Torquated Giant Appendix Epiploica Mimicking Intraperitoneal Liposarcoma: Report of a Case

2011 ◽  
Vol 96 (2) ◽  
pp. 117-119 ◽  
Author(s):  
Pascal Jeanmonod ◽  
Jens Sperling ◽  
Roland Seidel ◽  
Sven Richter ◽  
Otto Kollmar ◽  
...  
Keyword(s):  
Acute Abdomen ◽  
Sigmoid Colon ◽  
Clinical Symptoms ◽  
Iliac Fossa ◽  
Ca 125 ◽  
Epiploic Appendagitis ◽  
Reactive Protein ◽  
Pedunculated Tumor ◽  
The Right ◽  
Normal Laboratory

Abstract A 49-year-old woman presented with acute abdominal pain in the right iliac fossa in our emergency department. Pain was abrupt in onset and severely colicky in nature. Abnormal laboratory values included a C-reactive protein of 75 mg/L and a CA-125 of 70.3 U/mL. White blood cell count was normal. Abdominal computed tomography (CT) scan revealed an inhomogeneous mass of 9.5 × 3.5 × 5.5 cm in diameter close to the appendix vermiformis and the sigmoid colon. Because of the clinical symptoms of an acute abdomen an explorative laparotomy was performed. Intraoperatively a pedunculated tumor beginning at the serosa of the sigmoid colon was found. The appendix was unremarkable. The macroscopic aspect as well as the backtable incision of the tumor was suspicious of an intraperitoneal liposarcoma. Rapid section and histopathologic examination revealed necrotic fat tissue without any malignancy. The patient was discharged from the hospital 7 days after the operation with normal laboratory parameters and without further complication. When epiploic appendagitis is evident as a big tumor mass in addition to clinical symptoms of an acute abdomen and elevated tumor markers, surgical exploration is mandatory.

scholarly journals PSEUDOMYXOMA ON APPENDICULAR MUCOCELE

2020 ◽  
Vol 8 (12) ◽  
pp. 842-846
Author(s):  
Yehouenou Tessi T. Romeo ◽  
◽  
Asaad El Bakkari ◽  
Adeyemi A. Boris ◽  
Khadija Ben El Hosni ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Iliac Fossa ◽  
Disease Onset ◽  
Vermiform Appendix ◽  
Complete Resection ◽  
Mucocele Of The Appendix ◽  
Thin Walled ◽  
Ct Density ◽  
The Right ◽  
Underlying Pathology

Mucocele of the appendix is a descriptive term for mucinous distension of the appendiceal lumen (vermiform appendix) regardless of the underlying pathology. It refers to the progressive retrograde dilatation of the vermiform appendix with concomitant intraluminal accumulation of the mucoid substance. It is an uncommon pathology that occurs in both sexes. it especially poses the problem of differential diagnosis in particular in women because of the location of clinical symptoms in the right iliac fossa. The incidence is estimated between 0.2 % and 0.4 % of the appendectomied specimens.The estimated incidence is approximately 1/1 000 000/year. The disease onset is usually after the age of 40 years and more frequently affects females.The means of medical imaging are mainly ultrasound and scanner. On CT typical mucocele appears as a cecal-based, rounded and well-defined mass, thin-walled, with fine parietal calcifications CT density is variable, from fluid to tissue. A stercolith is sometimes visible at the base of the appendix. The wall of the mucocele may be thickened, irregular, taking the contrast there may be peri-appendicular inflammation, which may be inflammatory or tumor, without specificity.The treatment of unbroken appendicular mucocele is surgical, preferably by laparotomy than laparoscopy. The appendectomy is performed, without breaking the appendix, with complete resection of the meso-appendix, and sampling for cytology of the peritoneal fluid.

scholarly journals Idiopathic Omental Infarction Mimic Acute Appendicitis: A Case Report

2020 ◽  
pp. 1-3
Author(s):  
Hamad Almakinzy ◽  
Bandar Idress ◽  
Hamad Almakinzy
Keyword(s):  
Case Report ◽  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Inflammatory Markers ◽  
Iliac Fossa ◽  
Young Patients ◽  
Acute Onset ◽  
First Case ◽  
Laparoscopy Surgery ◽  
The Right

Idiopathic Omental Infarct (IOI) is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Since first case was described by Elitelin 1899, more than 300 cases have been published [1]. It can mimic serious surgical pathology. It occurs in <1% of appendicitis cases [2]. It’s challenge to diagnose, as features may mimic acute appendicitis and therefore in young patients, may only be discovered intra-operative. Here, we present a case of omental infarct in 26-year-old gentleman with no significant medical or surgical background who present with acute onset of right iliac fossa (RIF) pain. Examination revealed tenderness over the right iliac fossa and was having localized rebound. His inflammatory markers were high. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day.

scholarly journals A Rare Case of Pseudotumoral Ureteric Tuberculosis Causing Forniceal Rupture

