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Sample records for pain mimicking appendicitis

  1. Abdominal Mondor disease mimicking acute appendicitis

    PubMed Central

    Schuppisser, Myriam; Khallouf, Joe; Abbassi, Ziad; Erne, Michel; Vettorel, Denise; Paroz, Alexandre; Naiken, Surennaidoo P.

    2016-01-01

    Introduction Mondor disease (MD), a superficial thrombophlebitis of the thoraco-epigastric veins and their confluents is rarely reported in the literature. The superior epigastric vein is the most affected vessel but involvement of the inferior epigastric vessels or their branches have also been described. There is no universal consensus on treatment in the literature but most authors suggest symptomatic treatment with non-steroid anti-inflammatory drugs (NSAIDs). Case report We report the case of a marathon runner who presented with right iliac fossa pain mimicking the clinical symptomatology of an acute appendicitis. The history and the calculated Alvarado score were not in favor of an acute appendicitis. This situation motivated multiple investigations and we finally arrived at the diagnosis of MD. Discussion Acute appendicitis (AA) is the most common cause of surgical emergencies and one of the most frequent indications for an urgent abdominal surgical procedure around the world. In some cases, right lower quadrant pain remains unclear in spite of US, CT scan, and exclusion of urological and gynecological causes, thus we need to think of some rare pathologies like MD. Conclusion MD is often mentioned in the differential diagnosis of breast pathologies but rarely in abdominal pain assessment. It should be mentioned in the differential diagnosis of the right lower quadrant pain when the clinical presentation is unclear and when acute appendicitis has been excluded. Awareness of MD can avoid misdiagnosis and decrease extra costs by sparing unnecessary imaging. PMID:26803533

  2. Infectious ileocecitis--appendicitis mimicking syndrome.

    PubMed

    Zganjer, M; Roic, G; Cizmic, A; Pajic, A

    2005-01-01

    The purpose of our study is to emphasize the central role of ultrasound (US) in finding the cause of abdominal pain in children. Ultrasound of the lower abdomen quadrant should be considered in all cases in which the clinical signs and symptoms are not diagnostic of appendicitis. There is a wide range of clinical syndromes and diseases which can easily be diagnosed using a high resolution ultrasound with adjunct of color and power Doppler. The spectrum of abnormalities includes appendicitis, mesenteric lymphadenitis, infectious ileocecitis, Crohn's disease, intussusception, ovarian cysts, and encysted cerebrospinal fluid. One of the most common causes of acute abdominal pain in children is acute terminal ileitis (infectious ileocecitis) with mesenteric lymphadenitis. Ultrasound is the best tool to rapidly differentiate this disease from acute appendicitis, and prevent unnecessary laparotomy (Ref. 12). PMID:16201735

  3. Uncommon Caecum Diverticulitis Mimicking Acute Appendicitis

    PubMed Central

    Yilmaz, Özkan; Kiziltan, Remzi; Bayrak, Vedat; Çelik, Sebahattin; Çalli, Iskan

    2016-01-01

    Diverticulum of the cecum is a rarely seen reason of acute abdomen and it is difficult to be distinguished from appendicitis. The diagnosis is generally made during operation. We have presented this case in order to remember that it is a disease which should be kept in mind in cases of right lower quadrant pain. PMID:27006852

  4. Xanthogranulomatous Appendicitis Mimicking Residual Burkitt's Lymphoma After Chemotherapy

    PubMed Central

    Nam, Soomin; Choi, Sung-Eun; Kim, Yu Ri; Baik, Seung Hyuk; Sohn, Seung-Kook

    2016-01-01

    The case of a 23-year-old female treated with aggressive high-dose therapy for Burkitt's lymphoma is reported. A positron emission tomography and computed tomography scan after completion of chemotherapy revealed a residual hypermetabolic lesion in the right pelvic cavity. A pelvic magnetic resonance imaging scan showed circumferential wall thickening at the tip of the appendix. A laparoscopic exploration and appendectomy were performed, and a pathologic examination of the resected appendix revealed xanthogranulomatous appendicitis. This is a rare case of a xanthogranulomatous appendicitis mimicking remnant Burkitt's lymphoma after completion of chemotherapy. PMID:27218100

  5. Xanthogranulomatous Appendicitis Mimicking Residual Burkitt's Lymphoma After Chemotherapy.

    PubMed

    Nam, Soomin; Kang, Jeonghyun; Choi, Sung-Eun; Kim, Yu Ri; Baik, Seung Hyuk; Sohn, Seung-Kook

    2016-04-01

    The case of a 23-year-old female treated with aggressive high-dose therapy for Burkitt's lymphoma is reported. A positron emission tomography and computed tomography scan after completion of chemotherapy revealed a residual hypermetabolic lesion in the right pelvic cavity. A pelvic magnetic resonance imaging scan showed circumferential wall thickening at the tip of the appendix. A laparoscopic exploration and appendectomy were performed, and a pathologic examination of the resected appendix revealed xanthogranulomatous appendicitis. This is a rare case of a xanthogranulomatous appendicitis mimicking remnant Burkitt's lymphoma after completion of chemotherapy. PMID:27218100

  6. Solitary caecum diverticulitis mimicking acute appendicitis.

    PubMed

    Hot, Semih; Eğin, Seracettin; Gökçek, Berk; Yeşiltaş, Metin; Alemdar, Ali; Akan, Arzu; Karahan, Servet Rüştü

    2015-12-01

    Solitary cecum diverticulum is a benign formation, but it can be complicated with inflammation, perforation and bleeding. Cecum diverticulitis (CD) is the most common complication of caecal diverticulum and it has the highest incidence among Asians, but it is a rare condition in the western world. The incidence of colonic diverticular disease can vary according to national origin, cultural structure and nutritional habits. CD is not common in our country, but it is an important situation because of its clinical similarity with the commonly seen acute right side abdominal diseases like acute appendicitis. Preoperative diagnosis is difficult, and hence, the actual frequency is not known. The treatment of CD can vary from medical therapy to right hemi colectomy. In this study, we presented ten CD cases on whom surgical resection was performed in our surgery unit during the last 8 years. Our purpose was to increase the awareness of surgeons about this situation, and so, make them pay attention for not having their first experience in the operating room. PMID:27054646

  7. Primary choriocarcinoma of appendix mimicking acute appendicitis.

    PubMed

    Khan, Enam Murshed; Chakrabarti, Amrita; Dwary, Amit Dutt

    2015-01-01

    Choriocarcinoma is a malignant trophoblastic cancer, the incidence of primary choriocarcinoma (PCC) of the gastrointestinal tract (GIT) being extremely rare, with only 14 cases being reported in worldwide literature. Here we present an extremely rare case of PCCof the appendix in a 32-year-old male who presented with acute pain abdomen. Histopathological examination revealed PCC of the appendix. Examination of the testis was unremarkable. Further investigations revealed a very high serum beta-human chorionic gonadotropin (b-HCG) titer with a normal carcinoembryonic antigen (CEA). Radiological imaging showed multiple areas of liver metastasis. Chemotherapy-based treatment with bleomycin, etoposide, and cisplatin (BEP) regime was advised, however the patient failed to follow-up for further management. PMID:26881617

  8. Appendicitis

    MedlinePlus

    ... can be hard to diagnose appendicitis in young children, the elderly, and women of childbearing age. The first symptom is often pain around the belly button. Pain may be minor at first, but becomes more sharp and severe. ...

  9. Acute chylous ascites mimicking acute appendicitis in a patient with pancreatitis

    PubMed Central

    Smith, Emily K; Ek, Edmund; Croagh, Daniel; Spain, Lavinia A; Farrell, Stephen

    2009-01-01

    We report a case of acute chylous peritonitis mimicking acute appendicitis in a man with acute on chronic pancreatitis. Pancreatitis, both acute and chronic, causing the development of acute chylous ascites and peritonitis has rarely been reported in the English literature. This is the fourth published case of acute chylous ascites mimicking acute appendicitis in the literature. PMID:19824123

  10. Pill impaction mimicking appendicitis in an HIV-positive patient.

    PubMed

    Torno, Mauro; Shallman, Michael

    2009-01-01

    Abdominal pain is a frequent presenting symptom among HIV-positive patients seeking care at emergency departments. We report a case of a 45-year-old HIV-infected Hispanic man who presented with right lower quadrant pain accompanied by fever, decreased appetite, nausea, and vomiting. The results of a CT scan of his abdomen were normal with no evidence of appendicitis. A colonoscopy was performed and revealed an impacted pill in the appendiceal orifice. The pill was removed endoscopically, and pill impaction has not recurred. PMID:19209455

  11. Appendicitis

    MedlinePlus

    ... How Can I Help a Friend Who Cuts? Appendicitis KidsHealth > For Teens > Appendicitis Print A A A ... out, had appendicitis and needed surgery. What Is Appendicitis? Appendicitis is an inflammation of the appendix. The ...

  12. Two Cases of Omental Torsion Mimicking Acute Appendicitis

    PubMed Central

    Liaqat, Naeem; Dar, Sajid Hameed; Sandhu, Asif Iqbal; Nayyer, Sajid

    2014-01-01

    Acute appendicitis is often simulated by other entities like mesenteric adenitis, worm infestation, Meckel’s diverticulitis, urinary tract infection and rarely omental torsion. We report two cases, a 6 year old boy and an 11 year old girl, who presented with symptoms and signs of acute appendicitis but upon exploration turned out to be omental torsion. PMID:24834389

  13. Torsion of omental fibrous pseudotumour mimicking acute appendicitis

    PubMed Central

    Pennington, Thomas E.; Ozmen, John; Fenton-Lee, Douglas

    2016-01-01

    Unusual pathologies are occasionally found at laparoscopy when appendicitis is suspected. We present a case of strangulated inflammatory fibrous pseudotumour of the omentum presenting in a similar fashion to appendicitis. The infarcted omentum was excised, facilitating prompt resolution of symptoms. PMID:26811304

  14. Non-seminomatous testicular metastasis mimicking acute appendicitis.

    PubMed

    Beddy, P; Neary, P; Crotty, P; Keane, F B V

    2006-06-01

    This is the first report in the literature of a non-seminomatous metastasis from an occult testicular primary that presented as an acute appendicitis. The report highlights the necessity of testicular re-imaging in cases of occult malignancy and reviews the association of chromosome 12 with embryonal germ cell tumours. PMID:16764204

  15. Appendicitis

    MedlinePlus

    ... function. A blockage inside of the appendix causes appendicitis. The blockage leads to increased pressure, problems with ... to pass gas Low fever Not everyone with appendicitis has all these symptoms. Appendicitis is a medical ...

  16. Appendicitis

    MedlinePlus

    Appendicitis is swelling (inflammation) of the appendix. The appendix is a small pouch attached to the large ... Appendicitis is a very common cause of emergency surgery. The problem most often occurs when the appendix ...

  17. Appendicitis

    MedlinePlus

    ... removed? What Is Appendicitis? Your appendix (say: uh-PEN-dix) is a small, finger-shaped pouch connected ... or swells up, it's called appendicitis (say: uh-pen-di-SYE-tis). Both kids and adults can ...

  18. Primary signet ring cell carcinoma of the appendix mimicking acute appendicitis

    PubMed Central

    Fusari, Mario; Sorrentino, Nicoletta; Bottazzi, Enrico Coppola; Del Vecchio, Walter; Cozzolino, Immacolata; Maurea, Simone; Salvatore, Marco; Imbriaco, Massimo

    2012-01-01

    Primary signet ring cell carcinoma of the appendix is a very rare neoplasm that usually presents with signs and symptoms of acute appendicitis and in particular with a right lower abdominal pain. Preoperative imaging detection of appendiceal adenocarcinoma has an important value because it may result in an appropriate surgical procedure. We report a rare case of primary signet ring cell carcinoma of the vermiform appendix in an 80-year-old man who was misdiagnosed on computed tomography (CT) scan as acute appendicitis. PMID:23986852

  19. CT Findings of Foreign Body Reaction to a Retained Endoloop Ligature Plastic Tube Mimicking Acute Appendicitis: A Case Report.

    PubMed

    Ahn, Jae Hong; Kang, Chae Hoon; Choi, Soo-Jung; Park, Man Soo; Jung, Seung Mun; Ryu, Dae Shick; Shin, Dong Rock

    2016-01-01

    Many hospitals experience one or more retained surgical instrument events with risk of patient morbidity and medicolegal problems. Identification of retained surgical instrument is important. The radiologists should be familiar with imaging finding of retained surgical instrument. In a 62-year-old female with a retained plastic tube, localized peritoneal infiltration around air-containing tubular structure mimicked acute appendicitis on abdomen computed tomography (CT), one year after laparoscopic cholecystectomy. We reported CT findings of foreign body reaction related to retained Endoloop ligature plastic tube mimicking acute appendicitis. PMID:27390545

  20. CT Findings of Foreign Body Reaction to a Retained Endoloop Ligature Plastic Tube Mimicking Acute Appendicitis: A Case Report

    PubMed Central

    Kang, Chae Hoon; Choi, Soo-Jung; Park, Man Soo; Jung, Seung Mun; Ryu, Dae Shick; Shin, Dong Rock

    2016-01-01

    Many hospitals experience one or more retained surgical instrument events with risk of patient morbidity and medicolegal problems. Identification of retained surgical instrument is important. The radiologists should be familiar with imaging finding of retained surgical instrument. In a 62-year-old female with a retained plastic tube, localized peritoneal infiltration around air-containing tubular structure mimicked acute appendicitis on abdomen computed tomography (CT), one year after laparoscopic cholecystectomy. We reported CT findings of foreign body reaction related to retained Endoloop ligature plastic tube mimicking acute appendicitis. PMID:27390545

  1. Sonography of Abdominal Pain in Children: Appendicitis and Its Common Mimics.

    PubMed

    Sanchez, Thomas Ray; Corwin, Michael T; Davoodian, Andrew; Stein-Wexler, Rebecca

    2016-03-01

    Abdominal pain is very common in the pediatric population (<18 years of age). Sonography is a safe modality that can often differentiate the frequently encountered causes of abdominal pain in children. This pictorial essay will discuss the sonographic findings of acute appendicitis, including the imaging appearance of a perforated appendicitis. It will also present the sonographic features of the relatively common mimics of appendicitis, such as mesenteric adenitis/gastroenteritis, intussusception, Meckel diverticulum, and ovarian torsion. PMID:26892821

  2. Appendiceal Hemangioma, Mimicking Acute Appendicitis in a 17-Year-Old Girl

    PubMed Central

    Geramizadeh, Bita; Niakan, Amin; Zolmadjdi, Nadjmeh; Marzban, Mahsa

    2016-01-01

    Epithelial tumors of appendix are not so common, and mesenchymal tumors of the appendix are even less common. Capillary hemangioma of the appendix is an extremely rare event and to the best of our knowledge only 4 cases have been reported in the English literature so far. In this case report we want to explain our experience with an extremely rare occurrence of capillary hemangioma of appendix in a 17-year-old girl presented with right lower quadrant pain that was operated with the clinical impression of acute appendicitis. The patient has been operated as a routine appendectomy with a completely uneventful postoperative period. PMID:27441077

  3. Appendiceal Hemangioma, Mimicking Acute Appendicitis in a 17-Year-Old Girl.

    PubMed

    Geramizadeh, Bita; Niakan, Amin; Zolmadjdi, Nadjmeh; Marzban, Mahsa

    2016-06-28

    Epithelial tumors of appendix are not so common, and mesenchymal tumors of the appendix are even less common. Capillary hemangioma of the appendix is an extremely rare event and to the best of our knowledge only 4 cases have been reported in the English literature so far. In this case report we want to explain our experience with an extremely rare occurrence of capillary hemangioma of appendix in a 17-year-old girl presented with right lower quadrant pain that was operated with the clinical impression of acute appendicitis. The patient has been operated as a routine appendectomy with a completely uneventful postoperative period. PMID:27441077

  4. Appendicitis

    MedlinePlus

    ... may indicate appendicitis include • Rovsing’s sign. A health care provider tests for Rovsing’s sign by applying hand pressure to ... muscle also runs near the appendix. A health care provider tests for the obturator sign by asking the patient ...

  5. Pictorial essay: CT scan of appendicitis and its mimics causing right lower quadrant pain

    PubMed Central

    Sharma, Monika; Agrawal, Anjali

    2008-01-01

    CT scanning is widely used in the diagnostic workup of right lower quadrant pain. While appendicitis remains the most frequent cause, a majority of patients referred for suspected appendicitis turn out to have alternative diagnoses or a normal CT study. The purpose of our pictorial essay is to present an overview of the CT findings of appendicitis and its common mimics and to highlight the features that provide clues to alternative diagnoses.

  6. Computed tomography findings mimicking appendicitis as a manifestation of colorectal cancer☆

    PubMed Central

    Watchorn, Richard E.; Poder, Liina; Wang, Zhen J.; Yeh, Benjamin M.; Webb, Emily M.; Coakley, Fergus V.

    2009-01-01

    The primary computed tomography (CT) signs of appendicitis can also be seen with other inflammatory or neoplastic processes. We report on two cases in which appendiceal dilatation and peri-appendiceal fluid or stranding were the dominant imaging manifestations of colorectal carcinoma in the ascending colon. This study highlights the need to closely examine the ascending colon in patients with a suspected CT diagnosis of acute appendicitis, since these findings may be secondary to an inconspicuous colorectal carcinoma. PMID:19857802

  7. Co-infection with Enterobius vermicularis and Taenia saginata mimicking acute appendicitis.

    PubMed

    Saravi, Kasra H; Fakhar, Mahdi; Nematian, Javad; Ghasemi, Maryam

    2016-01-01

    In this report, we describe an unusual case of verminous appendicitis due to Enterobius vermicularis and Taenia saginata in a 29-year-old woman from Iran. The histopathological examinations and parasitological descriptions of both worms found in the appendix lumen are discussed. The removed appendix exhibited the macroscopic and microscopic features of acute appendicitis. Antihelminthic therapy was initiated with single doses of praziquantel for the taeniasis and mebendazole for the enterobiasis, and the patient was discharged. PMID:26754203

  8. Appendiceal Immunoglobulin G4-Related Disease Mimicking Appendiceal Tumor or Appendicitis: A Case Report

    PubMed Central

    Kim, Hyun Soo; Kang, Won Kyung

    2016-01-01

    Immunoglobulin G4 (IgG4)-related disease is an autoimmune disease that forms tumorous lesions. Several cases involving various organs are reported, however, IgG4-related disease involving appendix has not been reported yet. In this report, we presented a case of IgG4-related disease of appendix, which raised a suspicion of appendiceal tumor or usual appendicitis and, therefore, led to unnecessary surgical resection. IgG4-related disease should be considered in the differential diagnosis for a mass-like swelling of the appendix, in order to avoid unnecessary surgery. PMID:26798216

  9. Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments

    PubMed Central

    Goyal, Monika K.; Kuppermann, Nathan; Cleary, Sean D.; Teach, Stephen J.; Chamberlain, James M.

