should be thought in all cases of abdominal pain irrespective of its type and location, as must meningitis be thought in all cases of headaches. KYAMC Journal.2021;12(02): 101-106

scholarly journals Clinical presentation of strokes confined to the insula: a systematic review of literature

2021 ◽  
Author(s):  
Vincenzo Di Stefano ◽  
Maria Vittoria De Angelis ◽  
Chiara Montemitro ◽  
Mirella Russo ◽  
Claudia Carrarini ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Presentation ◽  
Insular Cortex ◽  
Affective Processing ◽  
Appropriate Treatment ◽  
Insula Cortex ◽  
Atypical Presentations ◽  
High Level ◽  
To Receive ◽  
Insular Region

Abstract Background and purpose The insular cortex serves a wide variety of functions in humans, ranging from sensory and affective processing to high-level cognition. Hence, insular dysfunction may result in several different presentations. Ischemic strokes limited to the insular territory are rare and deserve a better characterization, to be quickly recognized and to receive the appropriate treatment (e.g. thrombolysis). Methods We reviewed studies on patients with a first-ever acute stroke restricted to the insula. We searched in the Medline database the keywords “insular stroke” and “insular infarction”, to identify previously published cases. Afterwards, the results were divided depending on the specific insular region affected by the stroke: anterior insular cortex (AIC), posterior insular cortex (PIC) or total insula cortex (TIC). Finally, a review of the clinical correlates associated with each region was performed. Results We identified 25 reports including a total of 49 patients (59.7 ± 15.5 years, 48% male) from systematic review of the literature. The most common clinical phenotypes were motor and somatosensory deficits, dysarthria, aphasia and a vestibular-like syndrome. Atypical presentations were also common and included dysphagia, awareness deficits, gustatory disturbances, dysautonomia, neuropsychiatric or auditory disturbances and headache. Conclusions The clinical presentation of insular strokes is heterogeneous; however, an insular stroke should be suspected when vestibular-like, somatosensory, speech or language disturbances are combined in the same patient. Further studies are needed to improve our understanding of more atypical presentations.

scholarly journals Acute abdomen due appendicitis with atypical presentation leading to shock in an obese patient and with chronic liver disease

2014 ◽  
Vol 24 (1) ◽  
pp. 85
Author(s):  
Alexandra Damasio Todescatto ◽  
Felipe Ferreira Laranjeira ◽  
Júlia De Gasperi ◽  
Davyd Emaanuel Fin de Lehmann ◽  
Bruna Schmitt de Lacerda ◽  
...  
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Acute Abdomen ◽  
Collateral Circulation ◽  
Acute Abdominal Pain ◽  
Clinical Status ◽  
Chronic Liver ◽  
Difficult Diagnosis ◽  
Atypical Presentations ◽  
The Right

AIMS: To expose a case of acute abdomen due to appendicitis whose diagnosis was difficult and complicated because of the patient's profile and his comorbidities. CASE DESCRIPTION: Male patient, 52 years old, superobese, smoker and with chronic liver disease, complaining of acute abdominal pain in the right hypochondrium, vomiting and low diuresis. Initially with no signs of peritoneal irritation, the patient was medically managed, but presented worsening of clinical status, progressing to shock and cardiac arrest. The investigation by laparotomy found acute appendicitis, collateral circulation and liver cirrhosis. CONCLUSIONS: Acute abdomen has great impact on emergency care and, since it comprises several clinical situations, knowing and suspecting its main causes and its atypical presentations becomes essential, mainly in cases of difficult diagnosis.

Iatrogenic hydrohemothorax during percutaneous nephrolithotomy: A case report

2021 ◽  
Vol 1 (2) ◽  
pp. 079-082
Author(s):  
Tae Yeon Kim ◽  
Kyu Nam Kim ◽  
Lee Kwang Hyun ◽  
Bo Seok Kwon ◽  
Jo Hyung Jun
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Vital Signs ◽  
Pulmonary Complications ◽  
Fluid Retention ◽  
Air Bubbles ◽  
Close Cooperation ◽  
The Right ◽  
Pleural Injury ◽  
Routine Chest

Background: Percutaneous nephrolithotomy (PNL) is a widely used surgical method for renal stone management. However, it can be associated with several complications. Case: We report an acute hemothorax during PNL in 57-year-old male patient with a stone. After observing air bubbles at the diaphragm on the laparoscopic screen, we considered pulmonary complications. A chest radiograph demonstrated a shade that measured 130 mm wide and 70 mm long and fluid retention on the right side of the chest. During drainage of 200 ml of blood through a chest tube, the patient’s vital signs became unstable. After the patient received hydration and intravenous injection of vasopressor, his vital signs stabilized. Conclusions: Pulmonary complications due to pleural injury during PNL can result in death, but the complications can be managed by early diagnosis and treatment. Close cooperation between surgeon and anesthesiologist and routine chest radiographs after PNL can reduce the pulmonary complications.

scholarly journals Giant adrenal hemangioma: Unusual cause of huge abdominal mass