2021 ◽  
Vol 15 (7) ◽  
pp. 1449-1449
Author(s):  
M. Hajri ◽  
W. Ferjaoui ◽  
S. Baccouche ◽  
L. Gharbi ◽  
H. Mestiri ◽  
...  
Keyword(s):  
Iliac Fossa ◽  
Exploratory Laparotomy ◽  
Retroperitoneal Mass ◽  
Reactive Protein ◽  
Inflammatory Phase ◽  
History Of ◽  
Abdominal Examination ◽  
The Right ◽  
Protein Cell ◽  
Segmental Ureterectomy

A 55-year-old woman, with no medical history, presented with acute right flank pain. She had no history of other urinary complaints. On physical examination, the patient was tachycardic (pulse rate: 100bpm) and tachypneic (respiratory rate: 24 breaths/min), blood pressure was11/6 and temperature was 37.4°. The abdominal examination showed severe tenderness in the right flank and the right iliac fossa. All blood reports were normal, including C-reactive protein, cell blood count and serum creatinine. Computed Tomography of the abdomen revealed a right hydronephrosis with delayed phase contrast leak and a retroperitoneal mass of 48x36mm of unknown nature, enhanced after contrast injection, which seemed to compress the right ureter causing the forniceal rupture. A double J ureteral stent was insterted into the right renal cavities with favorable evolution and immediate resolution of pain. Surgical management of the mass was scheduled one month later after the inflammatory phase and resorption of the urinoma. The patient underwent an exploratory laparotomy. Intraoperatively, a tissular retroperitoneal mass of 4 cm was discovered which invadedthe right proximal ureter as well asthe duodenum and the ileocecal pedicle (Figure 1). Resection of the tumor was performed as well as a segmental ureterectomy, right colectomy, and resection of a small portion of the duodenum. Both ureteric and colic anastomosis were then performed along with duodenal suture. The post operative course was uneventful.

scholarly journals Persistent descending mesocolon: Case report

2012 ◽  
Vol 140 (9-10) ◽  
pp. 637-640 ◽  
Author(s):  
Zoran Trebjesanin ◽  
Srdjan Babic ◽  
Goran Vucurevic ◽  
Petar Popov ◽  
Nenad Ilijevski ◽  
...  
Keyword(s):  
Case Report ◽  
Small Bowel ◽  
Abdominal Wall ◽  
Sigmoid Colon ◽  
Internal Hernia ◽  
Splenic Flexure ◽  
Clinical Symptoms ◽  
Embryological Development ◽  
Descending Colon ◽  
The Right

Introduction. Positional anomalies of the right half of the colon are quite common whereas positional anomalies of the left half of the colon are much less common because of embryological disorders during the period of the embryological development of that part of the bowel. The process of the fixation of the descending colon to the posterior abdominal wall can be absent. In that case, when the descending colon has a free descending mesocolon, it shows some degree of mobility. Case Outline. We are presenting an example of one of the anomalies, which is characterized by the persistent descending mesocolon, which extends from the splenic flexure or just below it to the sigmoid colon. The persistent descending mesocolon in our case contains or surrounds almost complete small bowel in a recess which is located laterally to the left of the midline. The content of this hernial sac simulates the symptoms of an internal hernia followed by clinical symptoms and roendgenographical signs. Conclusion. We are of the opinion that this anomaly is more common than some surveys of literature would suggest.

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.

scholarly journals UNDESCENDED CAECUM AND APPENDIX WITH RIGHT SIDED SIGMOID COLON - A CASE REPORT

2013 ◽  
Vol 03 (04) ◽  
pp. 125-127 ◽  
Author(s):  
Meera Jacob ◽  
Shivarama C. H. ◽  
Bindu S. ◽  
Rani Nallathamby ◽  
Avadhani R.
Keyword(s):  
Sigmoid Colon ◽  
Undergraduate Students ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Iliac Fossa ◽  
Median Plane ◽  
Lumbar Region ◽  
Male Cadaver ◽  
Descending Colon ◽  
The Right

AbstractDuring routine dissection of abdomen for undergraduate students in Yenepoya Medical College, a male cadaver presented with variation in disposition of large intestine and inferior mesenteric artery. Caecum and appendix were present in the right lumbar region. The descending colon crossed the median plane in front of great vessels to the right side and then it continued as sigmoid colon in the right iliac fossa. Inferior mesenteric artery arose from right side of abdominal aorta to supply the left one third of ascending colon, descending colon and sigmoid colon.

scholarly journals Torsion of lesser omentum: A rare presentation of acute abdomen

2019 ◽  
Vol 1 (1) ◽  
pp. 41-43
Author(s):  
Muhammad Abdullah Khalid ◽  
Amina Amin ◽  
Mohammad Amir
Keyword(s):  
Laparoscopic Surgery ◽  
Acute Appendicitis ◽  
Ct Scan ◽  
Acute Abdomen ◽  
Epigastric Pain ◽  
Iliac Fossa ◽  
Rare Presentation ◽  
Epiploic Appendagitis ◽  
Omental Torsion ◽  
Focal Fat