    2016-01-01

    IMPORTANCE Racial disparities in use of analgesia in emergency departments have been previously documented. Further work to understand the causes of these disparities must be undertaken, which can then help inform the development of interventions to reduce and eradicate racial disparities in health care provision. OBJECTIVE To evaluate racial differences in analgesia administration, and particularly opioid administration, among children diagnosed as having appendicitis. DESIGN, SETTING, AND PARTICIPANTS Repeated cross-sectional study of patients aged 21 years or younger evaluated in the emergency department who had an International Classification of Diseases, Ninth Revision diagnosis of appendicitis, using the National Hospital Ambulatory Medical Care Survey from 2003 to 2010. We calculated the frequency of both opioid and nonopioid analgesia administration using complex survey weighting. We then performed multivariable logistic regression to examine racial differences in overall administration of analgesia, and specifically opioid analgesia, after adjusting for important demographic and visit covariates, including ethnicity and pain score. MAIN OUTCOMES AND MEASURES Receipt of analgesia administration (any and opioid) by race. RESULTS An estimated 0.94 (95% CI, 0.78–1.10) million children were diagnosed as having appendicitis. Of those, 56.8% (95% CI, 49.8%–63.9%) received analgesia of any type; 41.3% (95% CI, 33.7%–48.9%) received opioid analgesia (20.7% [95% CI, 5.3%–36.0%] of black patients vs 43.1% [95% CI, 34.6%–51.4%] of white patients). When stratified by pain score and adjusted for ethnicity, black patients with moderate pain were less likely to receive any analgesia than white patients (adjusted odds ratio = 0.1 [95% CI, 0.02–0.8]). Among those with severe pain, black patients were less likely to receive opioids than white patients (adjusted odds ratio = 0.2 [95% CI, 0.06–0.9]). In a multivariable model, there were no significant differences

  10. [Necrotizing fasciitis after "banal" back pain. An unusual course of a retrocoecal appendicitis and its sequellae].

    PubMed

    Wilharm, A; Gras, F; Mückley, T; Hofmann, G O

    2010-05-01

    Necrotizing fasciitis is a life-threatening disease which can only be successfully treated by an interdisciplinary team. An immediate and radical debridement with opening of all compartments and debridement of the affected fascia is the basis for a successful therapy. We report about the treatment of a 21-year-old man who was taken to hospital due to "banal" back pain which was caused by a perforated appendicitis. In only 2 days necrotizing fasciitis developed which spread out over the complete right leg. PMID:19812905

  11. An approach to model Right Iliac Fossa pain using pain-only-parameters for screening acute appendicitis.

    PubMed

    Chattopadhyay, Subhagata; Rabhi, Fethi; Acharya, U Rajendra; Joshi, Rohan; Gajendran, Rudhram

    2012-06-01

    Acute appendicitis (AA) is one of the commonest of multiple possible pathologies at the backdrop of Right Iliac Fossa (RIF) pain. RIF is the most common acute surgical condition of the abdomen. Even though AA is a recognized disease entity since decades, its diagnosis still lacks clinical confidence and mandates laboratory tests. Given the issue, this paper proposes a mathematical model using Pain-Only-Parameters (POP) obtained from available literature to screen AA. Weights have been assigned for each POP to create a training data matrix (N = 51) and used to calculate the cumulative effect or weighted sum, which is termed as the Pain Confidence Score (PCS). Based on PCS, a group of real-world patients (N = 40; AA and NA = 20 each) are classified as cases of AA or non-appendicitis (NA) with satisfactory results (sensitivity 85%, specificity 75%, precision 77%, and accuracy 80%). Most rural health centers (RHC) in developing nations lack specialist services and related infrastructure. Hence, such a tool could be useful in RHC to assist general physicians in screening AA and their timely referral to higher centers. PMID:20949312

  12. Appendicitis (For Parents)

    MedlinePlus

    ... Taking Your Child's Temperature What Happens in the Operating Room? Going to the Hospital Belly Pain Word! Peritonitis Appendicitis Hernias What's It Like to Have Surgery? Appendicitis Digestive System Contact Us Print Resources Send to a friend ...

  13. Seasonal variations of acute appendicitis and nonspecific abdominal pain in Finland

    PubMed Central

    Ilves, Imre; Fagerström, Anne; Herzig, Karl-Heinz; Juvonen, Petri; Miettinen, Pekka; Paajanen, Hannu

    2014-01-01

    AIM: To investigate whether seasonal changes had an effect on the incidence of acute appendicitis (AA) or nonspecific abdominal pain (NSAP). METHODS: We carried out a national register study of all patients with a hospital discharge diagnosis of AA and acute NSAP in Finland. Data were analyzed for the whole country and correlated to seasonal and weather parameters (temperature, humidity). Moreover, additional sub-analyses were performed for five geographically different area of Finland. RESULTS: The observation period spanned 21 years, with 186558 appendectomies, of which 137528 (74%) cases were reported as AA. The incidence of AA declined for 32% over the study period. The average incidence of the NSAP was 34/10000 per year. The mean annual temperature, but not relative humidity, showed clear geographical variations. The incidence of AA decreased significantly during the cold months of the year. No correlation was detected between temperature and incidence of NSAP. Humidity had a statistically significant impact on NSAP. CONCLUSION: The incidence of acute appendicitis is declining in Finland. We detected a clear seasonality in the incidence of AA and NSAP. PMID:24833844

  14. Varicella Zoster Infection: A Rare Cause of Abdominal Pain Mimicking Acute Abdomen

    PubMed Central

    Olmez, Deniz; Boz, Alper; Erkan, Nazif

    2009-01-01

    Varicella zoster is an acute viral infection that results from reactivation of a latent varicella zoster virus. It usually occurs in adult population and immune compromised patients. It rarely occurs in healthy children. Here we present a 14 years old male with varicella zoster that had abdominal pain mimicking acute abdomen to alert others who are consulted for the differentiation of acute abdomen and others who may be consulted for pain management. Keywords Varicella zoster; Abdominal pain PMID:22461879

  15. Intramuscular hemangioma mimicking myofascial pain syndrome: a case report.

    PubMed

    Kim, Dong Hwee; Hwang, Miriam; Kang, Yoon Kyoo; Kim, In Jong; Park, Yoon Kun

    2007-06-01

    Intramuscular hemangioma, an infrequent but important cause of musculoskeletal pain, is often difficult to establish the diagnosis clinically. This report describes a case of a 32-yr-old woman who presented with severe left calf pain for 10 yr. Initial conservative treatments consisting of intramuscular electrical stimulation, herb medication, acupuncture, and intramuscular lidocaine injection under the diagnosis of myofascial pain syndrome in other facilities, failed to alleviate the symptoms. On physical examination, there was no motor weakness or sensory change. Conventional radiography of the leg revealed a soft tissue phlebolith. Conventional angiography study showed hemangioma. Intramuscular hemangioma within the soleus muscle was confirmed by magnetic resonance imaging. Following surgical excision of the hemangioma, the patient's symptom resolved completely. Intramuscular hemangioma is a rare cause of calf pain and should be considered in the differential diagnosis if a patient with muscle pain, particularly if associated with a soft tissue mass, fails to respond to conservative treatment. PMID:17596677

  16. Intramuscular Hemangioma Mimicking Myofascial Pain Syndrome : A Case Report

    PubMed Central

    Hwang, Miriam; Kang, Yoon Kyoo; Kim, In Jong; Park, Yoon Kun

    2007-01-01

    Intramuscular hemangioma, an infrequent but important cause of musculoskeletal pain, is often difficult to establish the diagnosis clinically. This report describes a case of a 32-yr-old woman who presented with severe left calf pain for 10 yr. Initial conservative treatments consisting of intramuscular electrical stimulation, herb medication, acupuncture, and intramuscular lidocaine injection under the diagnosis of myofascial pain syndrome in other facilities, failed to alleviate the symptoms. On physical examination, there was no motor weakness or sensory change. Conventional radiography of the leg revealed a soft tissue phlebolith. Conventional angiography study showed hemangioma. Intramuscular hemangioma within the soleus muscle was confirmed by magnetic resonance imaging. Following surgical excision of the hemangioma, the patient's symptom resolved completely. Intramuscular hemangioma is a rare cause of calf pain and should be considered in the differential diagnosis if a patient with muscle pain, particularly if associated with a soft tissue mass, fails to respond to conservative treatment. PMID:17596677

  17. Chest Pain in Adolescent Japanese Male Mimicking Acute Coronary Syndrome

    PubMed Central

    Gupta, Sachin K.; Naheed, Zahra

    2014-01-01

    Acute chest pain with very elevated troponin level and abnormal EKG in adult population is considered sine qua non to acute coronary syndrome (ACS) unless proved otherwise. Similar presentation in adolescent population is seen less often but raises suspicion for ACS. Most common etiology for chest pain with cardiac enzyme elevation in adolescent population is usually viral myopericarditis. The adolescent population presenting with chest pain and elevated cardiac enzymes should be carefully evaluated for ACS and other etiologies including myocarditis, myopericarditis, pulmonary embolism, acute rheumatic fever, and trauma. We report one Japanese adolescent male with mycoplasma pneumoniae myocarditis who presented to the ER with chest pain, elevated cardiac enzymes, and abnormal EKG. PMID:25202456

  18. A Case of Painful Hashimoto Thyroiditis that Mimicked Subacute Thyroiditis.

    PubMed

    Seo, Hye Mi; Kim, Miyeon; Bae, Jaeseok; Kim, Jo-Heon; Lee, Jeong Won; Lee, Sang Ah; Koh, Gwanpyo; Lee, Dae Ho

    2012-04-01

    Hashimoto thyroiditis (HT) is an autoimmune thyroid disorder that usually presents as a diffuse, nontender goiter, whereas subacute thyroiditis (SAT) is an uncommon disease that is characterized by tender thyroid enlargement, transient thyrotoxicosis, and an elevated erythrocyte sedimentation rate (ESR). Very rarely, patients with HT can present with painful, tender goiter or fever, a mimic of SAT. We report a case of painful HT in a 68-year-old woman who presented with pain and tenderness in a chronic goiter. Her ESR was definitely elevated and her thyroid laboratory tests suggested subclinical hypothyroidism of autoimmune origin. (99m)Tc pertechnetate uptake was markedly decreased. Fine needle aspiration biopsy revealed reactive and polymorphous lymphoid cells and occasional epithelial cells with Hürthle cell changes. Her clinical symptoms showed a dramatic response to glucocorticoid treatment. She became hypothyroid finally and is now on levothyroxine therapy. PMID:22570820

  19. Serum, Saliva, and Urine Irisin with and Without Acute Appendicitis and Abdominal Pain

    PubMed Central

    Bakal, Unal; Aydin, Suleyman; Sarac, Mehmet; Kuloglu, Tuncay; Kalayci, Mehmet; Artas, Gokhan; Yardim, Meltem; Kazez, Ahmet

    2016-01-01

    A 112-amino-acid protein irisin (IRI) is widely expressed in many organs, but we currently do not know whether appendix tissue and blood cells express it. If appendix tissue and neutrophil cells express IRI, measuring its concentration in biological fluids might be helpful in the diagnosis of acute appendicitis (AA), since neutrophil cells are the currently gold-standard laboratory parameters for the diagnosis of AA. Therefore, the purpose of this study was to investigate the suitability of enzyme-linked immunosorbent assay-based measurements of the proposed myokine IRI for the discrimination of patients with AA from those with acute abdominal pain (AP) and healthy controls. Moreover, immunoreactivity to IRI was investigated in appendix tissues and blood cells. Samples were collected on admission (T1), 24 hours (T2), and 72 hours (T3) postoperatively from patients with suspected AA and from patients with AP corresponding to T1–T3, whereas control subject blood was once corresponding to T1. IRI was measured in serum, saliva, and urine by using enzyme-linked immunosorbent assay, whereas in appendix tissue and blood cells, IRI was detected by immunohistohcemistry. Appendix tissue and blood cells (except for erythrocytes) are new sources of IRI. Basal saliva, urine, and serum levels were higher in children with AA compared with postoperative levels (T2) that start to decline after surgery. This is in line with the finding that IRI levels are higher in children with AA when compared with those with AP or control subject levels, most likely due to a large infiltration of neutrophil cells in AA that release its IRI into body fluids. Measurement of IRI in children with AA parallels the increase or decrease in the neutrophil count. This new finding shows that the measurement of IRI and neutrophil count can together improve the diagnosis of AA, and it can distinguish it from AP. IRI can be a candidate marker for the diagnosis of AA and offers an additional parameter to

  20. Sacral perineural cyst mimicking inflammatory low back pain.

    PubMed

    Ostojic, P

    2015-02-01

    This case describes a 46-year-old woman with local pelvic and perineal pain, persisting for 2 years at presentation. The pain worsened during the night and morning and was alleviated during daily activities. Low back pain was associated with morning stiffness lasting longer than 2 h. Sometimes, she felt pain and numbness along her left S1 dermatome, without overt bladder or bowel incontinence. Lasegue's sign was negative. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated (35 mm/h and 9.4, respectively) and Mennel's sign was present on both sides, indicating possible inflammation of the sacroiliac joints. However, radiographs of the lumbosacral spine and sacroiliac joints were normal. Magnetic resonance imaging (MRI) revealed a large spinal meningeal cyst in the sacrum (60 × 37 × 22 mm) consisting of multiple perineural cysts. The cyst eroded the surrounding sacral bone structures, narrowed several sacral foramina, and compressed neighboring nerve fibers. MRI findings on sacroiliac and hip joints were normal. PMID:25315123

  1. Nanovesicle-Carbon Nanotube Hybrid Structures Mimicking Mammalian Pain Sensory System

    NASA Astrophysics Data System (ADS)

    Cho, Youngtac; Jin, Hye Jun; An, Jeong Mi; Park, Juhun; Moon, Seok Jun; Hong, Seunghun

    2015-03-01

    We developed a ``chemical-pain sensor'' based on a single-walled carbon nanotube-based field effect transistor (SWNT-FET) functionalized with rat pain sensory receptor, rat transient receptor potential vanilloid 1 (rTRPV1) mimicking a mammalian pain sensory system. The sensor can selectively detect chemical pain stimuli such as capsaicin and resiniferatoxin with a sensitivity of a 1 pM detection limit. Since this sensor allows one to quantitatively measure the concentration of chemical pain stimuli just like animal sensory systems, it can be used for various practical applications such as food screening. In addition, TRP families including rTRPV1 protein used for the sensor are now suggested as potential drug targets related to nerve and circulation disorders. Thus, the capability of measuring TRP responses using our sensor platform should open up other applications such as drug screening and basic research related with nerve and circulation systems.

  2. Chronic appendicitis in children

    PubMed Central

    Kim, David; Butterworth, Sonia A.; Goldman, Ran D.

    2016-01-01

    Abstract Question While the diagnosis of acute appendicitis is relatively straightforward, chronic appendicitis is an entity that can be controversial and is often misdiagnosed. How and when should clinicians be investigating chronic appendicitis as a cause of chronic and recurrent abdominal pain in the pediatric population? Answer Chronic appendicitis is a long-standing inflammation or fibrosis of the appendix that presents clinically as prolonged or intermittent abdominal pain. It is often a challenging diagnosis and might result in complications such as intra-abdominal infections or bowel obstruction or perforation. Clinical presentation, along with imaging studies, can help the clinician rule out other conditions, and among those who are diagnosed, for many children, appendectomy results in partial or complete resolution of pain symptoms. PMID:27303020

  3. Acute recurrent appendicitis with appendicolith.

    PubMed

    Hollerman, J J; Bernstein, M A; Kottamasu, S R; Sirr, S A

    1988-11-01

    Appendiceal disease can be acute, acute recurrent, or chronic. Acute appendicitis is the most common form. Acute recurrent appendicitis is more common than chronic appendicitis. In children the clinical manifestations of appendicitis are variable. Patients who have an appendicolith usually develop appendicitis, often with perforation. A case is presented of 3-year follow-up of a patient with an appendicolith and acute recurrent appendicitis. The literature about appendicoliths is reviewed. In the appropriate clinical setting, a history of prior episodes of similar right lower quadrant pain does not preclude the diagnosis of appendiceal disease. Awareness of the less common forms of appendicitis is important so that appropriate treatment is not delayed. PMID:3052484

  4. Abdominal pain

    MedlinePlus

    ... threatening conditions, such as colon cancer or early appendicitis , may only cause mild pain or no pain. ... Food poisoning Stomach flu Other possible causes include: Appendicitis Abdominal aortic aneurysm (bulging and weakening of the ...

  5. Laparoscopic treatment of perforated appendicitis

    PubMed Central

    Lin, Heng-Fu; Lai, Hong-Shiee; Lai, I-Rue

    2014-01-01

    The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis. PMID:25339821

  6. [A man with atypical appendicitis].

