“Worm within worm”: acute appendicitis containing an adult Ascaris lumbricoïdes

Appendicitis is the first aetiology for abdominal surgical emergency. Ascariasis is the most common helminth infection in tropical countries where it is endemic. The ability of intestinal helminths to wander through the digestive system means that it can end up in the appendix lumen and lead to appendicitis by luminal obstruction. However, this presentation is still rarely described in the literature. In fact, most of the diagnoses of roundworm associated with appendicitis are made retrospectively by the discovery of its eggs on the pathological examination of an appendectomy specimen. We report the case of a 7-year-old patient living in a tropical area who consulted for acute right lower quadrant pain. The ultrasound suspected the diagnosis of appendicitis and also revealed multiple intestinal worms including one in contact with the inflamed appendix. Surgical exploration confirmed appendicitis associated with roundworm partly in the appendicular lumen through a perforation.

RIPASA versus Alvarado score in the assessment of suspected appendicitis in children: a prospective study

Background Diagnosis of acute appendicitis remains a problem in children with right lower quadrant pain. Challenging diagnosis and fears of missing an inflamed appendix may lead to a negative appendectomy. Many scoring systems have been developed to reduce ambiguities in the diagnosis of appendicitis. Alvarado is one of the most commonly used scoring methods in pediatric patients. The RIPASA score is considered to be a better diagnostic scoring method in adults compared to Alvarado. The present study aims to compare RIPASA and Alvarado scoring systems in determining the possibility of acute appendicitis in children with right lower quadrant pain. This study included 179 consecutive pediatric patients who were referred to pediatric surgery with suspicion of acute appendicitis. The cut-off value was >7.5 for the RIPASA score vs. ≥7 for the Alvarado score. The possibility of appendicitis was divided into three groups for the Alvarado score and four groups for the RIPASA score. Results In this study, 158 of 179 patients were operated on. In 140 of the operated patients, the diagnosis of appendicitis was confirmed by histopathology. The negative appendectomy rate was 11.4%. Specificity and negative predictive value of RIPASA score were higher than those of Alvarado (p<0.001). No difference was found between the two scores concerning sensitivity, positive predictive value, and the area under the receiver operator characteristics curve (p>0.05). Conclusion The RIPASA scoring system can be used as an alternative to the Alvarado scoring system in the management of patients with right lower quadrant pain in emergency services and pediatric outpatient clinics. With the use of the RIPASA score, more patients with a low likelihood of appendicitis can be detected and further contributed to the reduction of the negative appendectomy rate.

Risk of Gastrointestinal Complications in Post Laparoscopic Cholecystectomy

Background: Post-cholecystectomy is related with a significant risk of developing gastrointestinal symptoms which affect the quality of life of patients. Objective: To assess the gastrointestinal complications risks in post-cholecystectomy patients (laparoscopic). Study Design: Retrospective study Place and Duration of Study: Department of Surgery, Services Hospital, Lahore from 1st April 2020 to 31st March 2021. Methodology: One hundred and fifty patients were enrolled. All patients under went laparoscopy for their acute or chronic cholelithiasis treatment. Patients demographic, body mass index, clinical assessment was documented. Patients were followed up for a period of six months and their gastrointestinal complains were recorded. Results: There were 86 females and 64 males with a mean age 49.8±6.3 years and mean body mass index were 24.8±3.6 kg/m2. Diarrhoea and fat intolerance were main complains within 56% and 57.3% patients within three months respectively. Flatulence, fat intolerance and right upper quadrant pain was also main complains of patients. Conclusion: Risk of diarrhoea, right upper quadrant pain, flatulence, and fat intolerance are noticeable as gastrointestinal complication in laparoscopic post-cholecystectomy patients. Keywords: Post-cholecystectomy, Gastrointestinal complications, Diarrhoea

Cholecystitis suspicion followed by and unexpected diagnosis: a case report

Gallbladder cancer is the 5th most common gastrointestinal cancer, is 2-3 times more frequent in females, and gallstones represent the most important association with this type of cancer. It is generally diagnosed incidentally after cholecystectomy for cholelithiasis and complete surgical resection offers the only potential cure. We report a case of a 42-year-old female, previously healthy, with upper right quadrant pain for 2 weeks and an ultrasound suggestive of cholecystitis. Unfortunately, intraoperative findings were discouraging.

