Histiocytic Necrotizing Lymphadenitis Mimicking Acute Appendicitis in a Child: A Case Report

Background: Histiocytic necrotizing lymphadenitis, also known as Kikuchi-Fujimoto disease (KFD), is a self-limiting inflammatory disease with low incidence and high misdiagnosis rate in children. Furthermore, cases where the clinical presentation resembles acute appendicitis are very rare.Case Presentation: A 14-year-old boy was misdiagnosed as acute appendicitis and received operative treatment at his early visit. He suffered from abdominal pain, vomiting, diarrhea, fever, and lymphadenitis at the ileocecal junction, which were found by B-ultrasonography examination and surgery. Lymphadenectomy, as well as appendectomy, was performed, and KFD was identified by pathological examination. The patient was transferred to our hospital for further therapy because of recurrent fever and abdominal pain after the appendectomy. His temperature became normal after methylprednisolone was administered, and no recurrence was observed till now during follow-up.Conclusions: Necrotizing lymphadenitis involving mesenteric lymph nodes may cause acute-appendicitis-like symptom; KFD should be a diagnostic consideration for mesenteric lymphadenitis.

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Imperforate hymen mimicking acute appendicitis in an adolescent woman: a rare presentation

BMJ Case Reports ◽

10.1136/bcr-2020-238547 ◽

2021 ◽

Vol 14 (3) ◽

pp. e238547

Author(s):

Victoria Rose Russell ◽

Mohamed Ibrahim ◽

Georgina Phillips ◽

Tom Setchell ◽

Sanjay Purkayastha

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Iliac Fossa ◽

Female Genital Tract ◽

Delayed Diagnosis ◽

Rare Presentation ◽

Left Iliac Fossa ◽

Imperforate Hymen ◽

Retrograde Menstruation ◽

Low Incidence

Imperforate hymen is a rare congenital malformation of the female genital tract. The condition poses several diagnostic challenges owing to its low incidence and often atypical presentation. Classical symptoms include amenorrhoea and cyclical abdominal pain. Delayed diagnosis leads to potentially irreversible and lifechanging sequelae including infertility, endometriosis and renal failure. A premenarchal 13-year-old girl with a background of chronic constipation presented with symptoms mimicking acute appendicitis. The underlying cause was imperforate hymen and retrograde menstruation. The diagnosis was made during diagnostic laparoscopy. As with this patient, pre-existing symptoms are often troublesome long before the true diagnosis is made. This case report highlights the importance of recognising imperforate hymen as a potential cause of acute abdominal pain in premenarchal adolescent girls. The clinical picture may present as right or left iliac fossa pain. Early identification reduces the risk of adverse complications and avoids unnecessary and potentially harmful interventions.

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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.

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The largest reported intrathoracic lipoma: a case report and current perspectives review

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-019-1030-8 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Mohammed Aldahmashi ◽

Abdalmotaleb Elmadawy ◽

Mahmoud Mahdy ◽

Mohamed Alaa

Keyword(s):

Single Case ◽

Tumor Resection ◽

Pathological Examination ◽

Complete Excision ◽

Case Presentation ◽

Medical Checkup ◽

Excellent Outcome ◽

The Right ◽

Intrathoracic Mass

Abstract Background The huge size intrathoracic lipomas are very rare. Few cases have been reported worldwide. To our knowledge, this presented case is one of the few cases reported. Here we report a single case as very huge intrathoracic lipoma compressing the right lung and displacing the diaphragm and liver downward. It has been managed by right posterolateral thoracotomy and complete excision, with excellent outcome. Case presentation A 32-year-old male presented with a symptomatic right intrathoracic mass, which was confirmed to be a lipomatous tumor using computed tomography. A penduculated tumor originating from the mediastinal pleura was resected through the conventional right posterior thoracotomy. Pathological examination indicated a diagnosis of fibrolipoma. Conclusion The tumor was symptomatic and relatively huge when detected during a medical checkup. This enabled the successful tumor resection via conventional thoracotomy approach. Although intrathoracic lipomas are histologically benign, careful observation and follow-up are crucial due to the possibility of recurrence.

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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.

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Conservative management of early uncomplicated appendicitis in children

International Surgery Journal ◽

10.18203/2349-2902.isj20170855 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1024 ◽

Cited By ~ 1

Author(s):