    PubMed

    du Pré, Bastiaan C; Akkersdijk, Willem L

    2012-01-01

    A 43-year-old man presented with acute left-sided middle and lower abdominal pain. He was diagnosed with 'left-sided acute appendicitis with non-rotation of the colon'. This is a rare and usually asymptomatic congenital anomaly. PMID:22551755

  7. The significance of urinary beta-2 microglobulin level for differential diagnosis of familial Mediterranean fever and acute appendicitis.

    PubMed

    Ugan, Yunus; Korkmaz, Hakan; Dogru, Atalay; Koca, Yavuz Savas; Balkarlı, Ayse; Aylak, Firdevs; Tunc, Sevket Ercan

    2016-07-01

    The clinical and laboratory parameters widely used are not specific to discriminate the abdominal pain due to FMF attack from that of acute appendicitis. The present study aims to investigate the urinary beta-2 microglobulin (U-β2M) level as a potential parameter to identify these two diseases mimicking each other. A total of 51 patients with established FMF diagnosis due to Tel Hashomer criteria on colchicine treatment (1-1.5 mg/day), 15 patients with acute appendicitis who had appropriate clinical picture and were also supported pathologically after the surgery, and 20 healthy controls were enrolled in the study. Of the 51 patients with FMF, 25 were at an attack period, while remaining 26 were not. For the diagnosis of acute attack, as well as physical examination, laboratory tests including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were performed. From urine specimens U-β2M, microalbumin, and N-acetyl glucosaminidase (U-NAG) were measured. U-β2M levels were significantly higher in acute appendicitis group compared to FMF attack, FMF non-attack, and control groups (p < 0.001, p < 0.001, and p < 0.001, respectively). U-NAG and microalbuminuria were significantly higher in acute appendicitis, FMF attack, and FMF non-attack groups compared to controls (U-NAG p < 0.001, p = 0.016, p = 0.004, microalbuminuria p < 0.001, p < 0.001, p < 0.001, respectively). Microalbuminuria was significantly higher in acute appendicitis group compared to the FMF attack group (p = 0.004). Determination of U-β2M levels may be helpful for differential diagnosis of peritonitis attacks of FMF patients on colchicine treatment and acute appendicitis. However, this finding should be substantiated with other studies. PMID:26873102

  8. Treating appendicitis with antibiotics.

    PubMed

    Brook, Itzhak

    2016-03-01

    A nonsurgical approach using antimicrobial agents has been advocated as the initial treatment of uncomplicated appendicitis. Several studies and meta-analyses explored this approach. Because many of these studies included individuals with resolving appendicitis, their results were biased. Antimicrobials, however, are warranted and needed for the management of surgical high-risk patients with perforated appendicitis and those with localized abscess or phlegmon. Randomized placebo-controlled trials that focus on early identification of complicated acute appendicitis patients needing surgery and that prospectively evaluate the optimal use of antibiotic treatment in patients with uncomplicated acute appendicitis are warranted. PMID:26689849

  9. Left Sided Appendicitis: Once Burned Twice Shy

    PubMed Central

    Spyridakis, Ioannis; Patoulias, Dimitrios; Tsioulas, Paschalis; Patoulias, Ioannis

    2016-01-01

    Acute appendicitis is one of the most common surgical conditions that are diagnosed in children presenting with acute abdominal pain in the emergency department. An atypical presentation of symptoms is encountered in 30% of cases. Atypical localization of the appendix as in left sided appendicitis, although rare, has an increased risk of missed or delayed diagnosis. We present two consecutive cases of left sided appendicitis in order to describe how increased awareness in the second case helped us to avoid pitfalls in the management and diagnosis of this atypical and variant condition. Increased cautiousness and awareness of left sided appendicitis can assist emergency physicians to avoid pitfalls in the management and diagnosis of this atypical and variant condition. PMID:27042523

  10. Left Sided Appendicitis: Once Burned Twice Shy.

    PubMed

    Kaselas, Christos; Spyridakis, Ioannis; Patoulias, Dimitrios; Tsioulas, Paschalis; Patoulias, Ioannis

    2016-02-01

    Acute appendicitis is one of the most common surgical conditions that are diagnosed in children presenting with acute abdominal pain in the emergency department. An atypical presentation of symptoms is encountered in 30% of cases. Atypical localization of the appendix as in left sided appendicitis, although rare, has an increased risk of missed or delayed diagnosis. We present two consecutive cases of left sided appendicitis in order to describe how increased awareness in the second case helped us to avoid pitfalls in the management and diagnosis of this atypical and variant condition. Increased cautiousness and awareness of left sided appendicitis can assist emergency physicians to avoid pitfalls in the management and diagnosis of this atypical and variant condition. PMID:27042523

  11. An uncommon late complication of appendicitis.

    PubMed

    Lapus, Robert M; Baker, Mark D

    2010-10-01

    A 10-year-old boy presented with a 2.5-week history of right leg pain and limp. A right flank mass was noted by a parent on the day of presentation. The child's past medical history was remarkable for perforated appendicitis treated with an interval laparoscopic appendectomy 2 years before this presentation. Abdominal and pelvic computed tomography revealed a retroperitoneal mass with calcifications, suggestive of a retained appendicolith with abscess formation. This case illustrates the importance of considering very late complications of appendicitis in patients presenting with fever and abdominal or flank pain or masses. PMID:20930600

  12. A curious cause of appendicitis.

    PubMed

    Stewart-Parker, Emma Patricia; Atta, Mustafa; Doddi, Sudeendra

    2016-01-01

    A previously healthy 10-year-old boy presented to the emergency department with central abdominal pain, loose stool and vomiting. He was diagnosed with gastroenteritis, but was well enough to be discharged. The next day he reattended with ongoing diarrhoea and vomiting, with the pain now localised to the right iliac fossa (RIF). Acute appendicitis was suspected, and he was taken for laparoscopic appendicectomy. At surgery, a gangrenous appendix was found, with pus extending from the pelvis up to the liver. The appendix was excised and thorough peritoneal washout performed. Postoperatively, he received 48 hours of intravenous antibiotics and was discharged home. Unfortunately the boy presented again 11 days later with right lower quadrant pain and fever. Ultrasound revealed a collection in the RIF, and he returned to theatre for washout. His recovery was slow until the peritoneal pus sent for bacterial culture grew Salmonella enteritidis, identification of which facilitated appropriate antibiotic treatment. PMID:27489071

  13. A curious cause of appendicitis

    PubMed Central

    Stewart-Parker, Emma Patricia; Atta, Mustafa; Doddi, Sudeendra

    2016-01-01

    A previously healthy 10-year-old boy presented to the emergency department with central abdominal pain, loose stool and vomiting. He was diagnosed with gastroenteritis, but was well enough to be discharged. The next day he reattended with ongoing diarrhoea and vomiting, with the pain now localised to the right iliac fossa (RIF). Acute appendicitis was suspected, and he was taken for laparoscopic appendicectomy. At surgery, a gangrenous appendix was found, with pus extending from the pelvis up to the liver. The appendix was excised and thorough peritoneal washout performed. Postoperatively, he received 48 hours of intravenous antibiotics and was discharged home. Unfortunately the boy presented again 11 days later with right lower quadrant pain and fever. Ultrasound revealed a collection in the RIF, and he returned to theatre for washout. His recovery was slow until the peritoneal pus sent for bacterial culture grew Salmonella enteritidis, identification of which facilitated appropriate antibiotic treatment. PMID:27489071

  14. [Ultrasonographic diagnosis of appendicitis. Value and limitations].

    PubMed

    Nguyen, Q K; Nguyen, V D; Nguyen, V T; Huynh, T T; Tran, V K

    1994-10-01

    Appendicitis is a frequently encountered surgical emergency which can be diagnosed by clinical and laboratory criteria. But there are some atypical cases that ultrasound can help to diagnose. From April the 9th 1992 to April the 11th 1993, we have examined by ultrasound 465 patients entered in our hospital for right lower quadrant pain. 190 patients have been diagnosed as appendicitis and operated (true positive = 124 cases, false negative = 54 cases and false positive = 12 cases). 275 patients have been diagnosed as negative and they are not operated (true = 273 cases, false positive = 2 cases). So in our study, the sensitivity is 70%, the specificity is 95% and the accuracy is 85%. Our scientific report has the objective to show the usefulness and the limits of ultrasound in the diagnosis of appendicitis. PMID:7799276

  15. Appendicitis after laparoscopic ovarian cystectomy—coincidence or complication

    PubMed Central

    Gallmann, Dalia Mirjam; Stoessel, Kurt-Aurel; Schoeb, Othmar

    2016-01-01

    Diagnosis of appendicitis, particularly in young women, may be challenging. In case of abdominal pain in the postoperative period of laparoscopic surgery, one should not only think of complications such as bleeding and injury of the bowel but also such as acute appendicitis. We report a case of a 26-year-old female patient with a post-laparoscopic acute appendicitis with appendicolithiasis 3 days after a laparoscopic ovarian cystectomy during which the appendix appeared inconspicuous. Appendicitis after gynecologic laparoscopy is a rare but potentially dangerous condition. One should consider the possibility of a postoperative appendicitis in case of an acute abdomen after laparoscopic surgery. Further studies might be of value to re-evaluate incidental appendectomy especially in cases of appendicolithiasis. PMID:27103602

  16. Appendicitis after laparoscopic ovarian cystectomy-coincidence or complication.

    PubMed

    Gallmann, Dalia Mirjam; Stoessel, Kurt-Aurel; Schoeb, Othmar

    2016-01-01

    Diagnosis of appendicitis, particularly in young women, may be challenging. In case of abdominal pain in the postoperative period of laparoscopic surgery, one should not only think of complications such as bleeding and injury of the bowel but also such as acute appendicitis. We report a case of a 26-year-old female patient with a post-laparoscopic acute appendicitis with appendicolithiasis 3 days after a laparoscopic ovarian cystectomy during which the appendix appeared inconspicuous. Appendicitis after gynecologic laparoscopy is a rare but potentially dangerous condition. One should consider the possibility of a postoperative appendicitis in case of an acute abdomen after laparoscopic surgery. Further studies might be of value to re-evaluate incidental appendectomy especially in cases of appendicolithiasis. PMID:27103602

  17. Calcific Tendinopathy of the Gluteus Medius Mimicking Lumbar Radicular Pain Successfully Treated With Barbotage: A Case Report.

    PubMed

    Jo, Hannae; Kim, Gowun; Baek, Sora; Park, Hee-Won

    2016-04-01

    We report a case of calcific tendinopathy of the gluteus medius initially misdiagnosed as a lumbar herniated intervertebral disc. It was successfully treated with barbotage under ultrasonographic guidance finally. A 56-year-old woman was referred to interventional pain clinic for right hip pain due to an L5-S1 disc herniation. Serial L5 and S1 spinal nerve root blocks and epidural steroid injections were administered. However, pain relief was sustained only for a very short period. Plain radiography of the right hip revealed a solid calcific nodule at adjacent to the insertion site of the gluteus medius tendon. Physical modalities and extracorporeal shock wave therapy failed to improve the pain. Therefore, we attempted ultrasound-guided barbotage of the calcification. Barbotage was performed twice serially and her pain was considerably improved. At 6-month follow-up, the calcification was completely resolved. PMID:27152290

  18. Calcific Tendinopathy of the Gluteus Medius Mimicking Lumbar Radicular Pain Successfully Treated With Barbotage: A Case Report

    PubMed Central

    Jo, Hannae; Kim, Gowun; Baek, Sora

    2016-01-01

    We report a case of calcific tendinopathy of the gluteus medius initially misdiagnosed as a lumbar herniated intervertebral disc. It was successfully treated with barbotage under ultrasonographic guidance finally. A 56-year-old woman was referred to interventional pain clinic for right hip pain due to an L5-S1 disc herniation. Serial L5 and S1 spinal nerve root blocks and epidural steroid injections were administered. However, pain relief was sustained only for a very short period. Plain radiography of the right hip revealed a solid calcific nodule at adjacent to the insertion site of the gluteus medius tendon. Physical modalities and extracorporeal shock wave therapy failed to improve the pain. Therefore, we attempted ultrasound-guided barbotage of the calcification. Barbotage was performed twice serially and her pain was considerably improved. At 6-month follow-up, the calcification was completely resolved. PMID:27152290

  19. Laparoscopic Surgery for Acute Appendicitis in Children With Cancer

    PubMed Central

    Singer, Julia; Stringel, Gustavo; Ozkaynak, Mehmet Fevzi; McBride, Whitney; Pandya, Samir

    2015-01-01

    Introduction: Abdominal pain during cancer chemotherapy may be caused by medical or surgical conditions. A retrospective review of 5 children with cancer who had appendicitis while receiving chemotherapy was performed. Case Descriptions: Three had acute lymphoblastic leukemia, and 1 each had T-cell lymphoblastic lymphoma and rhabdomyosarcoma. Two of the patients had a Pediatric Appendectomy Score of 6, and 1 each had a score of 7, 5, and 2. All had evidence of appendicitis on computed tomography. Laparoscopic appendectomy was performed without any perioperative complication. Discussion: Appendicitis is an important diagnosis in children with cancer, and laparoscopic appendectomy is safe and the procedure of choice. PMID:26390529

  20. Endometrial decidualization: a rare cause of acute appendicitis during pregnancy.

    PubMed

    Murphy, Skyle J; Kaur, Anupinder; Wullschleger, Martin E

    2016-01-01

    Appendicular endometriosis is a rare and poorly understood pathology that affects women in their reproductive years. In the gravid woman, ectopic endometrial tissue undergoes decidualization. This physiological process can result in acute appendicitis in exceptional cases. Here we describe a patient in her second trimester of pregnancy who presented with right iliac fossa pain and clinical, laboratory and imaging findings consistent with acute appendicitis. A laparoscopic appendectomy was performed with intraoperative findings suspicious for malignancy. Histological analysis made the surprising diagnosis of decidualized endometriosis causing luminal constriction resulting in acute appendicitis. We also detail the challenging diagnostic and management issues faced by clinicians in such cases. PMID:27106612

  1. Endometrial decidualization: a rare cause of acute appendicitis during pregnancy

    PubMed Central

    Murphy, Skyle J.; Kaur, Anupinder; Wullschleger, Martin E.

    2016-01-01

    Appendicular endometriosis is a rare and poorly understood pathology that affects women in their reproductive years. In the gravid woman, ectopic endometrial tissue undergoes decidualization. This physiological process can result in acute appendicitis in exceptional cases. Here we describe a patient in her second trimester of pregnancy who presented with right iliac fossa pain and clinical, laboratory and imaging findings consistent with acute appendicitis. A laparoscopic appendectomy was performed with intraoperative findings suspicious for malignancy. Histological analysis made the surprising diagnosis of decidualized endometriosis causing luminal constriction resulting in acute appendicitis. We also detail the challenging diagnostic and management issues faced by clinicians in such cases. PMID:27106612

  2. Unusual presentation of a familiar pathology: chronic appendicitis.

    PubMed

    Sierakowski, Kyra; Pattichis, Andrew; Russell, Patrick; Wattchow, David

    2016-01-01

    We present a case of a man who experienced night sweats, abdominal pain and fever for over 3 months, with incomplete response to broad-spectrum intravenous antibiotics. Although CT imaging was insufficient to identify the cause for his chronic abdominal pain, the abnormality of a 'misty mesentery' was crucial in guiding further investigation. The final diagnosis of chronic appendicitis was made through laparoscopic and pathological examination. This case highlights the utility of a collaborative diagnostic effort between disciplines. Chronic appendicitis can cause lingering abdominal pain. Early recognition and appropriate referral can save patients months and even years of unnecessary suffering. PMID:26869622

  3. Sonography of acute appendicitis and its mimics in children

    PubMed Central

    Sargar, Kiran M; Siegel, Marilyn J

    2014-01-01

    The diagnosis of acute right lower quadrant pain in a pediatric population is challenging. Acute appendicitis is the most common cause of an acute surgical abdomen. The common mimics of acute appendicitis are acute gastrointestinal and gynecologic diseases. This article reviews the sonographic findings of the spectrum of common acute abdominal emergencies in children with a focus on imaging clues to a specific diagnosis. This awareness can impact on diagnostic accuracy and impact patient management. PMID:25024527

  4. Appendicular mass complicating acute appendicitis in a patient with dengue fever.

    PubMed

    Low, Y N; Cheong, B M K

    2016-04-01

    Abdominal pain with dengue fever can be a diagnostic challenge. Typically, pain is localised to the epigastric region or associated with hepatomegaly. Patients can also present with acute abdomen. We report a case of a girl with dengue fever and right iliac fossa pain. The diagnosis of acute appendicitis was made only after four days of admission. An appendicular mass and a perforated appendix was noted during appendectomy. The patient recovered subsequently. Features suggestive of acute appendicitis are persistent right iliac fossa pain, localised peritonism, persistent fever and leucocytosis. Repeated clinical assessment is important to avoid missing a concurrent diagnosis like acute appendicitis. PMID:27326951

  5. Fiber Intake and Childhood Appendicitis.

    ERIC Educational Resources Information Center

    Brender, Jean D.; And Others

    1985-01-01

    Parents of 135 children with appendicitis and of 212 comparison children were interviewed about their children's diet. Results suggest that a liberal intake of whole-grain breads and cereals may decrease the risk of appendicitis during childhood. (KH)

  6. Gastrointestinal Zygomycosis Masquerading as Acute Appendicitis

    PubMed Central

    Choi, Won-Tak; Chang, Tammy T.; Gill, Ryan M.

