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Thapa N, Shrestha O, Basukala S, Shrestha K, Bhugai N, Joshi N, Regmi SK, Karki S, Gurung S. Case of giant appendicolith: A common ailment with a rare finding. Clin Case Rep 2023; 11:e7372. [PMID: 37251744 PMCID: PMC10213707 DOI: 10.1002/ccr3.7372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/31/2023] Open
Abstract
Giant appendicoliths are rare appendicoliths with the largest diameter of more than 2 cm. It can increase the risk of complications such as perforation or abscess formation. This is a case of an uncommon definitive pathology diagnosed for a right iliac fossa calcification with a rare transoperative finding.
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Affiliation(s)
- Niranjan Thapa
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Oshan Shrestha
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Sunil Basukala
- Department of SurgeryNepalese Army Institute of Health SciencesKathmanduNepal
| | - Kala Shrestha
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Nabaraj Bhugai
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Niraj Joshi
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | | | - Sagun Karki
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Suman Gurung
- Department of PathologyNepalese Army Institute of Health ScienceskathmanduNepal
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2
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Babington EA. Appendicoliths, the little giants: A narrative review. Radiography (Lond) 2023; 29:1-7. [PMID: 36179409 DOI: 10.1016/j.radi.2022.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/30/2022] [Accepted: 09/14/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This narrative review aims to collate the data in the existing literature on appendicoliths, by reviewing the available information on appendicoliths that have been previously reported in 24 publications, and providing the information in one article. KEY FINDINGS Appendicoliths are frequent culprits in causing luminal obstruction of the appendix, leading to appendicitis. They are calcified masses formed as a result of the aggregation of faecal particulates and inorganic salts within the lumen of the appendix. The presence of appendicoliths in an inflamed appendix influences the patient's treatment, as surgery is usually done to avoid appendix perforation and abscess formation, and also to prevent a future recurrence of the disease. Appendicoliths are mostly imaged using CT, Ultrasound, and plain X-rays; however, CT is the most frequently used modality, particularly in the imaging of complications caused by 'retained' appendicoliths. 'Retained' appendicoliths and their consequential abscesses have been reported in the sub-hepatic and intrahepatic regions, pelvic and tubo-ovarian regions, gluteal region, subcutaneous layer, subphrenic region, and through the diaphragm into the chest cavity. CONCLUSION This review provides useful information on the imaging appearances and complications caused by the presence of appendicoliths in an inflamed appendix, and it also provides information on the clinical implications of 'dropped' appendicoliths during appendectomy. IMPLICATIONS FOR PRACTICE Based on the findings of this review, it is recommended that the appropriate imaging modality (ultrasound and/or CT) should be considered when imaging appendicoliths and its complications. It is also suggested that retained appendicolith be considered a differential diagnosis when imaging patients with a history of appendectomy due to complicated appendicitis/perforation.
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Affiliation(s)
- Emmanuel A Babington
- Sheffield Hallam University, Sheffield, UK; Sonographer at the University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK.
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3
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Nishida N, Shono T, Shono K, Hashimoto Y, Kawakami K. Late Occurrence of the Tubo-Ovarian Abscess after Appendectomy for Perforated Appendicitis in a Virginal Adolescent Girl. J Pediatr Adolesc Gynecol 2022; 35:509-511. [PMID: 35038588 DOI: 10.1016/j.jpag.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/17/2021] [Accepted: 01/02/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tubo-ovarian abscess (TOA) is generally seen in sexually active women. It is rarely reported in virginal adolescent girls. CASE A 12-year-old virginal girl was referred to us for repeated fever and right lower abdominal pain. She had undergone an appendectomy for a perforated appendix with abscess 5 years previously. Laparoscopic surgery revealed pelvic adhesions associated with TOA in the right pelvis. At 2 months after laparoscopic drainage, she underwent resection of the affected tube with wedge resection of the ipsilateral ovary due to the recurrence of TOA. SUMMARY AND CONCLUSION Late occurrence of TOA should be considered in the differential diagnosis of repeated abdominal pain and fever in virginal adolescent girls with a history of appendectomy for complicated appendicitis, even if the history is remote.
