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Zheng C, Lin Y, Fang Y. Appendiceal torsion in premature infants: A case report. Asian J Surg 2024:S1015-9584(24)01347-2. [PMID: 39019754 DOI: 10.1016/j.asjsur.2024.06.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/28/2024] [Indexed: 07/19/2024] Open
Affiliation(s)
- Chao Zheng
- Department of Pediatric Surgery, Fujian Children's Hospital(Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics &Gynecology and Pediatrics, Fujian Medical University, China
| | - Yu Lin
- Department of Pediatric Surgery, Fujian Children's Hospital(Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics &Gynecology and Pediatrics, Fujian Medical University, China
| | - Yifan Fang
- Department of Pediatric Surgery, Fujian Children's Hospital(Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics &Gynecology and Pediatrics, Fujian Medical University, China.
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Chiarenza SF, Costa L, Bleve C. Torsion of cecal appendix. Report of the first Italian case and review of the literature. LA PEDIATRIA MEDICA E CHIRURGICA 2021; 43. [PMID: 33960760 DOI: 10.4081/pmc.2021.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022] Open
Abstract
In pediatric patients appendicitis is the most common cause of abdominal pain and surgery. Torsion of vermiform appendix is a rare cause, clinically indistinguishable from appendicitis with usually an intraoperative diagnosis. The first description of vermiform appendix torsion was made by Payne in 1918. Clinical presentation is similar to acute appendicitis. Preoperative investigations play a minimal role. Etiology of this condition is unclear, but is possible to distinguish a primary and a secondary torsion. We report a case of 5-years-old boy who presented with right lower quadrant abdominal pain. His clinical signs, symptoms and investigations mimicked an acute appendicitis. Intraoperatively we found a 720° appendix torsion on its base with its mesentery rotated in counter-clockwise direction. The appendix was gangrenous in appearance. A video-assisted trans-umbilical appendectomy was performed. We describe clinical presentation and management of this rare condition reviewing the literature.
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Affiliation(s)
- Salvatore Fabio Chiarenza
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza.
| | - Lorenzo Costa
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza.
| | - Cosimo Bleve
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza.
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Hakim M, Mostafa R, Al Shehri M, Sharawy S. Surgical management of subhepatic perforated appendicitis: a case report. J Med Case Rep 2020; 14:151. [PMID: 32917284 PMCID: PMC7488453 DOI: 10.1186/s13256-020-02499-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background Subhepatic appendicitis is an exceedingly rare presentation, accounting for 0.01% of acute appendicitis cases. It is of prime importance to be aware of variants and manage such challenging cases accordingly. Case presentation We present a case of a middle-aged Saudi woman with subhepatic perforated appendicitis and peritonitis who underwent an exploratory laparotomy and appendectomy. Conclusions The initial diagnosis and surgical management of such patients is challenging due to an atypical presentation. The surgical management of such patients is discussed with a brief review of the literature.
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Affiliation(s)
- Mumin Hakim
- Department of General Surgery, Saudi German Hospital, Al-Aseer, Kingdom of Saudi Arabia
| | - Rania Mostafa
- Department of General Surgery, Saudi German Hospital, Al-Aseer, Kingdom of Saudi Arabia
| | - Mohammed Al Shehri
- Department of General Surgery, Saudi German Hospital, Al-Aseer, Kingdom of Saudi Arabia
| | - Sherif Sharawy
- Department of General Surgery, Saudi German Hospital, Al-Aseer, Kingdom of Saudi Arabia.
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Endo K, Sato M, Saga K, Higashio A, Yuba Y, Morotomi Y. Torsion of vermiform appendix: case report and review of the literature. Surg Case Rep 2020; 6:6. [PMID: 31915956 PMCID: PMC6949350 DOI: 10.1186/s40792-020-0771-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/31/2019] [Indexed: 11/18/2022] Open
Abstract
Background Torsion of the vermiform appendix is a rare disease with symptoms very similar to those of acute appendicitis. We herein report a case of torsion of the vermiform appendix diagnosed by intraoperative findings. Case presentation A 4-year-old boy presented to our hospital because of abdominal pain and vomiting. Laboratory data revealed a C-reactive protein level of 0.08 mg/dL and white blood cell count of 19,300/μL (neutrophils, 88.9%). Abdominal ultrasound showed a target sign-like finding in the ileocecal region. A computed tomography scan showed swelling of the appendix. We performed an emergency operation under suspicion of acute appendicitis. Laparoscopic examination showed that the appendix had twisted 720° in the clockwise direction. Appendectomy was performed, and the postoperative course was uneventful. Conclusions Although torsion of the vermiform appendix is a very rare disease and difficult to differentiate from appendicitis, an inappropriate treatment plan could lead to necrosis and perforation of the appendix. It is important to consider this disease as a differential diagnosis in patients with right lower abdominal pain.