    2016-01-01

    Zygomycosis is a rare invasive opportunistic fungal infection that occurs in the setting of hematologic malignancies, chemotherapy-induced neutropenia, and immunosuppressive therapies. We report the first case of disseminated appendiceal zygomycosis due to Absidia spp. in a neutropenic patient who initially presented as acute appendicitis. A 63-year-old woman with acute myeloid leukemia presented as acute appendicitis while receiving induction chemotherapy and ultimately succumbed to overwhelming disseminated zygomycosis. Initial symptoms included loose stools and right lower abdominal pain unresponsive to broad-spectrum antibiotics. Clinical examination and cross-sectional imaging suggested acute appendicitis. The final diagnosis was established by histological evaluations of the ileocecectomy specimen, which showed angioinvasive fungal organisms within the necrotic appendiceal wall with characteristics typical of zygomycetes. Fungal cultures demonstrated Absidia spp. The patient was treated with amphotericin B but expired in the setting of fungal sepsis. A diagnosis of a fungal infection, including zygomycosis, should be considered in all chemotherapy-induced neutropenic patients who present with symptoms of acute appendicitis. A high index of clinical suspicion with prompt histologic and culture diagnosis of zygomycosis may reduce the high mortality and morbidity associated with zygomycosis of the gastrointestinal tract. PMID:27403107

  7. Operative management of appendicitis.

    PubMed

    St Peter, Shawn D; Snyder, Charles L

    2016-08-01

    Appendectomy has been the standard of care for appendicitis since the late 1800s, and remains one of the most common operations performed in children. The advent of data-driven medicine has led to questions about every aspect of the operation-whether appendectomy is even necessary, when it should be performed (timing), how the procedure is done (laparoscopic variants versus open and irrigation versus no irrigation), length of hospital stay, and antibiotic duration. The goal of this analysis is to review the current status of, and available data regarding, the surgical management of appendicitis in children. PMID:27521710

  8. Risk factors for the development of complicated appendicitis in adults

    PubMed Central

    Naderan, Mohammad; Babaki, Amir Eslami Shahr; Shoar, Saeed; Mahmoodzadeh, Hossein; Nasiri, Shirzad; Khorgami, Zhamak

    2016-01-01

    Objective: To investigate the patient’s history and physical examination information to find out risk factors associated with complicated appendicitis. Material and Methods: Two hundred patients who were admitted with complicated appendicitis (including abscess, phlegmon, and generalized peritonitis) were retrieved from our database. Two hundred patients with non-complicated acute appendicitis were randomly selected from the same period. These two groups were compared in terms of demographic characteristics, past medical history, and presenting symptoms. We made a multivariate analysis model using binary logistic regression and backward stepwise elimination. Results: Based on multivariate analysis, risk factors for complicated appendicitis included presenting with epigastric pain (OR=3.44), diarrhea (OR=23.4) or malaise (OR=49.7), history of RLQ pain within the past 6 months (OR=4.93), older age (OR=1.04), being married (OR=2.52), lack of anorexia (OR=4.63) and longer interval between onset of symptoms and admission (OR=1.46). Conversely, higher (academic) education was associated with decreased odds for complicated appendicitis (OR=0.26). Conclusion: Our findings suggest that a surgeon’s clinical assessment is more reliable to make a judgment. “Bedside evaluation” is a useful, cheap, quick and readily available method for identifying those at risk for developing complicated acute appendicitis. PMID:26985166

  9. Stump Appendicitis: A Clinical Enigma.

    PubMed

    Çiftci, F; Abdurrahman, I; Tatar, Z

    2015-01-01

    Appendectomy is one of the most frequently performed operations. Stump appendicitis, as a postoperative complication of appendectomy, is inflammation of the remnant residue when an incomplete excision occurs. We present a patient with stump appendicitis who had been operated on, laparoscopically, for acute appendicitis 6 months before. The patient was diagnosed with acute appendicitis, underwent surgery, and was discharged on postoperative day 3 without complications. Stump appendicitis is a rare cause of acute abdominal disease but should be considered in the differential diagnosis. Ultrasonography is helpful in the diagnosis. PMID:26713833

  10. Computer tomography imaging of an unusual cause of appendicitis: a case report

    PubMed Central

    Mols, Pierre; Ramadan, Ahmed S. E.; Ngassa, Michèle; Towo, Pierre Youatou

    2015-01-01

    Foreign body occlusion of appendices lumen is a quite rare cause of appendicitis due to foreign body. We present a case of a 63-year-old male who presented with right lower quadrant pain since 24 hours. Computed tomography (CT) demonstrated an acute appendicitis due to a metallic foreign body which was found to be a bullet. PMID:26029649

  11. Missed appendicitis after self-induced abortion

    PubMed Central

    Punguyire, Damien; Iserson, Victor Kenneth

    2011-01-01

    Female lower abdominal pain poses diagnostic difficulties for clinicians, especially when little more than the history and physical examination are available. A girl presented with constant lower abdominal pain after taking misoprostol for pregnancy termination. She was eventually referred to a rural District Hospital, where a laparotomy demonstrated acute appendicitis. After treating herself for a self-diagnosed pregnancy with illegally provided misoprostol, this patient presented with persistent lower abdominal pain. The differential diagnosis included ectopic pregnancy and all other causes of female abdominal pain. Yet diagnosing two diseases in the same anatomical area at the same time contradicts diagnostic parsimony. System problems in resource-poor areas can limit access to healthcare services and encourage dispensing potentially dangerous medications without clinicians’ authorization. It is dangerous to rely on patients’ self-diagnoses while neglecting other diagnoses. More than one diagnosis may be needed to explain temporally and anatomically related symptoms. PMID:22187620

  12. Acute appendicitis caused by foreign body ingestion.

    PubMed

    Kim, Joo Heung; Lee, Dae Sup; Kim, Kwang Min

    2015-09-01

    Foreign bodies usually do not cause complications and pass through the gastrointestinal tract spontaneously. Usually endoscopic intervention is recommended within 24 hours. Cases of acute appendicitis caused by foreign bodies are very rare. In our case, we experienced successful endoscopic and surgical treatment of a patient with ingestion of razor blade and some unrecognizable foreign bodies. A 22-year-old soldier was admitted with a small quantity of hematemesis and epigastric pain. We performed emergent endoscopy and successfully removed several foreign bodies. After 17 days, we performed appendectomy to remove the remaining foreign body and to relieve the symptoms. There is no doubt that endoscopic intervention is definitely useful method to remove foreign bodies. If there is no spontaneous drainage of the foreign body from the appendix, an appendectomy must be considered to remove the foreign body and prevent surgical complications such as appendicitis, periappendiceal abscess, and perforation. PMID:26366386

  13. Torsion of epiploic appendage mimic acute appendicitis.

    PubMed

    Pogorelić, Zenon; Stipić, Radoslav; Druzijanić, Nikica; Perko, Zdravko; Grandić, Leo; Vilović, Katarina; Mrklić, Ivana; Jurić, Ivo; Boschi, Vladimir; Bekavac, Josip

    2011-12-01

    Epiploic appendagitis is a rare cause of focal abdominal pain which, depending on its localisation, can mimic a variety of abdominal diseases. We report a case of 36-year-old woman who presented with a classic signs of acute appendicitis. On examination, the obese, afebrile, and had very strong right iliac fossa tenderness and guarding. The white cell count was 12.82 x 10(9)/L, and C reactive protein count was 15.13MG/DL. She underwent emergency laparoscopic procedure after the acute appendicitis diagnosis has been established. Laparoscopic exploration of the abdominal cavity showed vermiform, no inflamed, appendix and necrotic appendix epiploica of the caecum. The treatment consisted of typical laparoscopic appendectomy and laparoscopic resection of the necrotic appendix epiploica. The patient made rapid recovery and was discharged from the hospital on second day after the operation. Histological investigation of the appendix epiploica revealed gangrenous epiploic appendage. PMID:22397276

  14. Missed appendicitis diagnosis: A case report

    PubMed Central

    Cox, Jocelyn; Sovak, Guy

    2015-01-01

    Objective: The purpose of this case report is to highlight and emphasize the need for an appropriate and thorough list of differential diagnoses when managing patients, as it is insufficient to assume cases are mechanical, until proven non-mechanical. There are over 250,000 cases of appendicitis annually in the United States. Of these cases, <50% present with classic signs and symptoms of pain in the right lower quadrant, mild fever and nausea. It is standard for patients who present with appendicitis to be managed operatively with a laparoscopic appendectomy within 24 hours, otherwise the risk of complications such as rupture, infection, and even death increases dramatically. Clinical Features: This is a retrospective case report following a 27-year-old male with missed appendicitis, who presented to a chiropractor two-weeks after self-diagnosed food poisoning. On assessment, he was tender with resisted lumbar rotation. Psoas Sign, McBurney’s Point, vascular exam, hip exam, were negative. A diagnosis of an abdominal strain was provided. Two weeks later, he returned to the chiropractor without an improvement of symptoms. Intervention & Outcome: The patient was sent to the hospital, where he was provided a diagnosis of missed appendicitis. He required a hemicolonectomy due to the associated phlegmonous mass. Summary: When a patient presents to a chiropractic clinic with symptoms of abdominal pain, having a comprehensive list of non-mechanical differential diagnoses as well as mechanical differentials is crucial. Appropriate assessment and management of abdominal cases decreases the risk to patients, as missed diagnoses often require more invasive interventions. PMID:26500364

  15. Pain

    MedlinePlus

    ... realize you have a medical problem that needs treatment. Once you take care of the problem, pain ... Fortunately, there are many ways to treat pain. Treatment varies depending on the cause of pain. Pain ...

  16. Appendicitis in mature patients.

    PubMed Central

    Burns, R P; Cochran, J L; Russell, W L; Bard, R M

    1985-01-01

    All patients greater than 50 years of age (N = 96) admitted with a pre- or postoperative diagnosis of acute appendicitis from 1971 to 1980 were reviewed. A comparative series of 91 patients aged 25 to 50 years was similarly reviewed. Noninflammatory diseases of the appendix and incidental appendectomies were excluded. Detailed study of symptoms, clinical presentation, laboratory evaluation, radiographic evaluation, concomitant diseases, hospital course, surgical findings, complications, and mortality were completed. Comparison of patients aged 25 to 50 to patients older than 50 years revealed a statistically significant increased incidence of perforation in the older group (p less than 0.0001). Sixty-five per cent of the older group showed greater incidence of perforation. Further analysis of this series yields the hypothesis that the increased incidence of perforation is related to a significant decrease in the frequency of classic presentation in the greater-than-50 age group, a significant decrease in frequency of correct admission diagnosis and a significant delay between admission and surgical procedure in the older group. A more rapid pathophysiologic progression of appendicitis with increasing age was noted. A much higher percentage of older patients was undiagnosed until the surgical procedure. In this group, there was a longer duration of symptoms, less frequent classic presentation, and decreased frequency of right lower quadrant guarding and tenderness as compared to patients with correct diagnosis prior to surgery. Complications were much more frequent in older patients and higher still in those with perforation. Analysis of findings by decade of life revealed an anticipated high incidence of perforated appendicitis in patients greater than 50, but also showed a continuation of the high incidence of perforation into the decade 40 to 50. There were three deaths in the entire study group (1.6%) all occurring in the older age group with postoperative

  17. An unusual presentation of perforated appendicitis in epigastric region☆

    PubMed Central

    Odabasi, Mehmet; Arslan, Cem; Abuoglu, Hasan; Gunay, Emre; Yildiz, Mehmet Kamil; Eris, Cengiz; Ozkan, Erkan; Aktekin, Ali; Muftuoglu, M.A. Tolga

    2013-01-01

    INTRODUCTION Atypical presentations of appendix have been reported including backache, left lower quadrant pain and groin pain from a strangulated femoral hernia containing the appendix. We report a case presenting an epigastric pain that was diagnosed after computed tomography as a perforated appendicitis on intestinal malrotation. PRESENTATION OF CASE A 27-year-old man was admitted with a three-day history of epigastric pain. Physical examination revealed tenderness and defense on palpation of epigastric region. There was a left subcostal incision with the history of diaphragmatic hernia repair when the patient was 3 days old. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver. DISCUSSION While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality. CONCLUSION Atypical presentations of acute appendicitis should be kept in mind in patients with abdominal pain in emergency room especially in patients with previous childhood operation for diaphragmatic hernia. PMID:24441442

  18. Acute Appendicitis Secondary to Acute Promyelocytic Leukemia

    PubMed Central

    Rodriguez, Eduardo A.; Lopez, Marvin A.; Valluri, Kartik; Wang, Danlu; Fischer, Andrew; Perdomo, Tatiana

    2015-01-01

    Patient: Female, 43 Final Diagnosis: Myeloid sarcoma appendicitis Symptoms: Abdominal pain • chills • fever Medication: — Clinical Procedure: Laparoscopic appendectomy, bone marrow biopsy Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: The gastrointestinal tract is a rare site for extramedullary involvement in acute promyelocytic leukemia (APL). Case Report: A 43-year-old female with no past medical history presented complaining of mild abdominal pain, fever, and chills for the past day. On examination, she was tachycardic and febrile, with mild tenderness of her right lower quadrant and without signs of peritoneal irritation. Laboratory examination revealed pancytopenia and DIC, with a fibrinogen level of 290 mg/dL. CT of the abdomen showed a thickened and hyperemic appendix without perforation or abscess, compatible with acute appendicitis. The patient was given IV broad-spectrum antibiotics and was transfused with packed red blood cells and platelets. She underwent uncomplicated laparoscopic appendectomy and bone marrow biopsy, which revealed neo-plastic cells of 90% of the total bone marrow cellularity. Flow cytometry indicated presence of 92.4% of immature myeloid cells with t (15: 17) and q (22: 12) mutations, and FISH analysis for PML-RARA demonstrated a long-form fusion transcript, positive for APL. Appendix pathology described leukemic infiltration with co-expression of myeloperoxidase and CD68, consistent with myeloid sarcoma of the appendix. The patient completed a course of daunorubicin, cytarabine, and all trans-retinoic acid. Repeat bone marrow biopsy demonstrated complete remission. She will follow up with her primary care physician and hematologist/oncologist. Conclusions: Myeloid sarcoma of the appendix in the setting of APL is very rare and it might play a role in the development of acute appendicitis. Urgent management, including bone marrow biopsy for definitive diagnosis and urgent surgical intervention

  19. Acute Appendicitis and Pneumatosis in a Duplicated Appendix With Schistosoma Remnants.

    PubMed

    Handra-Luca, Adriana; Bisseret, Damien; Dragoescu, Ema

    2016-02-01

    Appendiceal pneumatosis is rare, reported either in the context of acute appendicitis or enterocolitis. Here, we report the case of an elderly adult in whom the acute appendicitis was associated with pneumatosis and occurred in the context of a malformed appendix with pathogenic organism remnants. A 72-year-old man presented with abdominal pain 3 weeks after posttraumatic dorsolumbar surgery. The computed tomography scan showed acute appendicitis and 2 diverticula. On microscopy, the appendix showed acute appendicitis along with a Cave-Wallbridge type A duplication. In addition, several optically clear spaces were observed in the entire appendiceal wall consistent with pneumatosis of the appendix. Focally, calcified structures suggesting pathogenic organisms such as Schistosoma were noted as well. In conclusion, we report a case of appendiceal pneumatosis occurring in the context of acute appendicitis in a duplicated appendix, with presence of calcified structures suggestive of pathogenic organisms. PMID:26272990

  20. Necrotizing fasciitis caused by perforated appendicitis: a case report

    PubMed Central

    Hua, Jie; Yao, Le; He, Zhi-Gang; Xu, Bin; Song, Zhen-Shun

    2015-01-01

    Acute appendicitis is one of the most common causes of acute abdominal pain. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in diagnosis or treatment may result in increased risks of complications, such as perforation, which is associated with increased morbidity and mortality rates. Necrotizing fasciitis caused by perforated appendicitis is extremely rare. We herein report a case of 50-year-old man presenting with an appendiceal abscess in local hospital. After ten days of conservative treatment with intravenous antibiotics, the patient complained about pain and swelling of the right lower limb and computed tomography (CT) demonstrated a perforated appendix and gas and fluid collection extending from his retroperitoneal cavity to the subcutaneous layer of his right loin and right lower limb. He was transferred to our hospital and was diagnosed with necrotizing fasciitis caused by perforated appendicitis. Emergency surgery including surgical debridement and appendectomy was performed. However, the patient died of severe sepsis and multiple organ failure two days after the operation. This case represents an unusual complication of a common disease and we should bear in mind that retroperitoneal inflammation and/or abscesses may cause necrotizing fasciitis through lumbar triangles. PMID:26045863

  1. Necrotizing fasciitis caused by perforated appendicitis: a case report.

    PubMed

    Hua, Jie; Yao, Le; He, Zhi-Gang; Xu, Bin; Song, Zhen-Shun

    2015-01-01

    Acute appendicitis is one of the most common causes of acute abdominal pain. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in diagnosis or treatment may result in increased risks of complications, such as perforation, which is associated with increased morbidity and mortality rates. Necrotizing fasciitis caused by perforated appendicitis is extremely rare. We herein report a case of 50-year-old man presenting with an appendiceal abscess in local hospital. After ten days of conservative treatment with intravenous antibiotics, the patient complained about pain and swelling of the right lower limb and computed tomography (CT) demonstrated a perforated appendix and gas and fluid collection extending from his retroperitoneal cavity to the subcutaneous layer of his right loin and right lower limb. He was transferred to our hospital and was diagnosed with necrotizing fasciitis caused by perforated appendicitis. Emergency surgery including surgical debridement and appendectomy was performed. However, the patient died of severe sepsis and multiple organ failure two days after the operation. This case represents an unusual complication of a common disease and we should bear in mind that retroperitoneal inflammation and/or abscesses may cause necrotizing fasciitis through lumbar triangles. PMID:26045863

  2. Amebiasis presenting as acute appendicitis.

    PubMed

    Andrade, Javier E; Mederos, Raul; Rivero, Haidy; Sendzischew, Morgan A; Soaita, Mauela; Robinson, Morton J; Sendzischew, Harry; Danielpour, Payman

    2007-11-01

    Amebiasis presenting as acute appendicitis is extremely rare. The case of a 38-year-old Hispanic man who presented to the hospital with symptoms and signs suggestive of acute appendicitis is reported. He underwent laparoscopic appendectomy and the pathologic examination of the appendix revealed multiple trophozoites of Entamoeba histolytica. The patient was treated postoperatively with metronidazole for amebiasis, and follow-up stool studies showed no sign of residual infection. The patient has remained asymptomatic. PMID:17984748