2015 ◽  
Vol 9 (11-12) ◽  
pp. 834 ◽  
Author(s):  
Mohamed Tarchouli ◽  
Adil Boudhas ◽  
Moulay Brahim Ratbi ◽  
Mohamed Essarghini ◽  
Noureddine Njoumi ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Abdominal Mass ◽  
Abdominal Distension ◽  
Microcytic Anemia ◽  
Hypochromic Microcytic Anemia ◽  
Normal Limits ◽  
Laboratory Examinations ◽  
Right Lobe ◽  
The Right

Adrenal hemangioma is an extremely rare benign and non-functioning neoplasm of the adrenal gland. We report a case of a 71-year-old woman admitted for intermittent abdominal pain and abdominal distension associated with vomiting and chronic constipation for 5 years. Physical examination revealed a large abdominal mass. Both computed tomography scan and magnetic resonance imaging suggested hemangioma in the right lobe of the liver. Laboratory examinations and tumour markers were within normal limits, except for hypochromic microcytic anemia. The mass was removed intact by conventional surgery and histopathology revealed a cavernous hemangioma of the adrenal gland with no signs of malignancy. Surgical resection was curative, with no recurrence at the 2-year follow-up.

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.

scholarly journals Mucinous cystadenomas of the liver

2013 ◽  
Vol 141 (3-4) ◽  
pp. 173-177
Author(s):  
Radoje Colovic ◽  
Nikica Grubor ◽  
Miodrag Jovanovic ◽  
Marjan Micev ◽  
Natasa Colovic ◽  
...  
Keyword(s):  
Frozen Section ◽  
Benign Tumors ◽  
Appropriate Treatment ◽  
Head Of The Pancreas ◽  
Malignant Alteration ◽  
Mucinous Cystadenomas ◽  
The Right ◽  
Healthy Liver ◽  
Single Lesion ◽  
Partial Excision

Introduction. Biliary cystadenomas of the liver are rare benign tumors prone to malignant alteration so that a total excision is recommended. Objective. The aim of the paper is to present our experience in treatment and to evaluate whether a simple ablation represents the appropriate treatment. Methods. Over a 10?year period 25 patients (24 women) of the average age of 58 years suffering from cystadenomas of the liver, 18 in the right, 4 in the left and 3 in both lobes of the liver were operated. Twenty?three patients had a single lesion, while two patients had 3 and 6 lesions, respectively. Pain was present in 20, occasional vomiting in 4, discomfort in 2 and a sense of fullness in 2 patients. Three patients were jaundiced, 1 due to cystadenoma of the liver, 2 due to concomitant tumors of the head of the pancreas, while 5 patients had concomitant diseases. Results. A total ablation was performed in 22 patients, left lateral bisegmentectomy in 1 and partial excision in 2 patients. Six additional procedures were performed. Five cystadenomas of the liver had ?ovarian like? stroma, all in women. A focal malignant alteration was found in 2 patients aged 66 and 79 years, respectively. Recurrence was registered in 1 female patient in whom a partial excision had been done. Two patients with concomitant malignancy and 1 patient who developed malignant histiocytosis six months after surgery, died after 1, 2 and 3 years, respectively. Conclusion. Biliary cystadenomas of the liver may be misdiagnosed as simple liver cysts, so that ?frozen section? histology is highly recommended. In most cases the tumor may be successfully treated by ablation up to the healthy liver tissue. Major liver resections are rarely necessary.

scholarly journals Tuberculous Sacroiliitis after a Penicillin Injection: A Case Report

2020 ◽  
Author(s):  
Mohammad Darvishi ◽  
Sana Rashidi ◽  
Setayesh Abazari
Keyword(s):  
Sacroiliac Joint ◽  
Vitamin B6 ◽  
Laboratory Data ◽  
Vital Signs ◽  
Major Health ◽  
The Past ◽  
Osteoarticular Tuberculosis ◽  
Lung Auscultation ◽  
The Right ◽  
Time Of Admission

Tuberculosis is one of the major health problems in developing countries affecting different organs such as bone and joints. One of the most important involvements of osteoarticular tuberculosis is that of the sacroiliac joint. In addition, its incidence has increased over the past several years. Early diagnosis is necessary to prevent further disorders such as neurological and surgical complications. We report a tuberculous arthritis case in the right sacroiliac joint, which developed after penicillin injection. The patient was a 32-year-old man admitted to Besat hospital, Tehran, Iran. He complained of pain, erythema and swelling in his right buttock starting approximately 17 years previously, after a penicillin injection, which was followed by the emergence of an orifice with yellow secretions. Over the years, the secretions continued but the pain, swelling and erythema were resolved. At the time of admission, his vital signs were stable and normal. In the physical examination, an orifice with a small amount of yellow secretion was detected on the right buttock as claimed by the patient. Lung auscultation was clear. No lymphadenopathy was detected. Laboratory data were normal. During hospitalization, initial antibiotic therapy was prescribed. After Mycobacterium tuberculosis was detected in culture, a 4-drug anti-TB therapy encompassing rifampin, isoniazid, ethambutol and pyrazinamide was prescribed for 18–24 months, in addition to daily vitamin B6 and pantoprazole.

