A case of Hickam's dictum: concurrent appendicitis and ectopic pregnancy

Appendiceal Endometriosis and Ectopic Pregnancy Occurring Simultaneously

BACKGROUND

In the setting of a known ectopic pregnancy, severe abdominal pain with clinical concern for rupture is an indication for emergency surgery. In rare cases, appendiceal pathology may occur simultaneously.

CASE

A woman with a known ectopic pregnancy presented to the emergency department with a clinical picture consistent with its rupture. At the time of surgery, an appendectomy also was performed owing to concern for concurrent appendicitis; histopathologic examination revealed appendiceal endometriosis.

CONCLUSION

During surgical management of ectopic pregnancy, it is important to undertake a thorough examination of the pelvis, because patients may present with multiple concurrent pathologies. In the setting of an emergency operation, when the diagnosis seems clear, this survey should not be forgotten.

Abdominal Pain in the Female Patient: A Case of Concurrent Acute Appendicitis and Ruptured Endometrioma

General surgeons are often asked to evaluate acute abdominal pain which has an expanded differential diagnosis in women of childbearing age. Acute appendicitis accounts for many surgical emergencies as a common cause of nongynecologic pelvic pain. In some rare instances, acute appendicitis has been shown to occur simultaneously with a variety of gynecologic diseases. We report a case of concurrent acute appendicitis and ruptured ovarian endometrioma.

Differential Diagnosis: Correctly Putting the Pieces of the Puzzle Together

Each day, we generate hypotheses about our environment—our perceptions of people, our expectations of events, and our interpretation of images. These hypotheses provide a framework by which we interpret our experiences. The same is true for differential diagnosis by which health care practitioners develop hypotheses or diagnoses from a set of cues provided during an encounter with a patient. For clinicians to be successful at differential diagnosis, they must use a multidimensional and complex process involving nonanalytic and analytic cognitive processes and metacognition—thinking about thinking. Our conclusions, however, can lead to errors in diagnosis. Many of these errors are due to errors in cognition. The purpose of this article is to discuss this complex process, identify common errors in cognition, and offer strategies to prevent these common errors in differential diagnosis.