  3. Are antibiotics a safe and effective treatment for acute uncomplicated appendicitis?

    PubMed

    Moraga, Felipe; Ahumada, Vanessa; Crovari, Fernando

    2016-01-01

    Acute appendicitis is a common cause of acute abdominal pain and the most frequent cause of emergency abdominal surgery. In the last two decades, growing evidence has been published about the use of antibiotics as the exclusive treatment for acute appendicitis. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified only one systematic review including one pertinent randomized trial. We generated a summary of findings following the GRADE approach. We concluded the use of antibiotics to treat acute uncomplicated appendicitis may be less effective than appendectomy and probably increases major complications compared with appendectomy. PMID:26817927

  4. Left-Sided Appendicitis in an Elderly Patient with Midgut Malrotation.

    PubMed

    Chuang, Pei Wen; Huang, Bo-Ming; Liu, Chung Hsien; Chen, Chien-Chin; Tsai, Ming-Jen

    2015-12-01

    Appendicitis is a common surgical abdominal disease with various presentations. Its diagnosis may be obscured by asymptomatic congenital anatomical anomalies like midgut malrotation. Midgut malrotation is a rare fetal anomaly resulting from incomplete or failure of midgut rotation and fixation. It is mostly presented with bowel obstruction or volvulus in early life. Presentation in adult is rare. Here, we report an elderly patient presented with left lower abdominal pain and urinary tract infection. Abdominal computed tomography revealed left-sided appendicitis with non-rotational-type midgut malrotation. Clinicians should bear in mind the possibility of underlying midgut malrotation, as appendicitis could be the first presentation of this rare congenital condition. PMID:27011586

  5. Endometriosis of the appendix presenting as acute appendicitis: a case report and literature review.

    PubMed

    Uwaezuoke, Stanley; Udoye, Ezenwa; Etebu, Ebitimitula

    2013-03-01

    Endometriosis is a common disease generally, but appendiceal endometriosis causing acute appendicitis is a very uncommon clinical phenomenon and a few cases have been reported. The authors aim to highlight the rarity of such clinical entity in Nigeria. A 29 year old nulliparous woman presented with severe right iliac fossa pains, tenderness and rebound tenderness on her second day of menstruation. She subsequently had appendicectomy and a histopathological diagnosis of appendiceal endometriosis causing acute appendicitis. Appendiceal endometriosis causing acute appendicitis is rare, and definitive diagnosis is performed through histopathological evaluation. Post-operative gynaecological follow-up is highly recommended. PMID:23559841

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

    PubMed Central

    Toumi, Zaher; Chan, Anthony; Hadfield, Matthew B; Hulton, Neil R

    2010-01-01

    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. PMID:20513274

  7. A Very Rare Complication of Acute Appendicitis: Appendicovesical Fistula

    PubMed Central

    Alis, Deniz; Samanci, Cesur; Namdar, Yesim; Ustabasioglu, Fethi Emre; Yamac, Elif; Tutar, Onur; Ucpinar, Burak; Onal, Bulent

    2016-01-01

    Appendicovesical fistula (AVF) is an uncommon type of enterovesical fistula and a very rare complication of acute appendicitis. Herein, we report a case of 39-year-old male patient who presented with persistent urinary tract infection, recurrent abdominal pain, and pneumaturia. Imaging techniques including ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) were performed to identify the abnormality. However, definitive diagnosis of AVF was made by cystoscopy. PMID:27239365

  8. Unusual case of appendicitis.

    PubMed

    Allen, Luke Nelson; Tsai, Alice Yi-Chien

    2016-01-01

    A teenage girl was admitted to the paediatric assessment unit with non-specific abdominal pain that gradually localised to the right iliac fossa (RIF). She remained systemically well; investigations including blood tests, urine sample and abdominal ultrasound were inconclusive. Surgical opinion was sought and the decision was made to perform a diagnostic laparoscopy due to the ongoing pain. Laparoscopy showed no evidence of any significant pathology, and appendicectomy was performed following the routine practice. Numerous pinworms came out while the appendix was resected. The RIF pain resolved and the patient made a full post-operative recovery. A stat dose of mebendazole and amoxicillin were given and the immediate family was also treated. Enterobius vermicularis (pinworm) causes significant morbidity worldwide and has a high prevalence among children in the UK. It can be easily treated and prompt recognition based on clinical symptoms can potentially prevent unnecessary surgery. PMID:27364910

  9. Wound management in perforated appendicitis.

    PubMed

    Lemieur, T P; Rodriguez, J L; Jacobs, D M; Bennett, M E; West, M A

    1999-05-01

    Open wound management after perforated appendicitis was common practice but, recently, primary closure has been advocated to reduce costs and morbidity. Hospital records from 319 adults who underwent appendectomy from 1993 to 1996 were reviewed to identify surgical wound infections (SWIs) and examine risk factors. Information about age, length of stay (LOS), operative time, white blood cell count, and antibiotic administration were obtained. Perforation was either noted at operation or identified microscopically by the pathologist. If primary wound closure was performed, patients with acute appendicitis and perforation had a 4-fold higher readmission rate, a 5-fold increase in SWI, and twice the LOS compared with patients with acute appendicitis without perforation. Patients with grossly perforated acute appendicitis had no difference in LOS if the wound was treated open or closed primarily. No patient with microscopic perforation and primary wound closure developed SWI. Primary wound closure after acute appendicitis was safe in the absence of clinical perforation. In the presence of clinical appendiceal perforation the wound should be left open. PMID:10231213

  10. Characteristic clinical features of Aspergillus appendicitis: Case report and literature review

    PubMed Central

    Gjeorgjievski, Mihajlo; Amin, Mitual B; Cappell, Mitchell S

    2015-01-01

    This work aims to facilitate diagnosing Aspergillus appendicitis, which can be missed clinically due to its rarity, by proposing a clinical pentad for Aspergillus appendicitis based on literature review and one new case. The currently reported case of pathologically-proven Aspergillus appendicitis was identified by computerized search of pathology database at William Beaumont Hospital, 1999-2014. Prior cases were identified by computerized literature search. Among 10980 pathology reports of pathologically-proven appendicitis, one case of Aspergillus appendicitis was identified (rate = 0.01%). A young boy with profound neutropenia, recent chemotherapy, and acute myelogenous leukemia presented with right lower quadrant pain, pyrexia, and generalized malaise. Abdominal computed tomography scan showed a thickened appendiceal wall and periappendiceal inflammation, suggesting appendicitis. Emergent laparotomy showed an inflamed, thickened appendix, which was resected. The patient did poorly postoperatively with low-grade-fevers while receiving antibacterial therapy, but rapidly improved after initiating amphotericin therapy. Microscopic examination of a silver stain of the appendectomy specimen revealed fungi with characteristic Aspergillus morphology, findings confirmed by immunohistochemistry. Primary Aspergillus appendicitis is exceptionally rare, with only 3 previously reported cases. All three cases presented with (1)-neutropenia, (2)-recent chemotherapy, (3)-acute leukemia, and (4)-suspected appendicitis; (5)-the two prior cases initially treated with antibacterial therapy, fared poorly before instituting anti-Aspergillus therapy. The current patient satisfied all these five criteria. Based on these four cases, a clinical pentad is proposed for Aspergillus appendicitis: clinically-suspected appendicitis, neutropenia, recent chemotherapy, acute leukemia, and poor clinical response if treated solely by antibacterial/anti-candidial therapy. Patients presenting with

  11. Appendicitis - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Appendicitis URL of this page: https://medlineplus.gov/languages/appendicitis.html Other topics A-Z A B ...

  12. Appendicitis - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Appendicitis URL of this page: https://www.nlm.nih.gov/medlineplus/languages/appendicitis.html Other topics A-Z A B ...

  13. UNDESCENDED TESTICLE COMPLICATING ACUTE APPENDICITIS*

    PubMed Central

    Herzig, Maximilian L.

    1924-01-01

    1. Symptoms referable to compression of the spermatic cord and incarceration of right testicle, obscure the underlying pathologic changes occurring in the vermiform appendix. 2. Testicular underdevelopment and resulting subnormal cerebration. 3. Operative technique: (a) Pre-operative diagnosis: Incarceration of right testicle and possible perforative appendicitis. (b) Descent of right incarcerated testicle. Bassini closure. (c) Exploratory laparotomy: Intramuscular gridiron incision. 4. Operative findings: (a) Strangulation and incarceration of undescended right testicle and spermatic cord in inguinal canal. (b) Copious pus, free in peritoneal cavity. An adherent, sloughing, perforative, retrocecal appendix identified, left undisturbed and free drainage established. 5. Progress: (a) Eventful recovery from acute suppurative appendicitis following drainage of appendical focus. (b) Marked development following the operative descent of an incarcerated testicle in a backward boy, age twelve, who had a bilateral cryptorchism. PMID:18739377

  14. Acute appendicitis following endoscopic mucosal resection of cecal adenoma.

    PubMed

    Nemoto, Yukako; Tokuhisa, Junya; Shimada, Nagasato; Gomi, Tatsuya; Maetani, Iruru

    2015-07-21

    Endoscopic mucosal resection (EMR) allows the removal of flat or sessile lesions, laterally spreading tumors, and carcinoma of the colon or the rectum limited to the mucosa or the superficial submucosa. Acute appendicitis is the most common abdominal emergency requiring emergency surgery, and it is also a rare complication of diagnostic colonoscopy and therapeutic endoscopy, including EMR. In the case presented here, a 53-year-old female underwent colonoscopy due to a positive fecal occult blood test and was diagnosed with cecal adenoma. She was referred to our hospital and admitted for treatment. The patient had no other symptoms. EMR was performed, and 7 h after the surgery, the patient experienced right -lower abdominal pain. Laboratory tests performed the following day revealed a WBC count of 16000/mm(3), a neutrophil count of 14144/mm(3), and a C-reactive protein level of 2.20 mg/dL, indicating an inflammatory response. Computed tomography also revealed appendiceal wall thickening and swelling, so acute appendicitis following EMR was diagnosed. Antibiotics were initiated leading to total resolution of the symptoms, and the patient was discharged on the sixth post-operative day. Pathological analysis revealed a high-grade cecal tubular adenoma. Such acute appendicitis following EMR is extremely rare, and EMR of the cecum may be a rare cause of acute appendicitis. PMID:26217100

  15. Acute appendicitis following endoscopic mucosal resection of cecal adenoma

    PubMed Central

    Nemoto, Yukako; Tokuhisa, Junya; Shimada, Nagasato; Gomi, Tatsuya; Maetani, Iruru

    2015-01-01

    Endoscopic mucosal resection (EMR) allows the removal of flat or sessile lesions, laterally spreading tumors, and carcinoma of the colon or the rectum limited to the mucosa or the superficial submucosa. Acute appendicitis is the most common abdominal emergency requiring emergency surgery, and it is also a rare complication of diagnostic colonoscopy and therapeutic endoscopy, including EMR. In the case presented here, a 53-year-old female underwent colonoscopy due to a positive fecal occult blood test and was diagnosed with cecal adenoma. She was referred to our hospital and admitted for treatment. The patient had no other symptoms. EMR was performed, and 7 h after the surgery, the patient experienced right -lower abdominal pain. Laboratory tests performed the following day revealed a WBC count of 16000/mm3, a neutrophil count of 14144/mm3, and a C-reactive protein level of 2.20 mg/dL, indicating an inflammatory response. Computed tomography also revealed appendiceal wall thickening and swelling, so acute appendicitis following EMR was diagnosed. Antibiotics were initiated leading to total resolution of the symptoms, and the patient was discharged on the sixth post-operative day. Pathological analysis revealed a high-grade cecal tubular adenoma. Such acute appendicitis following EMR is extremely rare, and EMR of the cecum may be a rare cause of acute appendicitis. PMID:26217100

  16. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis.

    PubMed

    Di Saverio, Salomone; Birindelli, Arianna; Kelly, Micheal D; Catena, Fausto; Weber, Dieter G; Sartelli, Massimo; Sugrue, Michael; De Moya, Mark; Gomes, Carlos Augusto; Bhangu, Aneel; Agresta, Ferdinando; Moore, Ernest E; Soreide, Kjetil; Griffiths, Ewen; De Castro, Steve; Kashuk, Jeffry; Kluger, Yoram; Leppaniemi, Ari; Ansaloni, Luca; Andersson, Manne; Coccolini, Federico; Coimbra, Raul; Gurusamy, Kurinchi S; Campanile, Fabio Cesare; Biffl, Walter; Chiara, Osvaldo; Moore, Fred; Peitzman, Andrew B; Fraga, Gustavo P; Costa, David; Maier, Ronald V; Rizoli, Sandro; Balogh, Zsolt J; Bendinelli, Cino; Cirocchi, Roberto; Tonini, Valeria; Piccinini, Alice; Tugnoli, Gregorio; Jovine, Elio; Persiani, Roberto; Biondi, Antonio; Scalea, Thomas; Stahel, Philip; Ivatury, Rao; Velmahos, George; Andersson, Roland

    2016-01-01

    Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics. PMID:27437029

  17. Atypical presentation of appendicitis in an adolescent cheerleader.

    PubMed

    DeFilippis, Ersilia M; Callahan, Lisa M

    2013-11-01

    A 15-year-old female cheerleader presented to a sports medicine physician for evaluation of a suspected hip flexor injury. Five weeks before presentation, the patient developed acute right lower quadrant (RLQ) pain. She was seen in a local emergency room where her vital signs, abdominal computed tomography, and ultrasound were normal. No definitive diagnosis was made. Her initial symptoms resolved. The patient then attended cheerleading camp where her RLQ pain recurred and she was referred to sports medicine for further evaluation. Her examination was significant for exquisite tenderness at McBurney point. She was referred for surgical evaluation for probable appendicitis. PMID:23846117

  18. Appendicitis in Dar es Salaam, histological pattern.

    PubMed

    Mbembati, N A; Lema, L E; Mwakyoma, H A; Ussiri, E V

    1996-03-01

    Histology of 378 appendicectomy specimens submitted to the Histopathology Department of Muhimbili Medical Centre from its surgical wards over a 10 year period (1985 to 1994) were reviewed. There were 185 cases (48.9 pc) of acute appendicitis, 101 cases (26.7 pc) of chronic appendicitis, 74 (19.6 pc) normal appendices and 13 cases (3.5 pc) schistosomal appendicitis. There were two cases of tuberculous appendicitis and two cases of mucocele of the appendix. Apart from the high frequency of chronic appendicitis the histological findings in this study compare well with findings reported from other studies. PMID:8653771

  19. Appendicitis complicated by appendiceal metastasis via peritoneal dissemination from lung cancer.

    PubMed

    Shiota, Naoki; Furonaka, Makoto; Kikutani, Kazuya; Haji, Keiko; Fujisaki, Seiji; Nishida, Toshihiro

    2016-07-01

    Peritoneal disseminations from lung cancer are difficult to detect during the patient's clinical course. Therefore, complications of this condition are unclear. We report a case in which peritoneal dissemination from lung cancer complicated appendicitis. A 74-year-old man with lung cancer who was receiving maintenance therapy presented at our hospital because of abdominal pain. It was the seventh day after the 14th cycle of maintenance therapy with bevacizumab. He was diagnosed with acute appendicitis. The resected appendix showed acute appendicitis complicated by appendiceal metastasis from lung cancer. Adenocarcinoma was observed predominantly in the serous membrane from the neck to the tail of the appendix. The distribution of the adenocarcinoma was diffuse. Peritoneal dissemination was considered the route of metastasis. He was admitted to the palliative care unit 10 months after appendectomy. Appendiceal metastasis via peritoneal dissemination from lung cancer complicated appendicitis in our patient who had been receiving bevacizumab. PMID:27512565

  20. Appendicitis complicated by appendiceal metastasis via peritoneal dissemination from lung cancer

    PubMed Central

    Furonaka, Makoto; Kikutani, Kazuya; Haji, Keiko; Fujisaki, Seiji; Nishida, Toshihiro

    2016-01-01

    Abstract Peritoneal disseminations from lung cancer are difficult to detect during the patient's clinical course. Therefore, complications of this condition are unclear. We report a case in which peritoneal dissemination from lung cancer complicated appendicitis. A 74‐year‐old man with lung cancer who was receiving maintenance therapy presented at our hospital because of abdominal pain. It was the seventh day after the 14th cycle of maintenance therapy with bevacizumab. He was diagnosed with acute appendicitis. The resected appendix showed acute appendicitis complicated by appendiceal metastasis from lung cancer. Adenocarcinoma was observed predominantly in the serous membrane from the neck to the tail of the appendix. The distribution of the adenocarcinoma was diffuse. Peritoneal dissemination was considered the route of metastasis. He was admitted to the palliative care unit 10 months after appendectomy. Appendiceal metastasis via peritoneal dissemination from lung cancer complicated appendicitis in our patient who had been receiving bevacizumab. PMID:27512565

  1. The utility of acoustic radiation force impulse imaging in diagnosing acute appendicitis and staging its severity

    PubMed Central

    Göya, Cemil; Hamidi, Cihad; Okur, Mehmet Hanifi; İçer, Mustafa; Oğuz, Abdullah; Hattapoğlu, Salih; Çetinçakmak, Mehmet Güli; Teke, Memik