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Affiliation(s)
- Nanako Nishida
- Department of Pediatric Surgery and Pediatric Urology, NHO Kokura Medical Center, Kitakyushu 802-8533, Japan
| | - Takeshi Shono
- Department of Pediatric Surgery and Pediatric Urology, NHO Kokura Medical Center, Kitakyushu 802-8533, Japan.
| | - Kumiko Shono
- Department of Pediatric Surgery and Pediatric Urology, NHO Kokura Medical Center, Kitakyushu 802-8533, Japan
| | - Yoshiko Hashimoto
- Department of Pediatric Surgery and Pediatric Urology, NHO Kokura Medical Center, Kitakyushu 802-8533, Japan
| | - Kosuke Kawakami
- Department of Obstetrics and Gynecology, NHO Kokura Medical Center, Kitakyushu 802-8533, Japan
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4
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Merlino L, Chiné A, Carletti G, Del Prete F, Codacci Pisanelli M, Titi L, Piccioni MG. Appendectomy and women’s reproductive outcomes: a review of the literature. Eur Surg 2021. [DOI: 10.1007/s10353-021-00703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Summary
Background
The most frequent abdominal surgery performed for benign disease in females of fertile age is appendectomy, which remains among the most common surgeries and is a possible cause of peritoneal adhesions. The fact that appendectomy can cause adhesions may lead one to think that this may be a relevant risk factor for infertility; however, there is no universal agreement regarding the association between appendectomy and fertility. The aim of this review is to evaluate weather appendectomy may have a relevant impact on female fertility.
Methods
The search was conducted in PubMed and there was no limitation set on the date of publication. All studies regarding populations of female patients who had undergone appendectomy for inflamed appendix, perforated appendix, or negative appendix between childhood and the end of the reproductive period were included.
Results
Some authors believe that pelvic surgery can cause adhesions which can potentially lead to tubal infertility by causing tubal obstruction or by altering motility of fimbriae, tubal fluid secretion, and embryo transport. On the other hand, the most recent evidence reported that removal of the appendix seems to be associated with an increased pregnancy rate in large population studies.
Conclusion
Despite the existence of contrasting opinions concerning fertility after appendectomy, the most recent evidence suggests that appendectomy may actually lead to improved fertility and decreased time to pregnancy. Appendectomy seems to be correlated with improved fertility and higher pregnancy rates.
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Rubino C, Barbati F, Regoli M, Bencini E, Mattei A, Fierro F, Brizzi I, Indolfi G. Recurrent Bilateral Salpingitis in a Sexually Inactive Adolescent: Don't Forget about the Appendix. J Pediatr Adolesc Gynecol 2021; 34:217-219. [PMID: 33358895 DOI: 10.1016/j.jpag.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 11/24/2020] [Accepted: 12/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Salpingitis is an acute inflammation of the fallopian tubes and is extremely uncommon in patients who are sexually inactive or premenarchal. CASE We describe a 15-year-old sexually inactive patient with recurrent bilateral salpingitis. After the second episode, she underwent an exploratory laparoscopy and was diagnosed with chronic appendicitis. SUMMARY AND CONCLUSION Appendicular involvement should be kept in mind in recurrent salpingitis episodes, especially if previous imaging studies do not show signs of appendicitis. Imaging studies should be repeated in experienced centers in case of recurrent episodes. Laparoscopy is the gold standard for the diagnosis of salpingitis and can confirm appendicular or other abdominal involvement. Early diagnosis can help to prevent recurrent episodes of salpingitis and thus reduce the risk of sequelae.
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Affiliation(s)
- Chiara Rubino
- Post-Graduate School of Pediatrics, University of Florence, Florence, Italy.
| | - Federica Barbati
- Post-Graduate School of Pediatrics, University of Florence, Florence, Italy
| | - Marta Regoli
- Pediatric Unit, Meyer Children's University Hospital, Florence, Italy
| | - Erica Bencini
- Pediatric Gynecology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Alberto Mattei
- Department of Minimally Invasive Gynecological Surgery, Centre Tuscany USL, Italy
| | - Francesca Fierro
- Radiology Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Ilaria Brizzi
- Pediatric Unit, Meyer Children's University Hospital, Florence, Italy
| | - Giuseppe Indolfi
- Department of NEUROFARBA, Meyer Children's University Hospital, University of Florence, Florence, Italy
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Sagkriotis I, Habib Z, Zardab M. Between a rock and a hard place: retained appendicolith causing a mechanical small bowel obstruction. J Surg Case Rep 2020; 2020:rjz393. [PMID: 33024543 PMCID: PMC7524605 DOI: 10.1093/jscr/rjz393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 06/11/2020] [Indexed: 11/13/2022] Open
Abstract
Here we report an unusual case of small bowel obstruction, preluded by an unremarkable presentation of appendicitis. The small bowel obstruction subsequently diagnosed involved deposition of an appendicolith within the small bowel. Radiographic features of this incident are discussed along with its pathomechanics. Surgical management was carried out and is detailed along with advice for the management of retained appendicolith.