Sunil Kumar Maini ◽

Neeraj Kumar Jain ◽

Manjari Goel Jain ◽

Vicky Khobragade

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Conservative Management ◽

Medical Management ◽

Surgical Intervention ◽

Lower Abdominal Pain ◽

Primary Treatment ◽

Research Centre ◽

Uncomplicated Appendicitis

Background: Right lower abdominal pain management in children is a challenging task for the surgeon. Most of the time right lower abdominal pain ends up in acute appendicitis. For long time appendicetomy was the treatment of choice. However surgical intervention has its own disadvantages such as pain, scarring, adhesions, hernia development and venous thrombosis disease. Anxiety and fear of surgery were also two difficulties in obtaining consent for surgery. Parents often request and insist for medical management. Their unwillingness for surgical intervention was the most important reason for medical management of uncomplicated acute appendicitis.Methods: Our prospective observational study was conducted in the Department of General Surgery, R.K.D.F. Medical College and Research Centre, Bhopal, Madhya Pradesh, India during period of January 2014 to January 2016 and follow up was done till December 2016. Our target group was children under 16 years. A total of 92 children with complaint of right lower abdominal pain attended the hospital for treatment. Routine investigations including ultrasonography of abdomen were performed for all the patients. Out of 92 patients diagnosis of acute appendicitis was made in 74 patients, Surgery was performed in 32 patients, while remaining 42 patients were treated conservatively and the results were analyzed.Results: In this study of 92 patients of pain in right iliac fossa below 16 years, 74 (80.43%) were diagnosed as acute appendicitis. 32 (43.24%) Patients were operated earlier. 42 (56.75%) Patient were treated conservatively. Out of 42 patients, 12 (16.21%) patients were operated within 1 year, 30 (40.54%) Patients didn’t require any surgical intervention during 1 year follow up. In present study, significant role of antibiotic was found in conservative management of acute appendicitis in children. So it can be concluded that conservative management of acute appendicitis in children can be attempted under observation.Conclusions: Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis. Appendicectomy should be done but conservative management of acute appendicitis in children can be attempted under observation.

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A 61-year-old Female with Right Upper Abdominal Pain

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.7.48514 ◽

2020 ◽

Vol 4 (4) ◽

pp. 630-631

Author(s):

Drew Long ◽

Brit Long

Keyword(s):

Interventional Radiology ◽

Abdominal Pain ◽

Source Control ◽

Day Hospital ◽

Biliary Injury ◽

Case Presentation ◽

Image Guided ◽

Upper Abdominal ◽

Gallbladder Fossa

Case Presentation: A 61-year-old female presented to the emergency department with right upper quadrant abdominal pain following a cholecystectomy 18 days prior. Computed tomography (CT) of her abdomen demonstrated a large abscess in her post-hepatic fossa. She was admitted to the general surgery service and received an image-guided percutaneous drain placement with interventional radiology with immediate return of purulent material. She was discharged home after a three-day hospital course with outpatient antibiotics and follow-up. Discussion: Patients may have multiple complications following cholecystectomy, including infection, bleeding, biliary injury, bowel injury, or dropped stone. The emergency clinician must consider cholecystectomy complications including gallbladder fossa abscess in patients presenting with abdominal pain in the days to weeks following cholecystectomy, especially if they present with signs of sepsis. Critical actions include obtaining CT and/or ultrasonography, initiating broad spectrum antibiotics, and obtaining definitive source control by either surgery or interventional radiology.

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Hanging Noncalculous Gallbladder

HPB Surgery ◽

10.1155/1996/60802 ◽

1996 ◽

Vol 9 (3) ◽

pp. 137-139 ◽

Cited By ~ 5

Author(s):

E. Tzardinoglou ◽

J. Prousalidis ◽

S. Apostolidis ◽

C. Katsohis ◽

H. Aletras

Keyword(s):

Abdominal Pain ◽

Gall Bladder ◽

Gallbladder Disease ◽

Pathological Examination ◽

Complete Relief ◽

Biliary Pain ◽

Abnormal Position ◽

The Mean ◽

One Year

The removal of acalculous and not acutely inflamed gall-bladder in patients with typical biliary pain remains a questionable procedure. This study was conducted to present our experience. In the period 1982- 90, 1089 cases of calculous and acalculous gallbladder disease were treated in our clinic. In this period, 27 patients were subjected to cholecystectomy because of an acalculous, non inflamed gallbladder which was elongated lying in an abnormal position with a long cystic duct. The mean duration ofsymptoms supportive of cholelithiasis, was 5 years. Oral cholecystogram and ultrasonography led to the diagnosis and other causes ofchronic abdominal pain were excluded. There were 13 lumbar, 9 pelvic and 5 iliac gallbladders, with poor function in 20 of them. During cholecystectomy, the organ was invested by peritoneum and suspended in 7 cases from a mesentery. On pathological examination mild chronic inflammation was reported in 19 cases and minimal changes in 8. The minimum follow up was one year and the maximum 9 years. Complete relief of symptoms was achieved in all the cases. In conclusion, cholecystectomy should be offered in these symptomatic "hanging" gallbladders.

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599 Acute Abdomen Secondary to Appendiceal volvulus: A Case Report

British Journal of Surgery ◽

10.1093/bjs/znab134.304 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Alamassi

Keyword(s):

