Double Magnet Ingestion Causing Intestinal Perforation with Peritonitis: Case Report and Review of the Literature

Introduction. Foreign body ingestion is a common pediatric complain, and most can be passed spontaneously; however, magnetic object ingestion is rather rare, and they can cause severe complications when multiple magnets are ingested, as they lead to entrapment of bowel walls between them, causing ischemia, pressure necrosis, perforation, and fistula formation. Case Presentation. Herein, we present a case of a 16-month-old female patient presented to our department complaining of continuous vomiting for two days along with fever and irritability. X-ray revealed dilated bowel loops with a radioopaque foreign body in the right lower quadrant. After discussing with the parents, exploratory laparotomy was done, showing two bowel perforations at the site of the magnets. Affected bowel was resected with anastomosis. The patient was discharged after 3 days with an uneventful recovery. Discussion. The diagnosis and management of magnet ingestion differ from those of small foreign bodies, which are usually managed conservatively by watchful waiting. Usually, the diagnosis is done due to complications such as peritonitis and death. On the other hand, management depends on the number, size, magnetic field, and shape of the magnet, and whether it has passed the pylorus or not. Conclusion. It is important to establish the diagnosis of this condition as early as possible to prevent complications. Despite the efforts that were made to try to prevent and minimize the risk of magnet ingestion, more investigations are required to reach a common and united strategy for management of such conditions.

“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.

A Case Giving Proof of Pathogenesis of Abdominoscrotal Hydrocele: A Case Report

An abdominoscrotal hydrocele (ASH) is an uncommon condition characterized by cystic mass that occupies the scrotum and abdomen. The characteristic aspect is the presence of two hydrocele sacs in the abdominal cavity and the scrotum, and compression of one side causes enlargement of the other side, thereby connecting the two sacs. There are several hypotheses regarding the occurrence of ASH. However, the evidence of the hypotheses is lacking. The patient was a 52-year-old male. During observation of the right inguinoscrotal hydrocele, the patient complained of a palpable mass lesion on the right lower quadrant of the abdomen. Physical examination revealed ASH that occurred with the growth of the inguinoscrotal hydrocele. This was further confirmed by sequential imaging test thereby proposing the verification of cephalad extension of hydrocele. The surgical excision was recommended and inguinal exploration was performed under general anesthesia. No evidence of relapse was observed during the 2-year follow-up period after surgery. The present case proves the cephalad extension of hydrocele among other hypotheses on the etiology of ASH.

Appendicitis in pregnancy: case report in a navy medical center of Mexico City

Acute appendicitis represents the most common non-obstetric surgical emergency during pregnancy, the most important clinical feature is abdominal pain in the right lower quadrant. Imaging studies can be used for diagnosis, where ultrasound and magnetic resonance imaging are mostly recommended. Timely diagnosis can prevent complications including fetal loss and preterm delivery. The case report orients the surgeon and obstetrician to make decisions in patients with this pathology

Inferior Vena Cava Thrombosis, Appendicitis Mimic

ABSTRACT Right lower quadrant abdominal pain is a common presentation to the Emergency Department. While appendicitis is a frequently diagnosed pathology associated with this complaint, there are multiple, well-documented alternatives that must be considered. The authors present a unique case of a 20 year old active duty male who presented with 3 days of acutely worsening right lower quadrant abdominal pain, right flank pain, and anorexia. Following a detailed work-up, computed tomography and magnetic resonance imaging (MRI) demonstrated a bland thrombus within the inferior vena cava (IVC) secondary to a vascular web. This case highlights the difficulty in astutely diagnosing appendicitis utilizing clinical examination and scoring metrics. While IVC thrombosis is a rare phenomenon, it should be considered in the emergency physician’s differential for right lower quadrant abdominal pain, particularly when additional nonspecific symptoms are present.

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.

Unusual cause of low abdominal pain

A 53-year-old woman, G2P2, was referred to the outpatient clinic because of chronic abdominal pain. Abdominal examination revealed tenderness in the right lower quadrant without peritoneal signs and blood analysis was normal. To exclude slow transit constipation a pellet study was performed: plain abdominal radio-graphy showed the presence of all ingested pellets and an abnormal, slightly lateralized and angulated position of the intrauterine device, a levonorgestrel intrauterine system called Mirena® which was placed five years earlier (figure 1). Subsequently an abdominal computed tomography was executed.

Huge subcutaneous extraperitoneal pseudocyst after migration of the ventriculoperitoneal shunt catheter

The formation of an intraperitoneal pseudocyst as a complication of ventriculoperitoneal shunts is well known. However, the formation of a pseudocyst at the subcutaneous extraperitoneal abdominal space is unusual and likely secondary to the migration of the peritoneal catheter. We present a 53-year-old male who had placement of a ventriculoperitoneal shunt for hydrocephalus secondary to a vestibular schwannoma. Five months later, he presented with an enormously distended abdomen. Investigations showed the peritoneal catheter in the extraperitoneal space within a large right lower quadrant abdominal wall pseudocyst. The patient was taken to the operating theatre, and the shunt was externalised at the original abdominal incision. Approximately 3 L of cerebrospinal fluid were aspirated from the distal peritoneal catheter. After negative cultures, a new peritoneal catheter was placed intraperitoneally at the contralateral lower abdominal quadrant. The contralateral quadrant was utilised to prevent fluid accumulation into the old extraperitoneal cavity.

Concurrent Spigelian and Grynfeltt-Lesshaft Hernias

Only 0.12% to 2% of diagnosed hernias are Spigelian type. Even less frequently encountered—Grynfeltt-Lesshaft hernias—hernias have unknown incidence. A Spigelian hernia is encountered along the Spigelian fascia and Grynfeltt-Lesshaft hernias are bounded by the superior lumbar triangle. These unique hernias can both be intermuscular, given their anatomical borders which allow concealment and preclusion of accurate diagnosis. Here, an 86-year-old male presented with symptoms consistent with small bowel obstruction. On physical exam, a right lower quadrant hernia and right posterior flank mass were appreciated. Computed tomography revealed obstruction secondary to bowel incarceration within Spigelian hernia and additional Grynfeltt-Lesshaft hernia. The patient underwent reduction and repair of Spigelian hernia with synthetic mesh, while repair of asymptomatic hernia was deferred. These unusual hernias are difficult to distinguish, given their negligible occurrence and unreliable exam findings. Clinicians must remain cognizant of their features to aid in diagnosis and mitigate potential sequelae.