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Affiliation(s)
| | - Zain Habib
- Burns and Plastics, MFT, Royal Childrens Hospital, Manchester, UK
| | - Mohammed Zardab
- Hepatobiliary Surgery, St Bartholomew's Hospital, London, UK
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Villarreal CM, Yedavally S, Mulhem E. Vegetable fibre in an infected ovarian dermoid cyst. BMJ Case Rep 2019; 12:12/3/e224867. [PMID: 30936324 DOI: 10.1136/bcr-2018-224867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tubo-ovarian abscesses (TOAs) are inflammatory masses involving the fallopian tube, ovary and occasionally other adjacent pelvic organs. A 32-year-old woman with no significant medical history presented with a chief complaint of lower abdominal pain. Initial CT of the abdomen was suggestive of a colon abscess; however, a repeat CT suggested a TOA. The left ovary was densely adherent to the left pelvic sidewall and the rectosigmoid colon. The content of the ovary was consistent with a dermoid and suspected of superinfection. Pathological examination of the tissue revealed normal ovarian cortical tissue, hair cells, melanin, and epidermal and neural tissue, as well as evidence of a foreign object resembling vegetable matter. The vegetable fibre found in this patient's biopsy was of an unclear aetiology, but probably indicates a perforation of the bowel. Any cause of bowel perforation adjacent to the adnexa can lead to TOA, therefore providing a rational speculation for this case.
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Affiliation(s)
- Carla M Villarreal
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Srikala Yedavally
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Elie Mulhem
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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8
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Affiliation(s)
- Raed Abdulkareem
- Department of General Surgery University of Illinois at Chicago Chicago, Illinois
| | - Francis J. Podbielski
- Department of Cardiovascular & Thoracic Surgery Advocate Christ Medical Center Oak Lawn, Illinois
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9
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Proffitt T, Whitworth K, Trigger C. Post-operative Appendix Specimen Retention Presenting as Small Bowel Obstruction. Clin Pract Cases Emerg Med 2017; 1:287-290. [PMID: 29849296 PMCID: PMC5965195 DOI: 10.5811/cpcem.2017.5.34078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/02/2017] [Accepted: 05/12/2017] [Indexed: 11/11/2022] Open
Abstract
One rare complication of appendectomy is a retained appendicolith, which can become a focal point for infection presenting hours to years after surgery. We present a case in which a 50-year-old male presented to the emergency department with a small bowel obstruction one week post appendectomy. A diagnostic laparoscopy was performed, and a necrotic appendiceal specimen containing a staple line across the base as well as an appendicolith was removed. It is crucial to include rare surgical complications in our differentials, alongside the more common pathologies when approaching and treating patients with abdominal pain.
