Traumatic appendicitis: fact or fiction?

A case of post-traumatic acute appendicitis: uncommon consequence of blunt abdominal trauma

Acute appendicitis is known to be caused by intraluminal obstruction of the appendiceal lumen. Nonobstructive causes of acute appendicitis are rarely reported. Posttraumatic appendicitis is uncommon, and few cases have been reported in the literature. We present a case of acute appendicitis in a 21-year-old male confirmed via a computed tomography scan 5 days after a blunt abdominal injury. A laparoscopic appendectomy was performed, and the diagnosis of acute perforated appendicitis and peri appendicitis was confirmed histopathologically. The patient had an uneventful recovery following surgery.

Retrocecal Appendicitis Post-blunt Abdominal Trauma: A Case Report

Appendicitis, characterized by inflammation and obstruction of the appendiceal lumen, is a common surgical emergency often attributed to various factors. We present the case of an 18-year-old female who developed retrocecal appendicitis following blunt abdominal trauma, a rare occurrence with significant diagnostic challenges. Initial symptoms mimicked upper abdominal trauma, evolving to classic signs of appendicitis within hours. Despite a negative pre-trauma history of abdominal pain, clinical evaluation led to a suspicion of appendicitis. Contrast-enhanced CT scan confirmed the thickening of the cecal appendix, prompting urgent surgical intervention. An open appendectomy revealed a congested retrocecal appendix, supporting the diagnosis. Our case underscores the importance of considering trauma as a potential trigger for appendicitis, especially in the absence of typical pre-trauma symptoms. Diagnostic criteria for post-trauma appendicitis are evolving, and we underscore a comprehensive clinical assessment alongside imaging modalities. While surgical management remains standard, newer approaches like endoscopic retrograde appendicitis therapy warrant exploration. Further research is essential to refine diagnostic and therapeutic strategies for this uncommon presentation, ensuring timely intervention and improved patient outcomes.

Appendicitis Post Fall in the Pediatric Population: A Case Report

The appendix is a small, finger-sized tubular pouch that extends from your large intestine. Regardless, the physiology of the appendix is still unclear. There are several factors that cause appendicitis, such as infection, underlying tumor, constipation, and trauma. Symptoms of right lower quadrant abdominal pain, nausea, anorexia, and fever, as well as physical signs such as rebound tenderness and McBurney point/sign, are typical of non-traumatic acute appendicitis. On the other hand, a thorough history and physical examination are paramount for an accurate diagnosis of acute traumatic appendicitis. If the history and physical examination are inconclusive, further evaluation with ultrasonography or computed tomography (CT) is advised. Upon reaching an accurate diagnosis, the course of treatment involves an appendectomy and intravenous antibiotics. This case describes a patient who suffered blunt traumatic abdominal injury from a fall resulting in acute appendicitis. For pediatric patients who complain of abdominal pain and present to the emergency department (ED), appendicitis should be on the differential diagnosis list, even if the patient's symptoms started after blunt abdominal trauma. Due to the rarity of appendicitis after trauma, rapid identification necessitates a high index of suspicion.

Acute peritonitis secondary to post-traumatic appendicitis: A case report and literature review

BACKGROUND

Blunt abdominal trauma has rarely been reported as a cause of acute appendicitis in the literature. However, the coexistence of the two conditions can cause issues for the patient. We present here a systematic review of cases of traumatic appendicitis as well as our own experience with a 12-year-old male patient.

CASE SUMMARY

A 12-year-old male was admitted 3 d after abdominal trauma, experiencing peritoneal syndrome. A pelvic formation was discovered during abdominal ultrasound, and surgical exploration revealed a perforated appendix. A literature review was conducted applying the keywords "appendicitis," "abdominal," and "trauma" to the PubMed, Embase, and Medline databases. Our initial search included 529 papers published between 1991 and 2022, of which 33 papers were finally included. They revealed 51 reported cases. The trauma mechanisms included road traffic accidents, falls, assaults, ball accidents, a horse kick, and a colonoscopy. Eight patients underwent surgical exploration with no prior radiological investigation, and twenty-six patients underwent an initial radiological examination. All reports indicated a perforated appendix.

CONCLUSION

Acute traumatic appendicitis represents a diagnostic quandary that can be misdiagnosed resulting in significant morbidity and potential mortality. A high level of suspicion combined with radiological examination may aid in the diagnosis and treatment of this condition.

Is pneumoperitoneum specific of post-traumatic appendicitis? Case report and literature review

Introduction

Acute appendicitis and blunt abdominal trauma may co-exist, imposing a dilemma of whether there is only coincidence or there is a cause to effect relationship. The etiopathogenesis of this rare association remains obscure. Pneumoperitoneum has rarely been described in patients with acute perforative appendicitis following abdominal trauma.

