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Badawy I, Mbaya K, Metwally H. Acute Appendicitis Presenting As Left Flank Pain: A Case Report. Cureus 2024; 16:e62181. [PMID: 38993448 PMCID: PMC11239144 DOI: 10.7759/cureus.62181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/13/2024] Open
Abstract
Acute appendicitis (AA) is a common surgical emergency. The diagnosis is mainly clinical and is largely based on the typical presentation of periumbilical pain radiating to the right iliac fossa. However, atypical presentations have been reported in the literature. Left-sided appendicitis is a rare presentation. Imaging with ultrasonography (US) and computed tomography (CT) is of paramount importance in such cases to aid diagnosis and exclude other causes. We report a case of a 21-year-old man who presented with acute left flank pain. He was diagnosed with AA by CT, which showed an appendix diameter of 13 mm.
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Affiliation(s)
- Ibrahim Badawy
- Urgent Care Department, Mediclinic Hospital, Al Ain, ARE
| | - Khaled Mbaya
- Urgent Care Department, Mediclinic Hospital, Al Ain, ARE
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Khatoon MA, Naeem S, Akmal U, Farid A, Ahmed Khan S. Retrocecal Ascending Appendix Attached to the Hepatic Flexure and Right Intra-abdominal Testis Identified During Open Appendicectomy: A Case Report. Cureus 2024; 16:e57484. [PMID: 38577167 PMCID: PMC10993090 DOI: 10.7759/cureus.57484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/06/2024] Open
Abstract
Appendicectomy, or the removal of the appendix, is an emergency procedure following symptomatic acute appendicitis. Diagnosis is made on clinical examination but can be confirmed on imaging if other abnormalities are suspected. A few variants of appendix anatomical position exist that can be difficult to manage. In addition, secondary findings during surgery can come unexpectedly. We report a case of a 14-year-old male, who presented to the emergency department at our government institution with abdominal pain and vomiting. Examination revealed an empty right scrotum, which was unnoticed by the patient and never examined previously due to residence in an area of limited healthcare access. Ultrasound done elsewhere was inconclusive. The surgical intervention showed a retrocecal appendix attached to an ascending colon terminating at hepatic flexure. The procedure was further complicated by the presence of the right intra-abdominal testis located below the cecum. Excised samples were sent for histopathology, and the patient was followed with biopsy reports. This case highlights the challenges encountered during routine appendicectomy with unusual findings.
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Affiliation(s)
- Malik Amna Khatoon
- Orthopaedic Surgery, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK
- General Surgery, Sindh Government Qatar Hospital, Karachi, PAK
| | - Sarosh Naeem
- General Surgery, Sindh Government Qatar Hospital, Karachi, PAK
| | - Urooj Akmal
- General Surgery, Sindh Government Qatar Hospital, Karachi, PAK
| | - Ahsan Farid
- General Surgery, Sindh Government Qatar Hospital, Karachi, PAK
| | - Salman Ahmed Khan
- Internal Medicine, Dow International Medical College, Karachi, PAK
- General Surgery, Sindh Government Qatar Hospital, Karachi, PAK
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Mozafari K, Kang T. A Case Report of Perforated Appendix Vermiform Attached to the Left Ovary. Cureus 2023; 15:e51270. [PMID: 38283434 PMCID: PMC10822120 DOI: 10.7759/cureus.51270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Acute appendicitis, a typical abdominal emergency, presents in nonperforated and perforated forms. While nonperforated cases often respond well to antibiotics or appendectomy, perforated cases pose more significant challenges. We report a unique case of appendicitis in a 34-year-old female with an unusual anatomical adherence to the left ovary. The patient successfully underwent laparoscopic surgery, during which precise incisions were made to accommodate the unique location of the appendix. This tailored approach contributed to a positive surgical outcome. This case underscores the importance of tailored surgical approaches in managing complex appendiceal variations.