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Affiliation(s)
- Tiffany Proffitt
- Lakeland Health, Department of Emergency Medicine, Saint Joseph, Michigan
| | - Kristen Whitworth
- Lakeland Health, Department of Emergency Medicine, Saint Joseph, Michigan
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10
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Habboub AY. Middlemore Hospital experience with tubo-ovarian abscesses: an observational retrospective study. Int J Womens Health 2016; 8:325-40. [PMID: 27524920 PMCID: PMC4965222 DOI: 10.2147/ijwh.s105913] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
AIM The aim of this paper was to study the characteristics of patients presenting to Middlemore Hospital with tubo-ovarian abscess (TOA) and to compare the outcomes of conservative medical management versus medical management with surgical drainage and medical management with radiological drainage. METHODS All patients admitted with a radiologically or surgically proven TOA between January 01, 2008 and December 31, 2010, were included and followed up until June 30, 2011. The total number of patient/index admission was 174. RESULTS The mean age of patients was 37.8 years. One hundred thirty patients had medical treatment only with hospitalization and antibiotics, and 44 patients were managed with antibiotics and surgical drainage. Complete resolution of TOA was 77.3% (99/128) for patients managed medically and 93.2% (41/44) for patients managed surgically. When the two groups were compared, patients who were managed surgically were more likely to have complete resolution of TOA within 6 months of index admission with an odds ratio (OR) of 4 and a P-value of 0.029. There was no statistically significant difference in the secondary outcomes namely of readmission with TOA (OR: 0.47) and the need for repeat surgical or radiological drainage (OR: 1.48). Nonetheless, the relative duration of hospitalization was longer for the surgical group with a P-value of <0.0001. The C-reactive protein and the size of TOA were the significant factors involved in the resolution of TOA. CONCLUSION The results of this study confirmed our initial hypothesis that we should consider surgical drainage more often, probably earlier, especially for the younger patients still desiring fertility preservation and for larger abscesses. Laparoscopic surgical drainage is safe and could be used as the procedure of choice. Conservative medical management is still acceptable with good cure rates of 77%. C-reactive protein and the size of the abscess were the important factors to consider when managing patients with TOA.
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11
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Lovrenski J, Jokić R, Varga I. Sonographically detected free appendicolith as a sign of retrocecal perforated appendicitis in a 2-year-old child. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:395-398. [PMID: 26890809 DOI: 10.1002/jcu.22337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/13/2015] [Accepted: 12/22/2015] [Indexed: 06/05/2023]
Abstract
Prompt and accurate diagnosis of perforated appendicitis is crucial for proper and timely treatment. The appendix, however, cannot always be identified with sonography (US). We report the case of a 2-year-old child with atypical clinical presentation, and US detection of a free appendicolith as a sign of perforated appendicitis, without visualization of the appendix itself. Laparoscopy revealed a retrocecal, gangrenous, perforated appendix with autoamputation, fibrinopurulent peritonitis, and a free appendicolith within the abdominal fluid. US detection of a free appendicolith in a child is a very rare, but unequivocal sign of perforated appendicitis, which should be sought. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:395-398, 2016.
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Affiliation(s)
- Jovan Lovrenski
- Radiology Department, Institute for Children and Adolescents Health Care of Vojvodina, Medical Faculty, University of Novi Sad, Hajduk Veljkova 10, 21000, Novi Sad, Serbia
| | - Radoica Jokić
- Pediatric Surgery Department, Institute for Children and Adolescents Health Care of Vojvodina, Medical Faculty, University of Novi Sad, Hajduk Veljkova 10, 21000, Novi Sad, Serbia
| | - Ivan Varga
- Radiology Department, Institute for Children and Adolescents Health Care of Vojvodina, Medical Faculty, University of Novi Sad, Hajduk Veljkova 10, 21000, Novi Sad, Serbia
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12
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Cox M, Gould SW, Podberesky DJ, Epelman M. Magnetic resonance imaging of acquired disorders of the pediatric female pelvis other than neoplasm. Pediatr Radiol 2016; 46:806-17. [PMID: 27229499 DOI: 10.1007/s00247-016-3595-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 01/29/2016] [Accepted: 02/19/2016] [Indexed: 02/04/2023]
Abstract
Transabdominal US remains the primary screening imaging modality of the pediatric female pelvis. However, MRI has become an invaluable adjunct to US in recent years. MRI offers superb soft-tissue contrast resolution that allows for detailed evaluation, particularly of the ovaries and their associated pathology. MRI can yield diagnostic information that is similar to or even better than that of US, especially in nonsexually active girls in whom transvaginal US would be contraindicated. MRI is generally a second-line examination and is preferred over CT because it does not involve the use of ionizing radiation. MRI might be underutilized in this population, particularly in differentiating surgical from nonsurgical conditions. This article reviews the relevant anatomy and discusses imaging of acquired conditions that involve the pediatric female genital tract, illustrating associated pathology with case examples.
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Affiliation(s)
- Mougnyan Cox
- Department of Medical Imaging, Nemours Children's Health System/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sharon W Gould
- Department of Medical Imaging, Nemours Children's Health System/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Daniel J Podberesky
- Department of Medical Imaging/Radiology, Nemours Children's Health System/Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL, 32827, USA
| | - Monica Epelman
- Department of Medical Imaging/Radiology, Nemours Children's Health System/Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL, 32827, USA.