    2014-01-01

    PURPOSE The aim of this study was to investigate the feasibility of using acoustic radiation force impulse (ARFI) imaging to diagnose acute appendicitis. METHODS Abdominal ultrasonography (US) and ARFI imaging were performed in 53 patients that presented with right lower quadrant pain, and the results were compared with those obtained in 52 healthy subjects. Qualitative evaluation of the patients was conducted by Virtual Touch™ tissue imaging (VTI), while quantitative evaluation was performed by Virtual Touch™ tissue quantification (VTQ) measuring the shear wave velocity (SWV). The severity of appendix inflammation was observed and rated using ARFI imaging in patients diagnosed with acute appendicitis. Alvarado scores were determined for all patients presenting with right lower quadrant pain. All patients diagnosed with appendicitis received appendectomies. The sensitivity and specificity of ARFI imaging relative to US was determined upon confirming the diagnosis of acute appendicitis via histopathological analysis. RESULTS The Alvarado score had a sensitivity and specificity of 70.8% and 20%, respectively, in detecting acute appendicitis. Abdominal US had 83.3% sensitivity and 80% specificity, while ARFI imaging had 100% sensitivity and 98% specificity, in diagnosing acute appendicitis. The median SWV value was 1.11 m/s (range, 0.6–1.56 m/s) for healthy appendix and 3.07 m/s (range, 1.37–4.78 m/s) for acute appendicitis. CONCLUSION ARFI imaging may be useful in guiding the clinical management of acute appendicitis, by helping its diagnosis and determining the severity of appendix inflammation. PMID:25323836

  2. A young man with concurrent acute appendicitis and incarcerated right indirect inguinal hernia

    PubMed Central

    Ditsatham, Chagkrit; Somwangprasert, Areewan; Watcharachan, Kirati; Wongmaneerung, Phanchaporn

    2016-01-01

    Objective Acute appendicitis and incarcerated hernia rarely present in the same episode. Our study reports patient presentation, diagnosis method, and treatment of an unusual case at the Chiang Mai University Hospital. Method Case report. Result A 20-year-old man visited the Chiang Mai University Hospital with right lower quadrant pain and a right groin mass which could not be reduced. The computerized tomography scan showed acute appendicitis and omentum in the hernia sac. Operative treatment was an appendectomy and herniorrhaphy. The treatment was successful, and the patient was discharged from our hospital without any complications. Conclusion Concurrent acute appendicitis and incarcerated hernia are very rare, but should be kept in mind if a patient presents with right lower quadrant pain and a right groin mass. Further investigation may be helpful if the diagnosis is uncertain. Operative priority treatment depends on each individual case. PMID:26834499

  3. Perforated double appendicitis: Horseshoe type.

    PubMed

    Bulut, Serap Pamak; Cabıoğlu, Neslihan; Akıncı, Muzaffer

    2016-01-01

    Appendix vermiformis duplex is an infrequent malformation. However if it is missed out, there might be some complications and medicolegal troubles. A surgeon must be aware of any other appendix during appendectomy. Therefore, the possible locations and shapes described in the Cave-Wallbridge classification should be considered by the surgeon. In this case report, we present a patient with a horseshoe-type dupplication of appendix in a perforated appendicitis diagnosed during an emergency laparotomy. PMID:27436939

  4. Perforated double appendicitis: Horseshoe type

    PubMed Central

    Bulut, Serap Pamak; Cabıoğlu, Neslihan; Akıncı, Muzaffer

    2016-01-01

    Appendix vermiformis duplex is an infrequent malformation. However if it is missed out, there might be some complications and medicolegal troubles. A surgeon must be aware of any other appendix during appendectomy. Therefore, the possible locations and shapes described in the Cave-Wallbridge classification should be considered by the surgeon. In this case report, we present a patient with a horseshoe-type dupplication of appendix in a perforated appendicitis diagnosed during an emergency laparotomy. PMID:27436939

  5. Lower Abdominal Pain.

    PubMed

    Carlberg, David J; Lee, Stephen D; Dubin, Jeffrey S

    2016-05-01

    Although most frequently presenting with lower abdominal pain, appendicitis, colitis, and diverticulitis can cause pain throughout the abdomen and can cause peritoneal and retroperitoneal symptoms. Evaluation and management of lower intestinal disease requires a nuanced approach by the emergency physician, sometimes requiring computed tomography, ultrasonography, MRI, layered imaging, shared decision making, serial examination, and/or close follow-up. Once a presumed or confirmed diagnosis is made, appropriate treatment is initiated, and may include surgery, antibiotics, and/or steroids. Appendicitis patients should be admitted. Diverticulitis and inflammatory bowel disease can frequently be managed on an outpatient basis, but may require admission and surgical consultation. PMID:27133242

  6. Paradigm Shifts in the Treatment of Appendicitis.

    PubMed

    Mak, Grace Zee; Loeff, Deborah S

    2016-07-01

    Acute appendicitis is the most common cause of emergent surgery in children. Historically, surgical dogma dictated emergent appendectomy due to concern for impending perforation. Recently, however, there has been a paradigm shift in both the understanding of its pathophysiology as well as its treatment to more nonoperative management. No longer is it considered a spectrum from uncomplicated appendicitis inevitably progressing to complicated appendicitis over time. Rather, uncomplicated and complicated appendicitis are now considered two distinct pathophysiologic entities. This change requires not only educating the patients and their families but also the general practitioners who will be managing treatment expectations and caring for patients long term. In this article, we review the pathophysiology of appendicitis, including the differentiation between uncomplicated and complicated appendicitis, as well as the new treatment paradigms. [Pediatr Ann. 2016;45(7):e235-e240.]. PMID:27403670

  7. Historical aspects of appendicitis in children.

    PubMed

    Hamill, James K; Liley, Andrew; Hill, Andrew G

    2014-05-01

    Evidence of appendicitis exists from ancient Egyptian mummies but the appendix was not discovered as an anatomical entity until the renaissance in Western European literature. Much confusion reigned over the cause of right iliac fossa inflammatory disease until the late 19th century, when the appendix was recognized as the cause of the great majority of cases. Coining the term 'appendicitis' and making the case for early surgery, Fitz in 1886 set the scene for recovery from appendicitis through operative intervention. PMID:24165165

  8. Radiation appendicitis: demonstration with graded compression US

    SciTech Connect

    Puylaert, J.B.; Hoekstra, F.; de Vries, B.C.; Rutgers, P.H.; Lalisang, R.I.; Ooms, E.C.

    1987-08-01

    In a patient who had received presurgical radiation therapy for extensive rectal carcinoma, ultrasonography with graded compression disclosed an inflamed appendix. The patient had no clinical signs of acute appendicitis. At laparotomy for resection of the rectal carcinoma, the appendix appeared grossly abnormal and was removed. Pathologic examination showed severe radiation enteritis of the appendix. The sonographic appearance of radiation appendicitis closely resembled that of acute appendicitis.

  9. Abdominal computed tomography during pregnancy for suspected appendicitis: a 5-year experience at a maternity hospital.

    PubMed

    Shetty, Mahesh K; Garrett, Nan M; Carpenter, Wendy S; Shah, Yogesh P; Roberts, Candace

    2010-02-01

    The objective of this article is to evaluate the role of computed tomography (CT) in a pregnant patient with right lower quadrant pain in whom there was a clinical suspicion of acute appendicitis. During a 5-year period the clinical records of all pregnant women who underwent imaging examination for clinically suspected appendicitis were reviewed. The imaging findings were correlated with patient management and final outcome. Thirty-nine pregnant patients were referred for imaging, of which 35 underwent initial evaluation with sonography, 23 of these women underwent a computed tomographic examination, and an additional 4 patients were directly imaged with CT without earlier sonographic assessment. Surgery confirmed appendicitis in all 5 patients who were operated on on the basis of findings of appendicitis on a CT scan. Two patients underwent surgery based on an alternate diagnosis suggested preoperatively (tubal torsion = 1, ovarian torsion = 1). All patients with negative findings at CT had an uneventful clinical course. In those patients who were evaluated only with ultrasound, a diagnosis of appendicitis was missed in 5 patients. The sensitivity of CT in the diagnosis of appendicitis in our study group was 100%, compared with a sensitivity of 46.1% for ultrasound. CT provides an accurate diagnosis in patients suspected to have acute appendicitis and is of value in avoiding false negative exploratory laparatomy with its consequent risk of maternal and fetal mortality and morbidity. Although sonography is the preferred initial imaging modality as its lack of ionizing radiation, CT is more accurate in providing a timely diagnosis and its use is justified to reduce maternal mortality and mortality in patients with appendicitis. PMID:20102691

  10. [New ways in the surgery of acute appendicitis?].

    PubMed

    Magdeburg, R; Kähler, G

    2013-06-01

    Acute appendicitis is still one of the most common abdominal emergencies necessitating operative treatment. For the past century, the conventional management of appendicitis has been open appendectomy. Since the introduction of laparoscopic appendectomy, it has been performed with increased frequency. Clinical trials evaluating outcomes comparing open appendectomy with laparoscopic appendectomy indicate that laparoscopic appendectomy is associated with lower complication rate and lower mortality and is to be considered the procedure of choice for patients with suspected acute appendicitis. Ever since Kalloo's first report on transgastric peritoneoscopy in a porcine model in 2004, this dramatic surgical revolution has prompted many surgeons and endoscopists to study this new technique. This complex technique involves breaching the wall of a hollow organ to gain access into the peritoneum: Natural Orifice Translumenal Endoscopic Surgery (NOTES). In recent years, several NOTES experiments have been carried out in animal models and even on humans, including appendectomy. NOTES may help to reduce surgical pain and shorten recovery time. The concept of NOTES has generated intensive interest in the medical community as well as in the group of patients. Although the novel procedure is still far from being mature and many technical problems have to be overcome and more clinical studies have to be done before its widespread application in human appendectomy, NOTES is a promising procedure for the future. PMID:23325519

  11. Gangrenous Appendicitis in a Boy with Mobile Caecum.

    PubMed

    Keskin, Suat; Keskin, Zeynep; Gunduz, Metin; Sekmenli, Taner; Kivrak, Hatice Yazar

    2015-04-01

    A mobile caecum and ascending colon is an uncommon congenital disorder, and it is even rarer as the cause of an acute abdomen during childhood. This report presents the case of a 6-year-old boy with acute gangrenous appendicitis with a mobile caecum and ascending colon. Data from the surgical course, as well as laboratory and imaging studies, were acquired and carefully examined. Emergency ultrasound (US) was performed and revealed no signs of appendicitis in the right lower quadrant. Serial imaging study, including non-enhanced computed tomography (CT), was performed. An imaging study identified epigastric appendicitis with mobile caecum. Surgery was executed under general anesthesia with a median incision extending from the epigastrium to the suprapubic region. The caecum was mobile and placed in the right epigastric area, next to the left lobe of the liver and gallbladder. The gangrenous appendix was discovered posterior to the caecum and transverse colon, enlarging to the left upper quadrant. Appendectomy was executed, the gangrenous appendix was confirmed pathologically, and the patient was released 4 days later. In the US, if there are unusual clinical findings or no findings in patients with abdominal pain, CT is beneficial in determining the location of the caecum and appendix and preventing misdiagnosis in children. PMID:26060548

  12. Abdominal CT Does Not Improve Outcome for Children with Suspected Acute Appendicitis

    PubMed Central

    Miano, Danielle I.; Silvis, Renee M.; Popp, Jill M.; Culbertson, Marvin C.; Campbell, Brendan; Smith, Sharon R.

    2015-01-01

    Introduction Acute appendicitis in children is a clinical diagnosis, which often requires preoperative confirmation with either ultrasound (US) or computed tomography (CT) studies. CTs expose children to radiation, which may increase the lifetime risk of developing malignancy. US in the pediatric population with appropriate clinical follow up and serial exam may be an effective diagnostic modality for many children without incurring the risk of radiation. The objective of the study was to compare the rate of appendiceal rupture and negative appendectomies between children with and without abdominal CTs; and to evaluate the same outcomes for children with and without USs to determine if there were any associations between imaging modalities and outcomes. Methods We conducted a retrospective chart review including emergency department (ED) and inpatient records from 1/1/2009–2/31/2010 and included patients with suspected acute appendicitis. Results 1,493 children, aged less than one year to 20 years, were identified in the ED with suspected appendicitis. These patients presented with abdominal pain who had either a surgical consult or an abdominal imaging study to evaluate for appendicitis, or were transferred from an outside hospital or primary care physician office with the stated suspicion of acute appendicitis. Of these patients, 739 were sent home following evaluation in the ED and did not return within the subsequent two weeks and were therefore presumed not to have appendicitis. A total of 754 were admitted and form the study population, of which 20% received a CT, 53% US, and 8% received both. Of these 57%, 95% CI [53.5,60.5] had pathology-proven appendicitis. Appendicitis rates were similar for children with a CT (57%, 95% CI [49.6,64.4]) compared to those without (57%, 95% CI [52.9,61.0]). Children with perforation were similar between those with a CT (18%, 95% CI [12.3,23.7]) and those without (13%, 95% CI [10.3,15.7]). The proportion of children with a

  13. [13-Year old boy with abdominal pain].

    PubMed

    Thomassen, Irene; Klinkhamer, Paul J J M; van de Poll, Marcel C G

    2012-01-01

    A 13-year old boy presents with pain in the lower right abdomen, showing clinical signs of appendicitis. During McBurney' incision an appendix sana was seen. Histologic examination showed penetrating enterobiasis. This was treated with mebendazol. PMID:22551758

  14. Acute appendicitis: position paper, WSES, 2013.

    PubMed

    Agresta, Ferdinando; Ansaloni, Luca; Catena, Fausto; Verza, Luca Andrea; Prando, Daniela

    2014-01-01

    Appendectomy is one of the most frequently performed operative procedures in general surgery departments of every size and category. Laparoscopic Appendectomy - LA - as compared to Open Appendectomy - OA - was very controversial at first but has found increasing acceptance all over the World, although the percentage of its acceptance is different in the various single National setting. Various meta-analyses and Cochrane reviews have compared LA with OA and different technical details. Furthermore, new surgical methods have recently emerged, namely, the single-port/incision laparoscopic appendectomy and NOTES technique. Their distribution among the hospitals, however, is unclear. Using laparoscopic mini-instruments with trocars of 2-3.5 mm diameter is proposed as a reliable alternative due to less postoperative pain and improved aesthetics. How to proceed in case of an inconspicuous appendix during a procedure planned as an appendectomy remains controversial despite existing study results. But the main question still is: operate or not operate an acute appendicitis, in the meaning of an attempt of a conservative antibiotic therapy. Therefore, we have done a literature survey on the performance of appendectomies and their technical details as well as the management of the intraoperative finding of an inconspicuous appendix in order to write down - under the light of the latest evidence - a position paper. PMID:24708651

  15. Appendicitis in double cecal appendix: Case report

    PubMed Central

    Alves, José Roberto; Maranhão, Ícaro Godeiro de Oliveira; de Oliveira, Patrick Vanttinny Vieira

    2014-01-01

    Double cecal appendix is a rare anatomical variation. Approximately 100 cases have been reported worldwide. It is usually diagnosed incidentally during emergency appendectomies due to inflammatory processes in the cecal appendix. Case presentation: male, white, 36 years old, obese, presenting with pain in the lower abdomen for 24 h followed by nausea, vomiting and mild fever. He was subjected to additional tests, with the leukogram showing leukocytosis and abdominal ultrasonography depicting cecal appendix with thickened wall, locally associated with small quantities of liquid and intestinal loop obstruction. He underwent laparotomy, revealing acute appendicitis. Another intestinal loop obstruction was identified next to the ileum, leading to recognizing another cecal appendix after local dissection. Double appendectomy and segmental iliectomy were performed although not needed. Results of the anatomopathological examination of the surgical samples showed acute inflammation in the two cecal appendices. So, performing a routine retroperitoneal release and a complete cecum evaluation during such surgical procedures is recommended and suggested due to the possibility of not identifying a second cecal appendix. PMID:25133154

  16. Acute neonatal appendicitis in a preterm.

    PubMed

    Mammou, Sihem; Ayadi, Imen; Ben Hamida, Emira; Marrakchi, Zahra

    2015-01-01

    Acute neonatal appendicitis is very rare in the neonatal period. It is usually associated with comorbidity including prematurity. Symptoms are non-specific. The prognosis is marked by high risk of mortality and morbidity. Here, we report a case of preterm new born who presented with sepsis, apnoea, and digestive signs. The laparotomy revealed perforated appendicitis complicated with peritonitis. PMID:26712299

  17. Acute neonatal appendicitis in a preterm

    PubMed Central

    Mammou, Sihem; Ayadi, Imen; Hamida, Emira Ben; Marrakchi, Zahra

    2015-01-01

    Acute neonatal appendicitis is very rare in the neonatal period. It is usually associated with comorbidity including prematurity. Symptoms are non-specific. The prognosis is marked by high risk of mortality and morbidity. Here, we report a case of preterm new born who presented with sepsis, apnoea, and digestive signs. The laparotomy revealed perforated appendicitis complicated with peritonitis. PMID:26712299

  18. Berberine Improves Intestinal Motility and Visceral Pain in the Mouse Models Mimicking Diarrhea-Predominant Irritable Bowel Syndrome (IBS-D) Symptoms in an Opioid-Receptor Dependent Manner

    PubMed Central

    Pan, Qiuhui; Fichna, Jakub; Zheng, Lijun; Wang, Kesheng; Yu, Zhen; Li, Yongyu; Li, Kun; Song, Aihong; Liu, Zhongchen; Song, Zhenshun; Kreis, Martin

    2015-01-01

    Background and Aims Berberine and its derivatives display potent analgesic, anti-inflammatory and anticancer activity. Here we aimed at characterizing the mechanism of action of berberine in the gastrointestinal (GI) tract and cortical neurons using animal models and in vitro tests. Methods The effect of berberine was characterized in murine models mimicking diarrhea-predominant irritable bowel syndrome (IBS-D) symptoms. Then the opioidantagonists were used to identify the receptors involved. Furthermore, the effect of berberineon opioid receptors expression was established in the mouse intestine and rat fetal cortical neurons. Results In mouse models, berberine prolonged GI transit and time to diarrhea in a dose-dependent manner, and significantly reduced visceral pain. In physiological conditions the effects of berberine were mediated by mu- (MOR) and delta- (DOR) opioidreceptors; hypermotility, excessive secretion and nociception were reversed by berberine through MOR and DOR-dependent action. We also found that berberine increased the expression of MOR and DOR in the mouse bowel and rat fetal cortical neurons. Conclusion Berberine significantly improved IBS-D symptoms in animal models, possibly through mu- and delta- opioid receptors. Berberine may become a new drug candidate for the successful treatment of IBS-D in clinical conditions. PMID:26700862

  19. Meralgia Paresthetica as a Presentation of Acute Appendicitis in a Girl With Acute Lymphoblastic Leukemia.

    PubMed

    Nishimura, Miho; Kodama, Yuichi; Fukano, Reiji; Okamura, Jun; Ogaki, Kippei; Sakaguchi, Yoshihisa; Migita, Masahiro; Inagaki, Jiro

    2015-04-01

    A 7-year-old girl with Philadelphia chromosome-positive acute lymphoblastic leukemia developed recurrent fever and meralgia paresthetica (MP) during chemotherapy, which resolved after administration of antibiotics. Five months after the onset of these symptoms, enhanced computed tomography showed a periappendiceal abscess extending into the psoas muscle. The cause of her fever and MP was thought to be appendicitis, which probably developed during induction chemotherapy but did not result in typical abdominal pain. Patients with recurrent fever and MP should be evaluated by imaging examinations including computed tomography to search for appendicitis. PMID:24942034

  20. Left-sided appendicitis in children with congenital gastrointestinal malrotation: a diagnostic pitfall in the emergency department

    PubMed Central

    Taslakian, Bedros; Issa, Ghada; Hourani, Roula; Akel, Samir

    2013-01-01

    Acute appendicitis is one of the most common conditions requiring emergency surgery. However, acute appendicitis presenting with left lower quadrant abdominal pain is extremely rare. Imaging, particularly CT , plays an important role in establishing an accurate and prompt diagnosis, as delay in diagnosis may occur due to lack of uniformity in the clinical signs and symptoms. We report a rare case of a 10-year-old boy who presented with persistent left lower quadrant pain of several days duration, in which the CT scan of the abdomen and pelvis was essential in establishing the correct diagnosis. The malpositioned inflamed appendix was clearly identified in the left side of the abdomen, with the characteristic CT findings of uncomplicated intestinal malrotation. Left-sided acute appendicitis should be considered in the differential diagnosis of young patients presenting with left lower quadrant pain, in order to avoid delay in diagnosis and guide the surgical intervention. PMID:23761499

  1. Appendicitis

    MedlinePlus

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  2. Appendicitis

    MedlinePlus

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  3. Appendicitis

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  4. Clinical significance of elevated serum and urine amylase levels in patients with appendicitis.