Case presentation

We report a rare case of acute perforated appendicitis after blunt abdominal trauma in an 8-year-old boy revealed by a pneumoperitoneum. We also reviewed the literature on this rare condition to assess the specificity of pneumoperitoneum in the diagnosis and to understand its etiopathogenesis.

Conclusion

Abdominal pain and fever several days after an abdominal trauma may be a sign of post-traumatic appendicitis in the pediatric population. Pneumoperitoneum is not specific of post-traumatic appendicitis but it can be a protective sign, since it will lead to immediate laparotomy in patients with an unrecognized surgical abdomen.

Acute perforated appendicitis after blunt abdominal trauma: A report from a 7-year-old

Individually, trauma and appendicitis are some of the most common conditions in clinical practice, particularly in emergency medicine. In rare cases, trauma and appendicitis may co-exist, imposing a dilemma of whether these are only coincidence or appendicitis develops because of trauma. We report here a case of acute perforated appendicitis after a blunt abdominal trauma caused by a horse hoof kick to the abdomen in a 7-year-old boy. We also discussed the potential pathophysiologic mechanisms behind and reviewed the literature on this rare condition.

Appendicitis following blunt abdominal trauma

Appendicitis is a frequently encountered surgical problem in the Emergency Department (ED). Appendicitis typically results from obstruction of the appendiceal lumen, although trauma has been reported as an infrequent cause of acute appendicitis. Intestinal injury and hollow viscus injury following blunt abdominal trauma are well reported in the literature but traumatic appendicitis is much less common. The pathophysiology is uncertain but likely results from several mechanisms, either in isolation or combination. These include direct compression/crush injury, shearing injury, or from indirect obstruction of the appendiceal lumen by an ileocecal hematoma or traumatic impaction of stool into the appendix. Presentation typically mirrors that of non-traumatic appendicitis with nausea, anorexia, fever, and right lower quadrant abdominal tenderness and/or peritonitis. Evaluation for traumatic appendicitis requires a careful history and physical exam. Imaging with ultrasound or computed tomography is recommended if the history and physical do not reveal an acute surgical indication. Treatment includes intravenous antibiotics and surgical consultation for appendectomy. This case highlights a patient who developed acute appendicitis following blunt trauma to the abdomen sustained during a motor vehicle accident. Appendicitis must be considered as part of the differential diagnosis in any patient who presents to the ED with abdominal pain, including those whose pain begins after sustaining blunt trauma to the abdomen. Because appendicitis following trauma is uncommon, timely diagnosis requires a high index of suspicion.

Seat Belt Compression Appendicitis following Motor Vehicle Collision

Appendicitis and trauma both present in emergency department commonly but their presentation together in the same patient is unusual. We present a case of a middle-aged man brought by emergency medical services (EMS) to the emergency department with complaints of abdominal pain after he was involved in motor vehicle collision. He was perfectly fine before the accident. His primary survey was normal. Secondary survey revealed tenderness in right iliac fossa with seat belt mark overlying it. Computerized tomography (CT) of the abdomen and pelvis was performed which showed 8 mm thickening of appendix with minimal adjacent fat stranding. There is also subcutaneous fat stranding of anterior lower abdominal wall possibly due to bruising. Impression of posttraumatic seat belt compression appendicitis was made. Laparoscopic appendectomy was done and patient recovered uneventfully. Histopathology showed inflamed appendix, proving it to be a case of seat belt compression appendicitis.

Traumatic appendicitis: a case report and literature review

Appendicitis and trauma may exist together, which causes an interesting debate whether trauma has led to appendicitis. We report a case of appendicitis after an abdominal trauma. Our patient developed acute appendicitis following a stab wound in the right iliac fossa. Surgical exploration confirmed the traumatic origin of appendicitis, appendectomy was performed and our patient made an excellent recovery. In non operative management of abdominal trauma, physical examinations and radiological explorations should be repeated in order to diagnose traumatic appendicitis.

Traumatic appendicitis in minor blunt abdominal injury

Trauma has been reported as a cause of appendicitis on several cases in the literature. The present study reports the relationship between blunt abdominal trauma (BAT) of injury severity score less than 4 and appendicitis. A 17-year-old girl developed appendicitis after a minor BAT. An ecchymosis at the right lower quadrant misled the diagnosis, which was made 1 day later. Laparotomy revealed an inflamed appendix, a few enlarged mesenteric lymph nodes, contusion, as well as punctuated bleeding sites of the caecum. Moreover, based on a brief literature review, the different pathophysiological mechanisms and the difficulties of diagnosis of this entity are discussed. It is suggested that appendicitis should be considered as a possibility in the setting of right lower quadrant pain following minor BAT, when there is clinical suspicion of an inflammatory process within the right iliac fossa.