Intraperitoneal Focal Fat Infarction is a rare cause of acute abdomen. There are two types, Omental Torsion and Epiploic Appendagitis. We present a case of 19 years old male who presented to ER with severe pain in epigastrium and right iliac fossa. Clinical diagnosis of acute appendicitis was made, but epigastric pain remained unexplained. CT scan was reported as non-significant. Diagnostic Laparoscopy picked lesser omental infarction and acute appendicitis. Patient was successfully managed by Laparoscopic Surgery. Symptoms not explained by a single pathology should be thoroughly investigated. CT Scan is the best investigation. Laparoscopic surgery is an effective and safe approach for small segmental omental torsion.

scholarly journals Evaluation of CA-125 Biomarker in Acute Appendicitis Patients: Correlation with Clinical Symptoms and Lab Results

2021 ◽  
Vol 14 (1) ◽  
pp. 162-167
Author(s):  
Mojtaba Ahmadinejad ◽  
Seyed A. Hashemi ◽  
Alireza Shirzadi ◽  
Ali Soltanian ◽  
Jafar Ashrafi ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Erythrocyte Sedimentation Rate ◽  
Sedimentation Rate ◽  
Complete Blood Count ◽  
Clinical Symptoms ◽  
Iliac Fossa ◽  
Ca 125 ◽  
Contour Plot ◽  
Diagnostic Significance ◽  
Erythrocyte Sedimentation

Objectives: The aim of this study is to evaluate the diagnostic significance of CA 125 in Acute Appendicitis (AA) along with the changes in its levels about clinical symptoms and lab findings. Methods: Patients referred at the emergency department of Madani hospital with the suspicion of AA and right iliac fossa pain were enrolled in this study. Preoperative CA 125 levels along with C-reactive Protein (CRP) and complete blood count were obtained. Lab findings, signs and symptoms were recorded for all the patients. Statistical analysis was conducted based on CA 125 < 16.4 U/mL and ≥ 16.4 U/mL using the logistic regression model, where variables such as fever, anorexia, CRP and Erythrocyte Sedimentation Rate (ESR) were added to the model. Results: Of 207 patients with the mean age of 26.55 ± 0.967 years, 48.8% of them were males and 51.20% were females. 122 of the total patients had CA 125 ≥ 16.4 U/mL. Anorexia was significantly associated with increased levels of CA 125. CA 125 was 2.14 times higher in patients presenting anorexia. However, ESR, CRP and fever were not associated with the elevation of CA 125. Based on the contour plot, it was deduced that leukocytosis at its lowest and erythrocyte sedimentation rate at its highest levels is associated with the maximum concentration of serum CA 125. Conclusion: Based on the findings from this study, CA 125 cannot be considered as a reliable diagnostic variable for acute appendicitis. Levels of CA 125 may vary with the severity of AA.

Off-Pump Supraarterial Decompression Myotomy for Myocardial Bridging

2005 ◽  
Vol 8 (1) ◽  
pp. 49 ◽  
Author(s):  
Mersa M. Baryalei ◽  
Theodorus Tirilomis ◽  
Wolfgang Buhre ◽  
Stephan Kazmaier ◽  
Friedrich A. Schoendube ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Exercise Testing ◽  
Clinical Symptoms ◽  
Therapeutic Option ◽  
Median Sternotomy ◽  
Myocardial Bridging ◽  
Off Pump ◽  
Hemodynamic Compromise ◽  
Artery Disease ◽  
The Right

Background: Myocardial bridging of the left anterior descending (LAD) artery may result in clinical symptoms. Surgery with cardiopulmonary bypass (CPB) is a therapeutic option with considerable risk. We hypothesized that off-pump supraarterial myotomy could be an effective treatment modality. Methods: Between October 1998 and May 2000, 13 patients were referred for surgery. All were symptomatic despite medical therapy. Anteroseptal ischemia had been proven by thallium scintigraphy in all 13 patients, exercise testing was positive in 11. All patients were operated on with an off-pump approach after median sternotomy. Results: Mean patient age was 61 8 years (range, 43-71 years). Coronary artery disease mandating additional bypasses was present in 3 patients. The bypasses were done off pump in 2 patients. Conversion to on-pump surgery was necessary in 3 of 13 patients (23%) because of hemodynamic compromise (1 patient), opening of the right ventricle (1 patient), and injury to the LAD (1 patient). Supraarterial myotomy was performed in all patients. One patient who underwent surgery with CPB developed postoperative anteroseptal myocardial infarction. Postoperative exercise testing was performed in all patients and did not reveal any persistent ischemia. Mortality was 0%. All patients were free from symptoms and had not undergone repeat interventions after an average of 51 7 months of follow-up. Conclusions: Off-pump supraarterial myotomy effectively relieves coronary obstruction but has a certain periprocedural risk as evidenced by 1 myocardial infarction, 1 right ventricular injury, and 1 LAD injury. Long-term freedom from symptoms and from reintervention favor further investigation of this surgical therapy.

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