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Affiliation(s)
- Kaveh Mozafari
- Surgery, West Suburban Medical Center, Oak Park, USA
- Medicine, St. George's University School of Medicine, St. George, GRD
| | - Thomos Kang
- General Surgery, Ascension Saint Agnes Hospital, Baltimore, USA
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Muncy BC, Desimone R, Seifarth FG. Retro-psoas appendicitis. BMJ Case Rep 2023; 16:e253128. [PMID: 37730427 PMCID: PMC10514624 DOI: 10.1136/bcr-2022-253128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
The vermiform appendix (VA) is known to exhibit a wide range of anatomic variability, with clinical presentation correlating with certain known anatomic positioning. To the best of our knowledge, we describe the second known case of a retro-psoas muscle VA variant and the first known case of appendicitis in such a location. Retroperitoneal access was obtained, and the appendix was freed from the intermuscular recess between the psoas and iliacus. The peritoneal defect was primarily repaired, and the patient was discharged on postoperative day 1 in good condition.
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Affiliation(s)
- Bradley C Muncy
- Division of Pediatric Surgery, WVU Medicine Children's Hospital, Morgantown, West Virginia, USA
| | - Rachel Desimone
- Division of Pediatric Surgery, Logan Health, Kalispell, Montana, USA
| | - Federico G Seifarth
- Division of Pediatric Surgery, WVU Medicine Children's Hospital, Morgantown, West Virginia, USA
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Singh N, Agrawal P, Singh DK, Agrawal GR. Computed tomography evaluation of variations in positions and measurements of appendix in patients with non-appendicular symptoms: time to revise the diagnostic criteria for appendicitis. Pol J Radiol 2023; 88:e407-e414. [PMID: 37808175 PMCID: PMC10551737 DOI: 10.5114/pjr.2023.131074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/30/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose To estimate the frequency distribution of different anatomical positions, and to measure the diameter, wall thickness, and length of appendix in patients with non-appendicular symptoms. Material and methods This retrospective observational study was conducted among 1,575 patients, who had undergone computed tomography (CT) scan of abdomen for various non-appendicular signs and symptoms. Frequency of distribution of different anatomic locations and measurements of various morphologic parameters were recorded. Results The most common location of appendix was retrocecal, followed by sub-cecal, post-ileal, and pelvic locations. The mean length of appendix was 66.7 mm (range, 6.3-123 mm), and the diameter was 6.3 mm (range, 2.8-11.3 mm). Diameter of > 6 mm was noted in 48.12% patients. The mean wall thickness was 2.37 mm, ranging 1.2-4.2 mm. The most common intra-luminal content was air-mixed with hypodense or hyperdense material observed in 70.5% of cases. Conclusions Although an appendix with diameter less than 6 mm may be considered normal, a diameter above 6 mm has an overlap between a normal and inflamed appendix. Therefore, it should be considered in association with clinical and secondary findings to avoid overdiagnosis and unnecessary appendicectomies. We strongly recommend that diameter-based CT criteria to diagnose appendicitis should be revised and standardized.
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Affiliation(s)
- Neha Singh
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Prasant Agrawal
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
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Trifina-Mikosch E, Barta J, Krampla W, Freibauer C, Lösch G, Kashofer K, Selkmann S, Mikosch P, Imhof M. Großer zystischer Abdominaltumor bedingt durch eine niedrig maligne Neoplasie der Appendix. Geburtshilfe Frauenheilkd 2023. [DOI: 10.1055/a-1976-7797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
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Ujjal S, Kroijer R. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac029. [PMID: 35198142 PMCID: PMC8856766 DOI: 10.1093/jscr/rjac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/16/2022] [Indexed: 11/30/2022] Open
Abstract
Acute appendicitis (AA) is the most common cause of acute abdomen worldwide and untreated it can lead to abscess formation, purulent or faeculent peritonitis, sepsis and death. This paper presents a rare case of an AA herniated in a retro-psoas muscle defect, which has not previously been reported in the literature. Our patient’s diagnosis and management was delayed due to the unusual presentation. This case emphasizes the importance to utilize AA scoring algorithms to aid decision-making as they have shown to reduce admissions, optimize the use of diagnostic imaging and reduce negative surgical explorations.
