Acute Appendagitis Presenting with Features of Appendicitis: Value of Abdominal CT Evaluation

Two-incision laparoscopic appendectomy for a severe hemophilia A child patient with coagulation factor VII deficiency: Case report and review of literature

RATIONALE

The main complication of patients with severe hemophilia is recurrent bleeding events that usually affected musculoskeletal contractures. And replacement therapy methods were continuously improved to minimize adverse impacts brought by those complications. However, only several cases reported about the appendectomy for hemophilia A. We report a case of acute appendicitis treated by two-incision laparoscopy in a boy with hemophilia A and coagulation factor VII deficiency for the first time.

PATIENT CONCERNS

An 8y7m-old Chinese boy presented with half a day of right sided abdominal pain, fever, nausea, and vomiting.

DIAGNOSES

He received a computed tomography (CT) scan which revealed an enlarged appendix, thickened wall and appendiceal fecalith, and had received a conservative anti-bacterial treatment for his acute appendicitis but failed. He was diagnosed with hemophilia A and coagulation factor VII deficiency.

INTERVENTIONS

Two-incision laparoscopic appendectomy was made in success with a careful management of perioperative period. We monitored the clotting factor FVIII level and gave him a replacement therapy.

OUTCOMES

The patient had an uneventful recovery.

LESSONS

It is important to exclude intraabdominal or retroperitoneal hemorrhage in patients suffering from hemophilia and acute abdominal pain. Pre-operative evaluation of validity of the FVIII replacement therapy is another effective strategy to assess the safety and feasibility of applying an operation procedure. The two-incision laparoscopic appendectomy is an effective treatment for this kind of patients for its minimal trauma and fast recovery characteristics. Our report shows that laparoscopic appendectomy is feasible in a child suffering from hemophilia after adequate blood clotting factor replacement treatment.

A mysterious cause of a surgical abdomen

BACKGROUND

Epiploic appendagitis is a rare cause of acute-onset abdominal pain. The severity of pain at presentation and the infrequency with which it is encountered make it a diagnostic challenge.

OBJECTIVES

To present a case report exemplifying a diagnostic challenge posed by acute-onset abdominal pain that eventually led to the diagnosis of epiploic appendagitis.

CASE REPORT

A 50-year-old woman presented to the Emergency Department complaining of excruciating, sudden-onset lower abdominal pain. All routine laboratory investigations were within normal limits, as were an acute abdominal X-ray series. Computed tomography scan of the abdomen and pelvis with contrast showed a focal fatty infiltration in the left lower quadrant with fat-stranding towards the colon, representing the classical radiological presentation of epiploic appendagitis. The patient was admitted and successfully managed conservatively with intravenous fluids and ibuprofen. The patient made a full recovery and was discharged 3 days after admission.

CONCLUSIONS

Due to its benign, self-limited course, it is important to recognize this disease process to avoid unnecessary surgical and medical interventions. Epiploic appendagitis should be suspected in patients presenting with acute onset abdominal pain localized to the left lower quadrant or right lower quadrant with no associated systemic manifestations. Improvements in imaging technology have enabled confirmation of the diagnosis with non-invasive methods.