scholarly journals Giant bilateral adrenal lipoma in a patient with congenital adrenal hyperplasia

2021 ◽  
Vol 2021 ◽  
Author(s):  
Tina Kienitz ◽  
Jörg Schwander ◽  
Ulrich Bogner ◽  
Michael Schwabe ◽  
Thomas Steinmüller ◽  
...  
Keyword(s):  
Congenital Adrenal Hyperplasia ◽  
Abdominal Mass ◽  
Clinical Signs ◽  
Adrenal Tumors ◽  
List Type ◽  
Adrenal Hyperplasia ◽  
Endocrine Society ◽  
Adrenal Imaging ◽  
Open Laparotomy ◽  
The Right

Summary Apart from adrenal myelolipomas, adrenal lipomatous tumors are rare and only seldom described in the literature. We present the case of a 50-year-old man, with a classical form of congenital adrenal hyperplasia (CAH), which was well treated with prednisolone and fludrocortisone. The patient presented with pollakisuria and shortness of breath while bending over. On MRI, fat-equivalent masses were found in the abdomen (14 × 19 × 11 cm on the right side and 10 × 11 × 6 cm on the left side). The right adrenal mass was resected during open laparotomy and the pathohistological examination revealed the diagnosis of an adrenal lipoma. Symptoms were subdued totally postoperatively. This is the first report of a bilateral adrenal lipoma in a patient with CAH that we are aware of. Learning points Macronodular hyperplasia is common in patients with congenital adrenal hyperplasia (CAH). Solitary adrenal tumors appear in approximately 10% of adult CAH patients and are often benign myelolipomas. The Endocrine Society Clinical Practice Guideline does not recommend routine adrenal imaging in adult CAH patients. Adrenal imaging should be performed in CAH patients with clinical signs for an adrenal or abdominal mass. Adrenal lipoma is rare and histopathological examinations should rule out a differentiated liposarcoma.

scholarly journals Giant cystic malignant pheochromocytoma invading right hepatic lobe: report on two cases

2008 ◽  
Vol 126 (4) ◽  
pp. 229-231 ◽  
Author(s):  
Sergio Renato Pais Costa ◽  
Nivaldo Marques Cabral ◽  
Ademir Torres Abhrão ◽  
Ricardo Borges da Costa ◽  
Lilian Mary da Silva ◽  
...  
Keyword(s):  
Abdominal Mass ◽  
Radical Right ◽  
Right Hepatectomy ◽  
Hepatic Tumors ◽  
Hepatic Lobe ◽  
Multiple Organs ◽  
Abdominal Masses ◽  
Retroperitoneal Sarcomas ◽  
The Right ◽  
Radiological Methods

CONTEXT: Cystic pheochromocytomas are uncommon neuroendocrine tumors that originate from the adrenal medulla. Differing from the more frequent solid pheochromocytomas, which produce catecholamines and present adrenergic syndrome, cystic pheochromocytomas may not produce these. Their symptoms are generally associated with an abdominal mass or even pain, particularly if the mass attains large dimensions. Similarly, radiological diagnosis may also be difficult. Right-side lesions may be confounded with cystic hepatic tumors or even retroperitoneal sarcomas with cystic areas, using radiological methods. Sometimes, there may be a preoperative diagnosis of malignancy. Invasion of organs in this region (i.e. liver or kidney), or even the presence of a large retroperitoneal mass (of uncertain origin) with which multiple organs are involved, may be indicative of malignant origin. CASE REPORT: Two cases of giant cystic pheochromocytoma that invaded the right hepatic lobe are described. These presented as abdominal masses. Both cases were malignant. They were treated by radical right nephrectomy plus right hepatectomy.

scholarly journals A Wandering Abdominal Mass in a Neonate: An Enteric Duplication Cyst Mimicking an Ovarian Cyst

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Shigeo Iijima
Keyword(s):  
Ovarian Cyst ◽  
Abdominal Mass ◽  
Duplication Cyst ◽  
Resonance Imaging ◽  
Urgent Surgery ◽  
Enteric Duplication Cyst ◽  
Antenatal Ultrasonography ◽  
Enteric Duplication ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Enteric duplication cysts are rare congenital anomalies that are prenatally diagnosed through antenatal ultrasonography (US). In female patients, however, attention must be paid since these formations might be confused with ovarian cysts. Herein, we present a case of a low birth weight female infant with an enteric duplication cyst. A cystic lesion was detected in the right abdomen of the fetus on antenatal US and magnetic resonance imaging (MRI). Serial US and MRI examinations performed after birth showed a single cyst that wandered from side to side in the abdomen; the initial diagnosis was thought to be an ovarian cyst. During laparotomy, however, it was found to be an enteric duplication cyst with volvulus. To our knowledge, there has been no report of an enteric duplication cyst presenting as a wandering abdominal mass. Our experience indicates that early intervention is necessary for patients who have a wandering abdominal mass to avoid complications and urgent surgery, whether it is an ovarian cyst or an enteric duplication cyst.

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