Sub hepatic acute appendicitis: a challenging case to diagnose and successfully managed by laparoscopic procedure

Sub hepatic acute appendicitis is a rare condition to occur. It can present as right upper quadrant pain and makes challenging in diagnosis and early management. Sub hepatic appendix normally due to malrotation of intestine during developmental period. This condition can mimic as acute cholecystitis, liver abscess. We are presenting a case of sub hepatic acute appendicitis and successfully managed by laparoscopic appendectomy. Sub hepatic acute appendicitis is challenging case to diagnosis and early management. Because late in diagnosis can cause to perforation of appendix and its complications.

Acute appendicitis: is it a seasonal disease?

Background: The aim of this study was to review the management of acute appendicitis in a rural hospital. It was generally reported to be more common in men. Appendicitis is the most common surgical cause of abdominal pain worldwide. Appendectomy is the lonely curative treatment of appendicitis.Methods: This was a retrospective study in which we reviewed the records of the patients who had been diagnosed and operated on for appendicectomy from January to December 2017 in a rural hospital. The data were analyzed with SPSS version 25.Results: The total number of the patients was 114. About 69.3% are males. The mean age was 25.11 years. About (39.5%) were above 20 years old. Most of the cases presented in the period between January and March (27.3%). Right lower quadrant pain was the most common presenting symptom (93.9%). Nausea and vomiting mentioned by 57 (50%) and 74 (64.9%) of the participants respectively, fever in 42 (36.8%), muscle guarding in 0.9%, tenderness in 44 (38.6%), abdominal ultrasound was requested in 96 (84%). The most common histological diagnosis was acute suppurative appendicitis with peri-appendicitis in 15 (13.2%). All the cases were treated with open appendicectomy.Conclusions: We concluded that male are more affected with acute appendicitis. The most common presenting symptom was right lower quadrant pain. The vast majority of the cases were in the winter. Ultrasound has been used in the most cases particularly in male more than in females. The most common histological diagnosis was acute suppurative appendicitis. Open appendicectomy is the main operative management in our pts.

Gallbladder volvulus: a case report

Background Gallbladder volvulus is a rare pathology first reported by Wendel in 1898. Although the main pathological process associated with gallbladder volvulus is not known, there is clinical evidence suggesting that lack of gallbladder adhesions to the liver leads to an eventual twisting around the cystic bile duct (a process that seems to favor older female populations). Case presentation In this report, an 81-year-old Caucasian elderly female presented to the emergency department with acute/severe right upper quadrant pain, which was also accompanied by an elevated leukocyte count. Relevant imaging showed a distended gallbladder with gallbladder wall thickening and a dilated common bile duct. The patient was subsequently admitted to the hospital for acute cholecystitis and scheduled for surgery the next day. Upon laparoscopic surgery, the gallbladder was black and gangrenous with no visible adhesions to the liver. Further inspection demonstrated that the gallbladder had twisted clockwise around the cystic bile duct. Conclusions While many previous cases have been reported since Wendel, further case studies are nevertheless important to help guide proper clinic evaluation and pinpoint the potential for a gallbladder volvulus.

Clinical and laboratory characteristics and prognosis of patients with hepatocellular carcinoma

Purpose: We investigated the influence of baseline characteristics of patients with hepatocellular carcinoma (HCC) on prognosis. Methods: A Retrospective descriptive study on patients with HCC was carry out at the Oncology Department of Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital (HCH), Viet Nam, from Oct 2015 to Dec 2019. Demographic, laboratory, tumor characteristics, and performance status were determined before treatment. Predictors of survival were identified using the Kaplan - Meir test and the Cox model. Result: A total of 261 patients, 87.4% male; median age was 58.4; 80,1% of patients admitted to hospital because of right upper quadrant pain. 45.2% ECOG 0, 51.7% ECOG 1; AFP > 400 ng/mlhas 67.4%. The most robust predictors of survival were tumor size, ECOG, portal vein tumor thrombus, Barcelona Clinic Liver Cancer (BCLC), initial treatment. Overall survival in patients with HCC was 9.0 months. In a multivariate analysis: BCLC and initial treatment modalities were independent predictors of survival. Conclusions - Patients with HCC had a poor survival with a median of nine months. Five easily measurable clinical variables were significant predictors of survival in patients with HCC.