Systematic review of blunt abdominal trauma as a cause of acute appendicitis

INTRODUCTION

Acute appendicitis commonly presents as an acute abdomen. Cases of acute appendicitis caused by blunt abdominal trauma are rare. We present a systematic review of appendicitis following blunt abdominal trauma. The aim of this review was to collate and report the clinical presentations and experience of such cases.

SUBJECTS AND METHODS

A literature review was performed using PubMed, Embase and Medline and the keywords 'appendicitis', 'abdominal' and 'trauma'.

RESULTS

The initial search returned 381 papers, of which 17 articles were included. We found 28 cases of acute appendicitis secondary to blunt abdominal trauma reported in the literature between 1991 and 2009. Mechanisms of injury included road-traffic accidents, falls, assaults and accidents. Presenting symptoms invariably included abdominal pain, but also nausea, vomiting and anorexia. Only 12 patients had computed tomography scans and 10 patients had ultrasonography. All reported treatment was surgical and positive for appendicitis.

CONCLUSIONS

Although rare, the diagnosis of acute appendicitis must be considered following direct abdominal trauma especially if the patient complains of abdominal right lower quadrant pain, nausea and anorexia. Haemodynamically stable patients who present shortly after blunt abdominal trauma with right lower quadrant pain and tenderness should undergo urgent imaging with a plan to proceed to appendicectomy if the imaging suggested an inflammatory process within the right iliac fossa.

Posttraumatic appendicitis: further extending the extended Focused Assessment with Sonography in Trauma examination

Several cases of appendicitis after blunt abdominal trauma have been reported in the literature. A 41-year-old man on a cruise ship began to experience acute abdominal pain several hours after cliff diving from a 20-ft height and landing hard against the water on his right side. The patient's symptoms were treated and he remained on the ship until its scheduled arrival in port 2 days later. In the emergency department, a bedside extended Focused Assessment with Sonography in Trauma (eFAST) examination showed no evidence of free fluid in the abdominal cavity, pericardial effusion, or pneumothorax. Next, an ultrasound of the right lower quadrant was performed, which revealed a 1.06 cm, noncompressible appendix consistent with appendicitis. Although physical examination remains the gold standard for evaluation of the acute abdomen, the presentation of acute appendicitis is historically unreliable and delays in its diagnosis can result in significant increases in morbidity and mortality. Ultrasonography has been shown to have clear value in the evaluation of the acute abdomen. It is the authors' opinion that ultrasonography may have an unrealized potential as a diagnostic tool for traumatic appendicitis in the trauma bay and as a triage tool for the cruise ship physician who must evaluate a patient with traumatic abdominal pain and determine the need for medical evacuation.

Acute appendicitis after a blunt perineal trauma: an illustrative case

Acute appendicitis after abdominal trauma, although rare, has been described in the past. We herein report, for the first time, a case of acute appendicitis after a blunt trauma to the perineum in a boy. Clinicians taking care of children with injuries to the abdomen or perineal area should be aware of the possibility that they can develop posttraumatic acute appendicitis.

The effect of blunt abdominal trauma on appendix vermiformis

OBJECTIVES

Trauma and appendicitis are the most common conditions of childhood for which surgical consultation is sought in emergency departments. Occasionally, appendicitis and trauma exist together, which causes an interesting debate whether trauma has led to appendicitis. We aimed to evaluate our patients with traumatic appendicitis and to discuss their properties in the light of the literature.

METHODS

We retrospectively reviewed the charts of children of blunt abdominal trauma accompanied by appendicitis.

RESULTS

Of 29 cases of blunt abdominal trauma that had required surgical exploration, five were found to have gross findings of acute appendicitis and underwent appendicectomy. Appendicitis was confirmed histopathologically.

CONCLUSION

It should be kept in mind that children managed for severe blunt abdominal trauma may develop appendicitis. If clinical outlook suggests appendicitis in cases conservatively managed for blunt abdominal trauma, physical examinations, abdominal ultrasonography and/or abdominal computed tomography should be repeated for diagnosis of traumatic appendicitis. This approach will help to protect the patients against the complications of appendicitis that are likely to develop.

Training Room Management of Medical Conditions: Sports Gastroenterology

Gastrointestinal (GI) illnesses are common in athletes. Various causes include adverse physiologic adaptations of the gut during exercise; excess ingestion of carbohydrate drinks, alcohol, and anti-inflammatory medications; emotional stressors; exposure to pathogens in closed environments and during travel; trauma; and abdominal wall pressure overload. Unfortunately, evidence-based management of GI illnesses in athletes is limited because most studies have compared various GI illnesses between different sports, rather than comparing athletes to nonathletes. This article reviews the evidence that is available specifically relating to etiology, pathophysiology, clinical presentation, relevant differential diagnoses, acute management, and recommendations for specialist consultation of various GI illnesses in the training-room setting.