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Uçar MG, İlhan TT, Kebapçılar A, Yormaz S, Çelik Ç. An extremely rare case of complicated appendicitis: in utero
appendix with fistula formation. ANZ J Surg 2016; 88:E552-E553. [PMID: 26990923 DOI: 10.1111/ans.13484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 12/15/2015] [Accepted: 12/23/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Mustafa G. Uçar
- Faculty of Medicine, Department of Gynecology and Obstetrics; Selcuk University; Konya Turkey
| | - Tolgay T. İlhan
- Faculty of Medicine, Department of Gynecology and Obstetrics; Selcuk University; Konya Turkey
| | - Ayşegül Kebapçılar
- Faculty of Medicine, Department of Gynecology and Obstetrics; Selcuk University; Konya Turkey
| | - Serdar Yormaz
- Faculty of Medicine, Department of Surgery; Selcuk University; Konya Turkey
| | - Çetin Çelik
- Faculty of Medicine, Department of Gynecology and Obstetrics; Selcuk University; Konya Turkey
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14
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Tayaran A, Boccola MA, Vanyai J. Preperitoneal abscess secondary to a retained appendicolith: an uncommon complication in an uncommon location. ANZ J Surg 2016; 88:648-649. [PMID: 26918395 DOI: 10.1111/ans.13457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ammar Tayaran
- Department of Surgery, Western Health, Melbourne, Victoria, Australia
| | - Mark A Boccola
- Department of Surgery, Western Health, Melbourne, Victoria, Australia
| | - Jacob Vanyai
- Department of Surgery, Western Health, Melbourne, Victoria, Australia
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15
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Limberg J, Ginsburg H, Lala S, Tomita S. Recurrent Pelvic Infections and Salpingitis after Perforated Appendicitis. J Pediatr Adolesc Gynecol 2015; 28:e177-8. [PMID: 26342348 DOI: 10.1016/j.jpag.2015.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The effect of perforated appendicitis on the adnexa is an issue of concern and controversy. Long-term fertility studies have been conflicting. CASE We present the case of a patient with chronic pelvic infections, salpingitis, and hydrosalpinx after perforated appendicitis. SUMMARY AND CONCLUSION Magnetic resonance imaging was helpful in diagnosing a chronically obstructed fallopian tube, likely secondary to the dense adhesions from her previously treated perforated appendicitis. Salpingectomy relieved her symptoms of chronic pain and recurrent infections.
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Affiliation(s)
- Jessica Limberg
- Department of Surgery, Division of Pediatric Surgery, New York University Langone Medical Center, New York, New York
| | - Howard Ginsburg
- Department of Surgery, Division of Pediatric Surgery, New York University Langone Medical Center, New York, New York
| | - Shailee Lala
- Department of Radiology, Division of Pediatric Radiology, New York University Langone Medical Center, New York, New York
| | - Sandra Tomita
- Department of Surgery, Division of Pediatric Surgery, New York University Langone Medical Center, New York, New York.
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Abstract
Acute appendicitis is a common pediatric surgical emergency. Successful surgical appendectomy requires removal of the appendix and its contents. A retained appendicolith is a complication that occurs when the appendicolith is expulsed from the appendix as a result of perforation or failure of removal during surgery. An ectopic appendicolith can migrate to a variety of ectopic locations, acting as a nidus for abscess. Clinical presentation may be delayed by days, weeks or even months after surgery. We present and discuss an unusual case of empyema caused by migration of an appendicolith into the chest cavity. Management of these retained appendicoliths requires drainage of the abscess and extraction of the appendicolith.
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17
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Kumar D, Ramanathan S, Al Faki A, Nepal P. Faecolith migrating from the appendix to produce liver abscess after subhepatic laparoscopic appendectomy. Trop Doct 2015; 45:241-4. [PMID: 25824562 DOI: 10.1177/0049475515577749] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The subhepatic position of an appendix may lead to difficulty in diagnosis of appendicitis, its surgical management as well as bizarre complications. A 'lost' appendicular faecolith is not an uncommon complication due to spillage during the removal of the appendix or due to perforation. Here we report a case of such a faecolith migrating into the liver parenchyma following intraoperative hepatic injury, and producing a liver abscess. The calcified lesion seen in the liver corresponded to a free-lying faecolith on a preoperative computed tomography scan. Liver abscess was presumed to arise from implantation of this foreign object into the liver parenchyma. Pigtail drainage of abscess was performed with good result.