Acute Appendicitis ◽

Fluid Collection ◽

Treatment Modalities ◽

Low Grade ◽

Case Presentation ◽

Acute Peritonitis ◽

Mucinous Neoplasms ◽

Neoplastic Process ◽

Pathological Subtypes

Abstract Introduction Appendiceal torsion is an uncommon precipitating factor for acute appendicitis. It is found to be in association with appendiceal mucocele. Case presentation A 38-year-old lady presented with acute peritonitis. CT Scan showed tubular fluid collection. This was suggested to be a torsion/volvulus of the appendix. The intraoperative finding were a distended appendix filled with mucus and twisted 720° at the base. Appendectomy was done. The histopathology showed low grade mucinus neoplasia. Discussion: Approximately, 50% of mucoceles are asymptomatic and incidentally discovered, whilst 40% present with acute appendicitis. There are two suggested pathogenesis: one being an obstructive mechanism causing high pressure in the appendix, resulting into gross mucinous accumulation and second being a neoplastic process. Appendiceal mucinous neoplasms are classified into LAMN, HAMN and mucinous appendiceal adenocarcinoma. It is important to differentiate between the pathological subtypes as the risk of occurrence of PMP may vary according to that. This would affect the treatment modalities; follow up planning, prognosis and risk of recurrence. It is important that extra precautions should be taken whilst handling the specimens intraoperatively to avoid spillage of the content as that might lead to implantation of neoplastic cells in the peritoneum and that might affect the overall survival rate.

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AB1051 KIKUCHI FUJIMOTO DISEASE, IS IT SLE?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5460 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1815.3-1816

Author(s):

J. Camins-Fàbregas ◽

V. Ortiz-Santamaria ◽

N. Busquets-Pérez ◽

A. Cuervo ◽

I. Cañas Alcántara ◽

...

Keyword(s):

Autoimmune Disease ◽

Autoimmune Diseases ◽

Lupus Erythematosus ◽

Clinical Manifestations ◽

Response To Treatment ◽

Systemic Autoimmune Disease ◽

Histiocytic Necrotizing Lymphadenitis ◽

Systemic Autoimmune Diseases ◽

Necrotizing Lymphadenitis

Background:Kikuchi-Fujimoto disease (KFD) is a rare entity characterized by adenopathies and fever. It raises a broad differential diagnosis that includes lymphoproliferative disorders, infections and systemic autoimmune diseases, and diagnostic confirmation is always by histology, which shows histiocytic necrotizing lymphadenitis. Although its course is generally benign and self-limited, it can be associated both at the time of diagnosis and during follow-up with systemic autoimmune diseases, the most frequent of which is systemic lupus erythematosus (SLE).Objectives:To describre the clinical and analytical characteristics of patients diagnosed with KFD and the development of systemic autoimmune disease.Methods:Patients diagnosed with KFD during the 1990s and 2020s are collected in a regional hospital (Granollers General Hospital). The clinic is documented at the diagnosis of EKF, the appearance of systemic autoimmune disease during follow-up and its clinical and analytical characteristics.Results:A total of 7 patients with EKF were diagnosed. All of them women with a mean age at diagnosis of 30 years. Diagnosis was made in all cases with compatible clinical symptoms, fever and lymphadenopathy, and lymph node biopsy confirming histiocytic necrotizing lymphadenitis. At the time of diagnosis, a patient was also diagnosed with SLE. During the follow-up, 4 of the 6 remaining patients developed clinical manifestations compatible with SLE (3 of them with systemic manifestations and a case of subacute cutaneous lupus. The mean time of onset of SLE was 34 months (between 6 months and 5 years). All of them received treatment with hydroxychloroquine, with good response to treatment.The clinical and analytical characteristics are presented in Table 1 below.Conclusion:In our center, 5 of the 7 patients (71%) diagnosed with EKF developed manifestations compatible with SLE. The importance of the diagnosis of EKF lies precisely in the possible association with systemic autoimmune disease, the most common being SLE, so it is recommended that patients be monitored to identify those who develop associated autoimmune disease.Disclosure of Interests:None declared

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Pulmonary Nodular Lymphoid Hyperplasia in a 53-year-old Man With Malignant Sign: a Case Report and Literature Review

10.21203/rs.3.rs-650543/v1 ◽

2021 ◽

Author(s):

Zhen Yang ◽

Lianshuang Wei ◽

Xu Li ◽

Xin Liu

Keyword(s):

Ground Glass Opacity ◽

Lymphoid Hyperplasia ◽

Chest Ct ◽

Benign Disease ◽

Pathological Examination ◽

Histopathologic Examination ◽

Imaging Findings ◽

Case Presentation ◽

Nodular Lymphoid Hyperplasia

Abstract Background: Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare benign illness. Due to atypical clinical and radiographic presentations, diagnosis largely depends on postoperative pathological examination. Thus, preoperative misdiagnosis is often occurred. Case presentation: We present a case of asymptomatic PNLH that was seen as ground-glass opacity (GGO) on computed tomography (CT). After 3-year observation, the diagnosis tends to adenocarcinoma owing to increasing density of the node and vessel convergence sign, which were signs of malignancy. Video-assisted segmentectomy (S10) was carried out. Histopathologic examination of postoperative specimen showed follicular lymphoid hyperplasia with interfollicular lymphoplasmacytosis, consistent with PNLH. The follow-up chest CT images showed no recurrence or metastasis.Conclusion: Although it is a benign disease, PNLH can exhibit malignant signs in the imaging examinations, which could lead to misdiagnosis. This reminds us of the uncertainty between imaging findings and diagnosis. The diagnosis depends on postoperative pathological examination. Surgical resection is not only diagnostic but also curative.

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