    PubMed

    Swensson, E E; Maull, K I

    1981-12-01

    During the 45 month period beginning January 1977, 251 patients with a pathologically confirmed diagnosis of acute appendicitis underwent celiotomy at the Medical College of Virginia Hospital. A preoperative serum or urine amylase determination was recorded in 155 of the patients (62 percent). Of this group, 15 patients (10 percent) had elevation of serum amylase or 2 hour urine amylase. Hyperamylasemia or hyperamylasuria directly led to misdiagnosis or treatment delay in 5 of the 15 patients. Appendiceal rupture occurred in three patients, two of whom had prolonged (greater than 1 month) hospitalizations directly attributable to the misdiagnosis. As a result of this study, we conclude that (1) acute appendicitis and elevated amylase levels may occur concurrently, (2) hyperamylasemia or hyperamylasuria should not dissuade the surgeon from early operation if other clinical features suggest appendicitis, and (3) abdominal pain and elevation of amylase level define significant intraabdominal disease, not specifically pancreatic disease. PMID:6172043

  5. Nematode infection: A rare mimic of acute appendicitis

    PubMed Central

    Hotchen, Andrew; Chin, Kian; Raja, Mahzar

    2014-01-01

    INTRODUCTION Acute appendicitis is a common condition seen in all surgical units. One rare condition that can mimic acute appendicitis is a nematode infection of the bowel. There have been few reported cases of nematode infection within the appendix and none that have been accompanied by intra-operative pictures. PRESENTATION OF CASE A 16-year-old female presented with a 12 h history of right iliac fossa pain and mild pyrexia. Bloods showed a neutrophilia and normal C-reactive protein. Laparoscopy was performed which revealed a non-inflamed appendix. The appendix was dissected and a live nematode was visualised exiting the base of the appendix. Anti-helminthics were given and the infection resolved. DISCUSSION Nematode infection is most commonly seen in Africa, Asia and South America. When seen within the United Kingdom (UK), it is seen most commonly within high-risk populations. Testing for these infections is not routine within the UK and when they are performed, the results take a considerable amount of time to return. These tests should be considered within high-risk populations so that unnecessary surgery can be avoided. CONCLUSION This case highlights the importance of considering rare causes of right iliac fossa pain including nematode infection in a young patient. The case highlights this by giving intra-operative pictures of live nematodes upon dissection of the appendix. PMID:25024022

  6. Macroamylasemia in a patient with acute appendicitis: a case report.

    PubMed

    Um, J W; Kim, K H; Kang, M S; Choe, J H; Bae, J W; Hong, Y S; Suh, S O; Kim, Y C; Whang, C W; Kim, S M

    1999-12-01

    Macroamylasemia is a condition of persistent, elevated serum amylase activity with no apparent clinical symptoms of a pancreatic disorder. In Korea, however, no such case has been reported to date. We report a case of a 17-year-old female diagnosed with macroamylasemia and acute appendicitis. One day earlier, she developed epigastric and right lower quadrant abdominal pain. She was characterized by high level of serum amylase, but normal lipase. Amylase isoenzyme analysis demonstrated increased fraction of salivary type and follow-up amylase level was persistently increased. Immunofixation disclosed the macroamylase binding with an immunoglobulin, consisting of IgA and kappa chain. The patient was treated by appendectomy, and the abdominal pain subsided. PMID:10642949

  7. Amebiasis presenting as acute appendicitis: Report of a case and review of Japanese literature

    PubMed Central

    Ito, Daisuke; Hata, Shojirou; Seiichiro, Shimizu; Kobayashi, Kaoru; Teruya, Masanori; Kaminishi, Michio

    2014-01-01

    INTRODUCTION Outside of these high-risk regions, acute amebic appendicitis is considerably rarer and the mortality rate is much higher than with non-amebic appendicitis. PRESENTATION OF CASE A 31-year-old woman presented with fever and right lower abdominal pain with no history of traveling abroad or sexual infection. Computed tomography revealed a dilated appendix and thickened cecal and ascending colon walls. She underwent an appendectomy for appendicitis. Owing to a lack of symptom resolution, we performed a pathologic examination of the appendix again that revealed multiple Entamoeba histolytica trophozoites; the serum amebic antibody was positive. She was treated postoperatively with metronidazole for amebiasis and discharged on postoperative day 12. DISCUSSION The mortality rate and frequency of severe postoperative intraabdominal complications were higher in the Japanese literature (1995–2013) (25% and 33%, respectively) than in other developed countries (3.3% and 19.4%, respectively). Japan is a low-risk area for amebiasis; many physicians fail to consider amebiasis in the differential diagnosis of acute abdomen. It is important to conduct further examinations, including those for amebiasis, when appendectomy does not resolve acute appendicitis. CONCLUSION We report a case of acute amebic appendicitis in a 31-year-old woman and review the ages at presentation, causative factors, treatments, and outcomes of 11 cases reported in Japan between 1995 and 2013. PMID:25460473

  8. AIR SCORE ASSESSMENT FOR ACUTE APPENDICITIS

    PubMed Central

    VON-MÜHLEN, Bruno; FRANZON, Orli; BEDUSCHI, Murilo Gamba; KRUEL, Nicolau; LUPSELO, Daniel

    2015-01-01

    Background: Acute appendicitis is the most common cause of acute abdomen. Approximately 7% of the population will be affected by this condition during full life. The development of AIR score may contribute to diagnosis associating easy clinical criteria and two simple laboratory tests. Aim: To evaluate the score AIR (Appendicitis Inflammatory Response score) as a tool for the diagnosis and prediction of severity of acute appendicitis. Method: Were evaluated all patients undergoing surgical appendectomy. From 273 patients, 126 were excluded due to exclusion criteria. All patients were submitted o AIR score. Results: The value of the C-reactive protein and the percentage of leukocytes segmented blood count showed a direct relationship with the phase of acute appendicitis. Conclusion: As for the laboratory criteria, serum C-reactive protein and assessment of the percentage of the polymorphonuclear leukocytes count were important to diagnosis and disease stratification. PMID:26537139

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

    PubMed

    Derr, Charlotte; Goldner, D Eliot

    2009-06-01

    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. PMID:19497487

  10. The role of neutrophil lymphocyte ratio to leverage the differential diagnosis of familial Mediterranean fever attack and acute appendicitis

    PubMed Central

    Kucuk, Adem; Erol, Mehmet Fatih; Senel, Soner; Eroler, Emir; Yumun, Havvanur Alparslan; Uslu, Ali Ugur; Erol, Asiye Mukaddes; Tihan, Deniz; Duman, Ugur; Kucukkartallar, Tevfik; Solak, Yalcin

    2016-01-01

    Background/Aims: Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by attacks of fever and diffuse abdominal pain. The primary concern with this presentation is to distinguish it from acute appendicitis promptly. Thus, we aimed to evaluate the role of neutrophil lymphocyte ratio (NLR) to leverage the differential diagnosis of acute FMF attack with histologically proven appendicitis. Methods: Twenty-three patients with histologically confirmed acute appendicitis and 88 patients with acute attack of FMF were included in the study. NLR, C-reactive protein and other hematologic parameters were compared between the groups. Results: Neutrophil to lymphocyte ratio was significantly higher in patients with acute appendicitis compared to the FMF attack group (8.24 ± 6.31 vs. 4.16 ± 2.44, p = 0.007). The performance of NLR in diagnosing acute appendicitis with receiver operating characteristic analysis with a cut-off value of 4.03 were; 78% sensitivity, 62% specificity, and area under the curve 0.760 (95% confidence interval, 0.655 to 0.8655; p < 0.001). Conclusions: This study showed that NLR, the simple and readily available inflammatory marker may have a useful role in distinguishing acute FMF attack from acute appendicitis. PMID:26864298

  11. [History of surgical treatment of appendicitis].

    PubMed

    Meljnikov, Igor; Radojcić, Branka; Grebeldinger, Slobodan; Radojcić, Nikola

    2009-01-01

    Most of the history of appendicitis and appendectomy has been made during the past two centuries. Jacopo Berengario da Carpi gave the first description of this structure in 1522. Gabriele Fallopio, in 1561, appears to have been the first writer to compare the appendix to a worm. In1579 Caspar Bauhin proposed the ingenious theory that the appendix served in intrauterine life as a receptacle for the faexes. Many of anatomists added more or less insignificant ideas concerning the structure of the appendix and entered upon useless controversy concerning the name, function, position of the appendix vermiformis. The first successful appendectomy was performed in 1735 by Claudius Amyand. Geillaume Dupuytren considered that acute inflammation of the right side of the abdomen arose from disease of the caecum and not the appendix. As surgeons were wary of opening the abdomen for examination, early stages of appendicitis remained unknown. John Parkinson was able to give a good description of fatal appendicitis in 1812. Surgeons began draining localised abscesses which had already formed. In 1880 Robert Lawson Tait made the first diagnosis of appendicitis and surgically removed the appendix. In 1886 Reginald Heber Fitz published a study on appendicitis and named the procedure an appendectomy. In 1889, Tait split open and drained an inflamed appendix without removing it. Charles McBurney proposed his original muscle splitting operation in 1893 and this was modified by Robert Fulton Weir in 1900. Today we have a multiplicity of signs and symptoms, helping to diagnose appendicitis, and there are a lot of techniques for operation with little essential difference throughout. Kurt Semm performed the first laparoscopic appendectomy in 1981 which became a new gold standard in surgical treatment of acute and chronic appendicitis. PMID:20391748

  12. A case of Fournier’s gangrene in a young immunocompetent male patient resulting from a delayed diagnosis of appendicitis

    PubMed Central

    Wanis, Michael; Nafie, Shady; Mellon, John Kilian

    2016-01-01

    We discuss the case of a 28-year-old male patient presenting to our department with an atypical history of acute scrotal swelling on a background of abdominal pain. He was diagnosed with a perforated appendicitis and Fournier’s gangrene. PMID:27106611

  13. A case of Fournier's gangrene in a young immunocompetent male patient resulting from a delayed diagnosis of appendicitis.

    PubMed

    Wanis, Michael; Nafie, Shady; Mellon, John Kilian

    2016-01-01

    We discuss the case of a 28-year-old male patient presenting to our department with an atypical history of acute scrotal swelling on a background of abdominal pain. He was diagnosed with a perforated appendicitis and Fournier's gangrene. PMID:27106611

  14. Henoch-Schönlein Purpura Associated with Gangrenous Appendicitis: A Case Report

    PubMed Central

    SEMEENA, NK; ADLEKHA, Shashikant

    2014-01-01

    Henoch-Schönlein Purpura (HSP) is a leucocytoclastic vasculitis of unclear aetiology characterised by symmetrical, non-traumatic, nonthrombocytopenic purpura mostly involving the lower limbs and buttocks, as well as arthritis, gastrointestinal manifestations, and occasional nephritis. A 35 years old male presented with purpuric rash on the lower extremities, abdominal pain, fever, arthralgia, and melaena. A diagnosis of HSP with appendicitis was made, which is an exceedingly rare phenomenon. PMID:24876811

  15. Missed appendicitis: did unexpected intraluminal densities play a role?

    PubMed

    Harper, Rachel; Friedman, Benjamin T; Strote, Jared

    2016-01-01

    A healthy 19-year-old boy presented to our emergency department with abdominal pain. His history, examination and laboratory evaluation raised concern for appendicitis. A CT study of the abdomen and pelvis was carried out by the radiologist and emergency physician and was notable only for a large amount of unexpected high-attenuation intraluminal material. With further history, this was thought to be most likely retained bismuth from over-the-counter medicine ingestion. The patient was discharged home without a diagnosis. Further review of the CT scan by a second radiologist revealed a concern for appendiceal enlargement and associated free fluid. The patient was called back for further evaluation and treatment and ultimately an appendectomy was performed. Physicians should be aware of the causes and impact of unexpected radiopaque intraluminal contents on radiological studies. Most commonly from ingested medicine, such findings can obscure mucosal details, mimic active bleeding or create a distraction from other abnormalities. PMID:27605197

  16. [Acute appendicitis in children: serious complications when treatment is delayed].

    PubMed

    Tan, E C T H; Rieu, P N M A; Severijnen, R S V M

    2002-08-10

    Three children, two boys aged 9 and 6 and a 12-year-old girl, had diffuse abdominal complaints, diarrhoea and a (sub)febrile temperature for several days. On admission, they were found to have a perforated inflamed appendix and peritonitis. Following asystole, intra-abdominal abscesses and an enterocutaneous fistula, the oldest boy showed good recovery after a hospital stay of two months; the girl recovered after one month in hospital following a psoas muscle abscess and two episodes of constrictive pericarditis with threatened tamponade. The younger boy was dead on arrival at the hospital. Appendicitis is not always easy to diagnose. An atypical presentation, very often with diarrhoea, can result in diagnostic delay. Early surgical consultation is mandatory in a child with progressive abdominal pain. PMID:12198823

  17. Mild Appendicitis Complication Rates Similar for Surgery, Antibiotics

    MedlinePlus

    ... html Mild Appendicitis Complication Rates Similar for Surgery, Antibiotics Decision not to operate might be matter of ... 25, 2016 FRIDAY, March 25, 2016 (HealthDay News) -- Antibiotics can be used to treat mild appendicitis, but ...