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Affiliation(s)
- Devendra Kumar
- Consultant, Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmad Al Faki
- Consultant, Department of General Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Pankaj Nepal
- Specialist, Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
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18
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Black MT, Ha BY, Kang YS, Garland AM. Perihepatic abscess caused by dropped appendicoliths following laparoscopic appendectomy: sonographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:366-369. [PMID: 22573213 DOI: 10.1002/jcu.21940] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 03/28/2012] [Indexed: 05/31/2023]
Abstract
We report the case of a 6-year-old girl presenting with acute appendicitis complicated by perforated appendix, followed by perihepatic abscess associated with ectopic appendicoliths. CT findings were initially suspicious for an intrahepatic abscess with internal calcifications. However, on sonography the abscess appeared to be in a perihepatic location. Perihepatic abscess associated with a dropped or retained appendicolith has been rarely reported. Awareness of the possibility of a perihepatic abscess as a complication of laparoscopic appendectomy and use of sonography should result in optimal management of this rare complication.
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Affiliation(s)
- Michelle T Black
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
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19
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Petrou NA, Goumalatsos G, Tosson S. Uncalcified faecal matter: an unusual cause of female pelvic pain. Eur J Obstet Gynecol Reprod Biol 2012. [PMID: 23195043 DOI: 10.1016/j.ejogrb.2012.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Parsons SR, Bennett JE, Kaloo P, Scott M. Appendicitis and uterine abscess: presentation of an unusual fistula between the gynaecological and gastrointestinal tracts. BMJ Case Rep 2012; 2012:bcr.09.2011.4795. [PMID: 22984000 DOI: 10.1136/bcr.09.2011.4795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors present the case of a 65-year-old woman with clinical and radiological evidence of pelvic sepsis and a medical history of endometrial ablation 20 years previously. She underwent laparotomy after failing to settle with a course of intravenous antibiotics and her appendix was found to have perforated into the uterus with abscess formation which had not discharged vaginally presumably due to widespread intrauterine synechia following her endometrial ablation. She underwent appendectomy and hysterectomy and made a full recovery with no complications. Macroscopic and microscopic examination suggested the appearances are those of an abscess of the uterine fundus with part of the appendix incorporating into the abscess mass.
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Affiliation(s)
- Sian Ruth Parsons
- Colorectal Surgery Department, Gloucester Royal Hospital, Gloucester, UK
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Tuboovarian Abscess due to Colonic Diverticulitis in a Virgin Patient with Morbid Obesity: A Case Report. Case Rep Med 2012; 2012:413185. [PMID: 22952477 PMCID: PMC3431136 DOI: 10.1155/2012/413185] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 07/22/2012] [Indexed: 11/17/2022] Open
Abstract
Since tuboovarian abscess is almost always a complication of pelvic inflammatory disease, it is rarely observed in virgins. A 30-year-old virgin patient presented with pelvic pain, fever, and vaginal spotting for the previous three weeks. Her abdominopelvic computed tomography scan revealed bilateral multiseptated cystic masses with prominent air-fluid levels suggesting tuboovarian abscesses. The sigmoid colon was lying between two tuboovarian masses, and its borders could not be distinguished from the ovaries. The patient was presumed to have bilateral tuboovarian abscesses which developed as a complication of the sigmoid diverticulitis. She was administered intravenous antibiotic therapy followed by percutaneous drainage under ultrasonographic guidance. She was discharged on the twenty second day with prominent clinical and radiological improvement. Diverticulitis may be a reason for development of tuboovarian abscess in a virgin patient. Early recognition of the condition with percutaneous drainage in addition to antibiotic therapy helps to have an uncomplicated recovery.
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Kaya B, Eris C. Different clinical presentation of appendicolithiasis. The report of three cases and review of the literature. Clin Med Insights Pathol 2011; 4:1-4. [PMID: 21487530 PMCID: PMC3072212 DOI: 10.4137/cpath.s6757] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
An appendicolith is composed of firm feces and some mineral deposits. After increased use of abdominal computed tomography, appendicoliths are more frequently detected. Most of the patients with appendicolith are asymptomatic. However, an appendicolith may be associated with complicated appendicitis with serious outcomes. We reported three patients who exhibited different clinical symptoms due to appendicolithiasis. While one of the patients was confused with urolithiasis, the other two patients presented with phlegmenous and perforated appendicitis. We submit that appendicoliths may present different clinical findings and can mimic several pathologies including urinary disorders.
