Testicular torsion in a patient with Ehlers-Danlos syndrome

Appendiceal torsion in Ehlers-Danlos syndrome: A case report of a rare phenomenon in a rare disease

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Appendiceal torsion, a rare phenomenon, may be seen in Ehlers-Danlos syndrome.

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Appendiceal torsion is clinically indistinguishable from acute appendicitis.

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Ehlers-Danlos syndrome contributes to surgical problems due to fragility of tissue.

Introduction

Appendiceal torsion is a rare phenomenon with only a few reported cases and never in a patient with Ehlers-Danlos syndrome (EDS). We present the first case of appendiceal torsion leading to acute appendicitis in a patient with EDS.

Presentation of case

A 36-year-old male with history of musculoskeletal EDS presented with one week of abdominal pain localizing to the right lower quadrant. He was evaluated in the emergency department with a complete set of labs and CT abdomen/pelvis. The CT scan showed acute appendicitis, but did not mention any appendiceal torsion. He was taken to the operating room for a standard laparoscopic appendectomy. Intraoperatively, there was inflammation at the tip of the appendix with a 270-degree torsion of the mid-appendix and mesoappendix. After untwisting, the appendix was safely removed from the base of the cecum. Patient recovered well postoperatively and no masses or tumors were identified on final pathology.

Discussion

Primary appendiceal torsion occurs without an identifiable cause and secondary torsion occurs due to pathology such as carcinoid tumor or other masses. Patients with EDS may be more prone to either torsion as they have hyperelastic skin, joints and ligaments. EDS patients require special workup prior to any operation including cardiopulmonary evaluation and may have unique postoperative complications.

Conclusion

The ligamentous hypermobility of EDS may have predisposed our patient to appendiceal torsion and acute appendicitis. This is a rare phenomenon and may be underdiagnosed in EDS patients. Practitioners should be aware of this manifestation of EDS.

Urogenital and pelvic complications in the Ehlers-Danlos syndromes and associated hypermobility spectrum disorders: A scoping review

The Ehlers-Danlos syndromes (EDS) and associated hypermobility spectrum disorders (HSD) are a heterogenous group of connective tissue disorders associated with significant morbidity. The urogenital aspects of these disorders are understudied and there is little guidance on the prevalence, types, or outcomes of urogenital complications in EDS/HSD. Our objective was to perform a scoping review to characterize and synthesize the literature reporting urogenital and pelvic complications in EDS/HSD patients. We performed a systematic search of three databases (Medline, CINAHL, Embase) to January 2019. English language, full-text articles reporting on urogenital or pelvic complications in EDS/HSD were included. A total of 105 studies were included (62 case reports/series, 43 observational) involving patients with hypermobile (23%), vascular (20%), classical (12%) EDS, and HSD (24%). Some studies looked at multiple subtypes (11%) or did not report subtype (33%). Reported complications included urinary (41%), gynecological (36%), obstetrical (25%), renal (9%), and men's health problems (7%), with some studies reporting on multiple areas. Urinary and gynecological complications were most prevalent in patients with HSD, while a broad range of complications were reported in EDS. While further research is required, results suggest a higher index of suspicion for urogenital problems is probably warranted in this population.