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Affiliation(s)
- Kosuke Endo
- Department of Pediatric Surgery, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan.
| | - Masahito Sato
- Department of Pediatric Surgery, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Kenichi Saga
- Department of Pediatric Surgery, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Atsushi Higashio
- Department of Pediatric Surgery, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Yoshiaki Yuba
- Department of Pathology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Yoshiki Morotomi
- Department of Pediatric Surgery, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
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5
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Chiapponi C, Jannasch O, Petersen M, Lessel W, Bruns C, Meyer F. A rare case of perforated "sub-hepatic appendicitis" - a challenging differential diagnosis of acute abdomen based on the combination of appendicitis and maldescent of the caecum. Pathol Res Pract 2016; 213:75-78. [PMID: 27908462 DOI: 10.1016/j.prp.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 03/02/2015] [Accepted: 11/09/2016] [Indexed: 11/26/2022]
Abstract
Unusual locations of the appendix vermiformis can result in delay in appropriate diagnosis and treatment of appendicitis. So an inflamed appendix in a sub-hepatic caecum caused by caecal maldescent for example can mimic cholecystitis, the pain being localized in the right upper quadrant. Here, we present a case of perforated sub-hepatic appendicitis with peritonitis, requiring open ileocaecal resection. Review of the existing literature has demonstrated that this pathology is uncommon, yet not so rare as one might presume. In conclusion, surgeons should be aware of this possibility in the diagnostic and therapeutic management of acute abdomen.
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Affiliation(s)
- Costanza Chiapponi
- Dept. of General, Abdominal and Vascular Surgery, University Hospital of Magdeburg, Germany.
| | - Olof Jannasch
- Dept. of General, Abdominal and Vascular Surgery, University Hospital of Magdeburg, Germany
| | - Manuela Petersen
- Dept. of General, Abdominal and Vascular Surgery, University Hospital of Magdeburg, Germany
| | - Wiebke Lessel
- Institute of Pathology, University Hospital, Magdeburg, Germany
| | - Christiane Bruns
- Dept. of General, Abdominal and Vascular Surgery, University Hospital of Magdeburg, Germany
| | - Frank Meyer
- Dept. of General, Abdominal and Vascular Surgery, University Hospital of Magdeburg, Germany
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Abstract
A middle-aged woman was admitted with recurrent episodes of ill-defined right-sided abdominal pain, more prominent in the right upper quadrant. Surgical history revealed a laparoscopic cholecystectomy, 1 month prior, for gallstones that were thought to be the cause of her symptoms. However, she continued to experience similar pain with exacerbation leading to readmission. Blood tests revealed increased inflammatory markers and an ultrasound scan showed a tubular hypoechoic structure between her right kidney and liver corresponding to the area of maximal tenderness. A diagnostic laparoscopy was performed and a subhepatic inflammatory mass of appendicular origin was found. This required mobilisation of the right colon and appendicectomy. The patient made an uneventful recovery after being readmitted for an ileus treated conservatively. Histology revealed acute appendicitis with mucosal ulceration.
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Affiliation(s)
- William Robert Ball
- Department of Surgery, University Hospital North Staffordshire, Stoke-on-Trent, UK.
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Kilincaslan H, Gedik AH, Bilici M, Cakir S. Rare case of an abdominal mass presenting as acute abdomen: torsion of the vermiform appendix. Pediatr Int 2013; 55:e14-6. [PMID: 23679175 DOI: 10.1111/j.1442-200x.2012.03746.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 06/16/2012] [Accepted: 07/25/2012] [Indexed: 11/29/2022]
Abstract
Torsion of the vermiform appendix is a rarely observed acute abdominal emergency. The clinical manifestations are similar to acute appendicitis. It should be included in the differential diagnosis if a patient presents with intermittent abdominal pain and an acute abdominal emergency. Here, we describe a 4-year-old male patient with a mass located in the right lower abdominal quadrant, whose clinical findings were consistent with an acute abdomen. The gangrenous appendix was found in the pelvic cavity and its stump was twisted clockwise. A 1.5-cm fecalith was detected in the appendix lumen and appendectomy was performed.
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Affiliation(s)
- Huseyin Kilincaslan
- Department of Pediatric Surgery, Bezmialem Vakif University, Istanbul, Turkey
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Dimitriadis PA, Makar RR, Randall JK, Ramus J. Appendiceal torsion associated with undescended caecum: a case report and review of the literature. BMJ Case Rep 2012; 2012:bcr-2012-006932. [PMID: 23010467 DOI: 10.1136/bcr-2012-006932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Torsion of the vermiform appendix is a rare disorder that causes symptoms similar to those of acute appendicitis. Primary and secondary causes of appendiceal torsion have been reported in the literature. Laparoscopy appears to be the most appropriate modality for diagnosis and treatment where the condition is suspected. To our knowledge this is the first case of appendiceal torsion in an adult causing right upper quadrant pain related to caecal malposition.
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