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Affiliation(s)
- Bulent Kaya
- Fatih Sultan Mehmet Training and Research Hospital, Department of General Surgery, Istanbul, Turkey
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Acker S, Bazella C, Ponsky T. Tubo-Ovarian Abscess Following Perforated Appendicitis in an Adolescent. J Gynecol Surg 2011. [DOI: 10.1089/gyn.2009.0091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shannon Acker
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Corinne Bazella
- Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH
| | - Todd Ponsky
- Department of Pediatric Surgery, Case Western Reserve University, Cleveland, OH
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Abstract
A 10-year-old boy presented with a 2.5-week history of right leg pain and limp. A right flank mass was noted by a parent on the day of presentation. The child's past medical history was remarkable for perforated appendicitis treated with an interval laparoscopic appendectomy 2 years before this presentation. Abdominal and pelvic computed tomography revealed a retroperitoneal mass with calcifications, suggestive of a retained appendicolith with abscess formation. This case illustrates the importance of considering very late complications of appendicitis in patients presenting with fever and abdominal or flank pain or masses.
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Servaes S, Victoria T, Lovrenski J, Epelman M. Contemporary Pediatric Gynecologic Imaging. Semin Ultrasound CT MR 2010; 31:116-40. [DOI: 10.1053/j.sult.2010.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
BACKGROUND/AIM To examine the relationship between acute appendicitis and the presence of an appendicolith in abdominal CT scans of patients attending emergency services. MATERIALS AND METHODS Abdominal CT scan reports were retrospectively reviewed for 267 patients through the PACS database. A 16-slices MDCT GE Light Speed scanner (Milwaukee WI) was used with a scanning protocol of 5 mm axial collimation and a pitch of 1.0, along with oral contrast material (Gastrografin 3.7% diatrizoate meglumine) and 140 mL of intravenous (IV) nonionic contrast material (Omnipaque). Particular attention was given to the study protocol, patients' age, and gender. STATISTICAL ANALYSIS We used MS-EXCEL and SPSS version 12.0 to perform chi-square and Fisher's exact tests. Bookends and Papers, components in Mac OS X software, were used for literature reviews and the organization of results. RESULTS Two hundred and sixty-seven abdominal CT scan reports were examined along side their respective images on a GE Centricity workstation. Thirty-four (12.7%) were labeled as acute appendicitis cases based on the CT findings and the rest were assigned other diagnoses. Twenty-six of the 267 CT scan reports were plain studies and 241 were contrast-enhanced scans. Less than half of the patients (123, 46.1%) were males and 144 (53.9%) were females. Thirteen males (48.1%) and 14 (51.9%) females were found to have an appendicolith. Only 3% in the <or= 11 years' age group, in contrast to 40% in the 11-20 years' age group, was diagnosed with appendicitis. The incidence in other age groups was as follows: 19% in the 21-30, 14% in the 31-40, 2.5% in the 41-50, 8% each in the 51-60 and 61-70, and none in the >or=71 years' age groups. CONCLUSIONS We conclude that the presence of an appendicolith i) has no particular predilection for gender or age, and ii) is not associated with a diagnosis of appendicitis.
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Affiliation(s)
- Ahmad Aljefri
- Department of Radiology, King Fahad Medical City, Saudi Arabia
| | - Nizar Al-Nakshabandi
- Department of Radiology, King Khalid University Hospital, King Saud University, Saudi Arabia,Address for correspondence: Dr. Nizar Al-Nakshabandi, Department of Radiology, King Khalid university Hospital, King Saud University, Saudi Arabia. E-mail:
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Niyogi A, Dalton J, Clarke S, Stafford M. Recurrent unilateral hydrosalpinx: a rare complication of acute perforated appendicitis. Arch Gynecol Obstet 2009; 280:835-8. [PMID: 19255767 DOI: 10.1007/s00404-009-1012-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Accepted: 02/12/2009] [Indexed: 01/07/2023]
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