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Affiliation(s)
- Suresh Ujjal
- Department of General Surgery, Hospital of Southwest Jutland, Esbjerg 6700, Denmark
- Correspondence address. Mave- og Tarmkirurgisk Afdeling, Sydvestjysk Sygehus, Finsensgade 35, 6700 Esbjerg, Danmark. Tel: +45-79182000; E-mail:
| | - Rasmus Kroijer
- Department of General Surgery, Hospital of Southwest Jutland, Esbjerg 6700, Denmark
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Lee HJ, Woo JY, Byun J. Right hydronephrosis as a sign of complicated appendicitis. Eur J Radiol 2020; 131:109241. [PMID: 32916410 DOI: 10.1016/j.ejrad.2020.109241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/09/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Acute appendicitis is known for one of the most common cause of acute abdomen. However, it is still challenging to clearly distinguish complicated from uncomplicated appendicitis preoperatively. We investigated the association between right hydronephrosis and complicated appendicitis compared with other computed tomography (CT) findings of acute appendicitis. MATERIALS AND METHODS 1275 patients who pathologically diagnosed with acute appendicitis were included. They were classified into the complicated appendicitis and uncomplicated appendicitis groups based on their histopathological results. We reviewed their CT findings, including right hydronephrosis, appendiceal wall defect, periappendiceal abscess, extraluminal or intraluminal free air, appendicolith, appendiceal dilatation, appendiceal wall thickening, periappendiceal infiltration, periappendiceal fluid collection, and ascites. Comparison between the two groups was performed and the diagnostic performance of each CT finding was evaluated. The location of appendix and periureteral extension of periappendiceal infiltration were evaluated in patients with right hydronephrosis. RESULTS Out of 1275 patients, 29 (2.3 %) patients showed right hydronephrosis. Right hydronephrosis was significantly related to complicated appendicitis with the odds ratio of 4.90 (95 % confidence interval, 1.62-14.83; P = 0.005). Right hydronephrosis yielded specificity of 99.3 %. All patients with right hydronephrosis accompanied with periappendiceal infiltration and 28 (96.6 %) patients showed periureteral extension. Subcecal and pelvic areas are the most common locations, with 11 (37.9 %) patients each. CONCLUSION The presence of right hydronephrosis was specific finding for complicated appendicitis and it could be considered as one of indirect sign of complicated appendicitis.
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Affiliation(s)
- Hyung Ju Lee
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ji Young Woo
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
| | - Jieun Byun
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
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Ultrasound diagnosis of acute appendicitis complicating De Garengeot's hernia. J Ultrasound 2020; 24:205-209. [PMID: 32356219 DOI: 10.1007/s40477-020-00466-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 12/16/2022] Open
Abstract
De Garengeot's hernia is a rare condition defined by the herniation of the vermiform appendix within a femoral hernia sac. We report a case of an 80-year-old woman admitted to our emergency department complaining of pain in the right groin. This symptomatology, present for 2 days, increased in the following 12 h. Ultrasonography (US) and contrast-enhanced computed tomography (CECT) were performed, which showed the herniation of the vermiform appendix in the femoral hernia sac. Doppler ultrasonography (DUS) and CECT were the fundamental imaging investigations for this diagnosis. The management of De Garengeot's hernia is surgical through herniorrhaphy, which makes it possible to repair the femoral hernia and perform an appendicectomy in case of appendicitis.
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Rousan LA, Jibril MI. Retro-psoas muscle vermiform appendix: an unusual location. Surg Radiol Anat 2020; 42:1259-1261. [PMID: 32342137 DOI: 10.1007/s00276-020-02477-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Abstract
The vermiform appendix is considered the most mobile organ in the human body. Due to its various positions in the abdomen and pelvis, it may result in confusion in diagnosis to the surgeons when it becomes inflamed. Atypical locations of the appendix have been reported previously in the literature. We report an unusual location of the vermiform appendix in the right retro-psoas muscle space that was incidentally discovered in a male patient who was involved in a road traffic accident.
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Affiliation(s)
- Liqa A Rousan
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Jordan University of Science and Technology, PO box 3030, Irbid, 22110, Jordan.
| | - Mohammad I Jibril
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Jordan University of Science and Technology, PO box 3030, Irbid, 22110, Jordan
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