  18. Appendicitis in Children: Evaluation of the Pediatric Appendicitis Score in Younger and Older Children

    PubMed Central

    Salö, Martin; Friman, Gustav; Stenström, Pernilla; Ohlsson, Bodil; Arnbjörnsson, Einar

    2014-01-01

    Background. This study aimed to evaluate Pediatric Appendicitis Score (PAS), diagnostic delay, and factors responsible for possible late diagnosis in children <4 years compared with older children who were operated on for suspected appendicitis. Method. 122 children, between 1 and 14 years, operated on with appendectomy for suspected appendicitis, were retrospectively analyzed. The cohort was divided into two age groups: ≥4 years (n = 102) and <4 years (n = 20). Results. The mean PAS was lower among the younger compared with the older patients (5.3 and 6.6, resp.; P = 0.005), despite the fact that younger children had more severe appendicitis (75.0% and 33.3%, resp.; P = 0.001). PAS had low sensitivity in both groups, with a significantly lower sensitivity among the younger patients. Parent and doctor delay were confirmed in children <4 years of age with appendicitis. PAS did not aid in patients with doctor delay. Parameters in patient history, symptoms, and abdominal examination were more diffuse in younger children. Conclusion. PAS should be used with caution when examining children younger than 4 years of age. Diffuse symptoms in younger children with acute appendicitis lead to delay and to later diagnosis and more complicated appendicitis. PMID:25574500

  19. Appendicitis in children less than five years old: A challenge for the general practitioner.

    PubMed

    Marzuillo, Pierluigi; Germani, Claudio; Krauss, Baruch S; Barbi, Egidio

    2015-05-01

    Acute appendicitis is one of the most common indications for abdominal surgery in pediatrics with peak incidence in the second decade of life. Acute appendicitis in the first years of life is an uncommon event. The clinical presentation is often varied and the diagnosis may be overshadowed by other medical conditions. Gastroenteritis is the most common misdiagnosis, with a history of diarrhea present in 33% to 41% of patients. Pain is the most common presenting symptom in children less than 5 years old, followed by vomiting, fever, anorexia and diarrhea. The most common physical sign is focal tenderness (61% of the patients) followed by guarding (55%), diffuse tenderness (39%), rebound (32%), and mass (6%). Neonatal appendicitis is a very rare disease with high mortality; presenting symptoms are nonspecific with abdominal distension representing the main clinical presentation. The younger the patient, the earlier perforation occurs: 70% of patients less than 3 years develop a perforation within 48 h of onset of symptoms. A timely diagnosis reduces the risk of complications. We highlight the epidemiology, pathophysiology, clinical signs and laboratory clues of appendicitis in young children and suggest an algorithm for early diagnosis. PMID:26015876

  20. Evaluation of Clinical Alvarado Scoring System and CT Criteria in the Diagnosis of Acute Appendicitis

    PubMed Central

    Gunes Tatar, Idil; Yilmaz, Kerim Bora; Sahin, Alpaslan; Aydin, Hasan; Akinci, Melih; Hekimoglu, Baki

    2016-01-01

    Aim. The aim was to evaluate the clinical Alvarado scoring system and computed tomography (CT) criteria for the diagnosis of acute appendicitis. Material and Methods. 117 patients with acute abdominal pain who underwent abdominal CT were enrolled in this retrospective study. Patient demographics, clinical Alvarado scoring, CT images, and pathologic results of the patients were evaluated. Results. 39 of the 53 patients who were operated on had pathologically proven acute appendicitis. CT criteria of appendiceal diameter, presence of periappendiceal inflammation, fluid, appendicolith, and white blood cell (WBC) count were significantly correlated with the inflammation of the appendix. The best cut-off value for appendiceal diameter was 6.5 mm. The correlation between appendiceal diameter and WBC count was 80% (P = 0.01 < 0.05). The correlation between appendiceal diameter and Alvarado score was 78.7% (P = 0.01 < 0.05). Conclusion. Presence of CT criteria of appendiceal diameter above 6.5 mm, periappendiceal inflammation, fluid, and appendicolith should prompt the diagnosis of acute appendicitis. Since patients with acute appendicitis may not always show the typical signs and symptoms, CT is a helpful imaging modality for patients with relatively low Alvarado score and leukocytosis and when physical examination is confusing. PMID:27242926

  1. Systemic Mastocytosis Presenting as Acute Appendicitis: A Case Report and Review of the Literature

    PubMed Central

    A. Akbar, Syed; Raza, Shahzad; E. Denney, Jason; J. Johannesen, Eric; C. Doll, Donald

    2013-01-01

    Systemic mastocytosis is characterized by abnormal growth and accumulation of mast cells in various organs. Gastrointestinal (GI) symptoms are common disease manifestations in this disease and can significantly impair the quality of life. Signs of GI systemic mastocytosis include steatorrhea, malabsorption, hepatomegaly, splenomegaly, portal hypertension, and ascites. Acute appendicitis as a presenting feature in systemic mastocytosis has not been reported in the literature previously. In this report, we discuss the case of a female patient with systemic mastocytosis (c-KIT D816V (+)) who was admitted for right-sided acute abdominal pain. Laboratory study revealed an normal white blood cell count with eosinophilia and an elevated serum tryptase level of 23 μg/l. CT of the abdomen and pelvis showed an enlarged appendix of 12 mm in diameter, with minimal wall enhancement. Laparoscopic appendectomy was performed. The appendix was found to be hyperemic and firm, and it was densely adherent to the posterior cecum, the surrounding peritoneal wall, and the overlying mesenteric fat. Pathology revealed acute appendicitis with greater than 30 mast cells per high-power field by immunoperoxidase studies with mast cell tryptase and CD117. The patient subsequently improved and was discharged home. This case is the first reported case with a histological diagnosis of acute appendicitis resulting from mast cell infiltration. Physicians should be aware of acute appendicitis as a manifestation of systemic mastocytosis. Prompt diagnosis and management may prevent potentially fatal complications of appendiceal perforation and peritonitis. PMID:23626557

  2. Appendicitis in children less than five years old: A challenge for the general practitioner

    PubMed Central

    Marzuillo, Pierluigi; Germani, Claudio; Krauss, Baruch S; Barbi, Egidio

    2015-01-01

    Acute appendicitis is one of the most common indications for abdominal surgery in pediatrics with peak incidence in the second decade of life. Acute appendicitis in the first years of life is an uncommon event. The clinical presentation is often varied and the diagnosis may be overshadowed by other medical conditions. Gastroenteritis is the most common misdiagnosis, with a history of diarrhea present in 33% to 41% of patients. Pain is the most common presenting symptom in children less than 5 years old, followed by vomiting, fever, anorexia and diarrhea. The most common physical sign is focal tenderness (61% of the patients) followed by guarding (55%), diffuse tenderness (39%), rebound (32%), and mass (6%). Neonatal appendicitis is a very rare disease with high mortality; presenting symptoms are nonspecific with abdominal distension representing the main clinical presentation. The younger the patient, the earlier perforation occurs: 70% of patients less than 3 years develop a perforation within 48 h of onset of symptoms. A timely diagnosis reduces the risk of complications. We highlight the epidemiology, pathophysiology, clinical signs and laboratory clues of appendicitis in young children and suggest an algorithm for early diagnosis. PMID:26015876

  3. Melorheostosis mimicking synovial osteochondromatosis.

    PubMed

    Wadhwa, Vibhor; Chhabra, Avneesh; Samet, Jonathan D

    2014-01-01

    Melorheostosis is an uncommon, sporadic, sclerosing bone lesion that may affect the adjacent soft tissues. It has been associated with many entities such as osteopoikilosis, soft tissue vascular malformations, bone and soft tissue tumors, nephrotic syndrome, segmental limb contractures, osteosarcoma, desmoid tumor, and mesenteric fibromatosis. Synovial osteochondromatosis is a benign neoplasia of the hyaline cartilage presenting as nodules in the subsynovial tissue of a joint or tendon sheath. The intra-articular extension of melorheostosis mimicking synovial osteochondromatosis has not been reported before. In this article, the authors describe an unusual case mimicking synovial chondromatosis arising as a result of melorheostosis and their characteristic imaging findings. PMID:25971832

  4. Appendicitis Diagnosed by Emergency Physician Performed Point-of-Care Transvaginal Ultrasound: Case Series

    PubMed Central

    Bramante, Robert; Radomski, Marek; Nelson, Mathew; Raio, Christopher

    2013-01-01

    Lower abdominal pain in females of reproductive age continues to be a diagnostic dilemma for the emergency physician (EP). Point-of-care ultrasound (US) allows for rapid, accurate, and safe evaluation of abdominal and pelvic pain in both the pregnant and non-pregnant patient. We present 3 cases of females presenting with right lower quadrant and adnexal tenderness where transvaginal ultrasonography revealed acute appendicitis. The discussion focuses on the use of EP- performed transvaginal US in gynecologic and intra-abdominal pathology and discusses the use of a staged approach to evaluation using US and computed tomography, as indicated. PMID:24106529

  5. Cytomegalovirus appendicitis in an immunocompetent host.

    PubMed

    Canterino, Joseph E; McCormack, Michael; Gurung, Ananta; Passarelli, James; Landry, Marie L; Golden, Marjorie

    2016-05-01

    Cytomegalovirus (CMV) is a common viral pathogen. Asymptomatic infection or a mononucleosis syndrome are the most common manifestations in otherwise healthy individuals. End-organ disease is rare in immunocompetent individuals. Here, we describe a case of CMV appendicitis in a patient without an immune-compromising condition. PMID:26942831

  6. Necrotizing fasciitis: a rare complication of appendicitis.

    PubMed

    Mazza, J F; Augenstein, J S; Kreis, D J

    1987-09-01

    The mortality of acute appendicitis increases sixfold if perforation occurs. We have reported a case of perforated appendix complicated by necrotizing fasciitis of the abdominal wall and retroperitoneum. We believe this complication has not been previously described in the English literature. PMID:2957793

  7. Developing and evaluating an automated appendicitis risk stratification algorithm for pediatric patients in the emergency department

    PubMed Central

    Deleger, Louise; Brodzinski, Holly; Zhai, Haijun; Li, Qi; Lingren, Todd; Kirkendall, Eric S; Alessandrini, Evaline; Solti, Imre

    2013-01-01

    Objective To evaluate a proposed natural language processing (NLP) and machine-learning based automated method to risk stratify abdominal pain patients by analyzing the content of the electronic health record (EHR). Methods We analyzed the EHRs of a random sample of 2100 pediatric emergency department (ED) patients with abdominal pain, including all with a final diagnosis of appendicitis. We developed an automated system to extract relevant elements from ED physician notes and lab values and to automatically assign a risk category for acute appendicitis (high, equivocal, or low), based on the Pediatric Appendicitis Score. We evaluated the performance of the system against a manually created gold standard (chart reviews by ED physicians) for recall, specificity, and precision. Results The system achieved an average F-measure of 0.867 (0.869 recall and 0.863 precision) for risk classification, which was comparable to physician experts. Recall/precision were 0.897/0.952 in the low-risk category, 0.855/0.886 in the high-risk category, and 0.854/0.766 in the equivocal-risk category. The information that the system required as input to achieve high F-measure was available within the first 4 h of the ED visit. Conclusions Automated appendicitis risk categorization based on EHR content, including information from clinical notes, shows comparable performance to physician chart reviewers as measured by their inter-annotator agreement and represents a promising new approach for computerized decision support to promote application of evidence-based medicine at the point of care. PMID:24130231

  8. Urticaria mimickers in children.

    PubMed

    Mathur, Anubhav N; Mathes, Erin F

    2013-01-01

    Acute urticaria is a self-limited cutaneous condition marked by transient, erythematous, and pruritic wheals. It is a hypersensitivity response that is often secondary to infection, medications, or food allergies in children. In contrast, the urticarial "mimickers" described in this review article are often seen in the context of fever and extracutaneous manifestations in pediatric patients. The differential diagnosis ranges from benign and self-limited hypersensitivity responses to multisystem inflammatory diseases. Establishing the correct diagnosis of an urticarial rash in a pediatric patient is necessary to both prevent an unnecessary work up for self-limited conditions and to appropriately recognize and evaluate multisystem inflammatory disorders. Herein, we describe two cases to illustrate the clinical manifestations, laboratory findings, histopathology and differential diagnoses for several mimickers of acute urticaria including: urticaria multiforme, serum sickness like reaction, Henoch-Schönlein purpura, acute hemorrhagic edema of infancy, systemic onset juvenile idiopathic arthritis, cryopyrin associated periodic syndromes, and urticarial vasculitis. PMID:24552410

  9. Intestinal Infarction Caused by Thrombophlebitis of the Portomesenteric Veins as a Complication of Acute Gangrenous Appendicitis After Appendectomy

    PubMed Central

    Tang, Rui; Tian, Xiaodong; Xie, Xuehai; Yang, Yinmo

    2015-01-01

    Abstract The clinical symptoms of pylephlebitis caused by acute appendicitis are varied and atypical, which leads to delayed diagnosis and poor outcomes. Here, we report a case of intestinal necrosis caused by thrombophlebitis of the portomesenteric veins as a complication of acute appendicitis after appendectomy. The patient had acute abdominal pain with tenderness and melena on the 3rd day after appendectomy for the treatment of gangrenous appendicitis. He was diagnosed with intestinal infarction caused by thrombophlebitis of the portomesenteric veins based on enhanced CT and diagnostic abdominal paracentesis. The patient was treated by bowel excision anastomosis and thrombectomy. After postoperative antibiotic and anticoagulation treatments, the patient recovered well and was discharged 22 days after the 2nd operation. A follow-up CT scan showed no recurrence of portomesenteric veins thrombosis 3 months later. Thrombophlebitis of the portomesenteric veins is a rare but fatal complication of acute appendicitis. For all the cases with acute abdominal pain, the possibility of thrombophlebitis should be considered as a differential diagnosis. Once pylephlebitis is suspected, enhanced CT scan is helpful for early diagnosis, and sufficient control of inflammation as well as anticoagulant therapy should be performed. PMID:26091450

  10. Perforated appendicitis caused by foreign body ingestion.

    PubMed

    Baek, Seong Kyu; Bae, Ok Suk; Hwang, Ilseon

    2012-04-01

    Most ingested foreign bodies pass through the gastrointestinal tract without any incident. However, foreign bodies lodged in the appendix can cause an inflammatory reaction with or without perforation. Here, we present a case of a 54-year-old woman with perforated appendicitis who consumed wild game containing a shot pellet. Five months before admission, she had eaten the meat of a pheasant that had been shot with a shotgun. Abdominal computed tomography confirmed the diagnosis of perforated appendicitis with abscess due to a foreign body. Subsequently, a laparoscopic appendectomy was performed. Follow-up radiographs obtained after the surgery did not identify the foreign body. Histolopathologic examination confirmed appendiceal perforation with focal inflammation secondary to a foreign body. PMID:22487649

  11. Teratodermoid mimicking cholecystitis.

    PubMed

    Iftikhar, Hina; Idu, Shareen; Omer, Abdel

    2016-05-01

    An acute abdomen assessment in pregnancy is complicated. Pain can have obstetric and nonobstetric causes. Cholecystitis is a common cause of pain in pregnancy with significant morbidity if not managed promptly. We report a case of a ruptured, torted, right ovarian teratodermoid erroneously diagnosed as cholecystitis in pregnancy. PMID:27190615

  12. Improving diagnosis of appendicitis. Early autologous leukocyte scanning

    SciTech Connect

    DeLaney, A.R.; Raviola, C.A.; Weber, P.N.; McDonald, P.T.; Navarro, D.A.; Jasko, I. )

    1989-10-01

    A prospective nonrandomized study investigating the accuracy and utility of autologous leukocyte scanning in the diagnosis of appendicitis was performed. One hundred patients in whom the clinical diagnosis of appendicitis was uncertain underwent indium 111 oxyquinoline labelling of autologous leukocytes and underwent scanning 2 hours following reinjection. Of 32 patients with proved appendicitis, three scans revealed normal results (false-negative rate, 0.09). Of 68 patients without appendicitis, three scans had positive results (false-positive rate, 0.03; sensitivity, 0.91; specificity, 0.97; predictive value of positive scan, 0.94; predictive value of negative scan, 0.96; and overall accuracy, 0.95). Scan results altered clinical decisions in 19 patients. In 13 cases, the scan produced images consistent with diagnoses other than appendicitis, expediting appropriate management. Early-imaging In 111 oxyquinoline autologous leukocyte scanning is a practical and highly accurate adjunct for diagnosing appendicitis.

  13. Lumbar Epidural Varix Mimicking Perineural Cyst

    PubMed Central

    Pusat, Serhat; Kural, Cahit; Aslanoglu, Atilla; Kurt, Bulent

    2013-01-01

    Lumbar epidural varices are rare and usually mimick lumbar disc herniations. Back pain and radiculopathy are the main symptoms of lumbar epidural varices. Perineural cysts are radiologically different lesions and should not be confused with epidural varix. A 36-year-old male patient presented to us with right leg pain. The magnetic resonance imaging revealed a cystic lesion at S1 level that was compressing the right root, and was interpreted as a perineural cyst. The patient underwent surgery via right L5 and S1 hemilaminectomy, and the lesion was coagulated and removed. The histopathological diagnosis was epidural varix. The patient was clinically improved and the follow-up magnetic resonance imaging showed the absence of the lesion. Lumbar epidural varix should be kept in mind in the differential diagnosis of the cystic lesions which compress the spinal roots. PMID:23741553

  14. Unusual perforated appendicitis within umbilical hernia: CT findings.

    PubMed

    Arnáiz, J; Ortiz, A; Marco de Lucas, E; Piedra, T; Jordá, J; Arnáiz, A M; Pagola, M A

    2006-01-01

    We present the first imaging report of perforated appendicitis in an umbilical hernia. Computed tomography demonstrated a gas-forming abscess within an umbilical hernia and the cecum was found inside the hernial sac, with an inner relation to the abscess. Computed tomographic findings suggested appendicitis as possible diagnosis, which was confirmed at surgery. Physicians must consider appendicitis within the differential diagnosis of an abdominal abscess located near to the cecum, even at an unexpected location. PMID:16465570

  15. Inflammatory Myofibroblastic Tumor Mimicking Apical Periodontitis.

    PubMed

    Adachi, Makoto; Kiho, Kazuki; Sekine, Genta; Ohta, Takahisa; Matsubara, Makoto; Yoshida, Takakazu; Katsumata, Akitoshi; Tanuma, Jun-ichi; Sumitomo, Shinichiro

    2015-12-01

    Inflammatory myofibroblastic tumors (IMTs) are rare. IMTs of the head and neck occur in all age groups, from neonates to old age, with the highest incidence occurring in childhood and early adulthood. An IMT has been defined as a histologically distinctive lesion of uncertain behavior. This article describes an unusual case of IMT mimicking apical periodontitis in the mandible of a 42-year-old man. At first presentation, the patient showed spontaneous pain and percussion pain at teeth #28 to 30, which continued after initial endodontic treatment. Panoramic radiography revealed a radiolucent lesion at the site. Cone-beam computed tomographic imaging showed osteolytic lesions, suggesting an aggressive neoplasm requiring incisional biopsy. Histopathological examination indicated an IMT. The lesion was removed en bloc under general anesthesia, and the patient manifested no clinical evidence of recurrence for 24 months. Lesions of nonendodontic origin should be included in the differential diagnosis of apical periodontitis. Every available diagnostic tool should be used to confirm the diagnosis. Cone-beam computed tomographic imaging is very helpful for differential diagnosis in IMTs mimicking apical periodontitis. PMID:26602450

  16. Hepatobiliary scan with delayed gallbladder visualization in a case of acute appendicitis

    SciTech Connect

    Smathers, R.L.; Harman, P.K.; Wanebo, H.J.; Read, M.E.

    1982-05-01

    A 40-year-old woman presented with acute epigastric pain with vomiting. Within 24 hours, the pain spread to the right periumbilical region. /sup 99m/Tc disofenin hepatobiliary scan failed to demonstrate the gallbladder on a 60-minute view. The presumative diagnosis of acute cholecystitis was thought to be confirmed on this basis by the patient's physicians. However, a 75-minute view demonstrated filling of the gallbladder. In hepatobiliary scanning for acute abdominal pain, delayed views (2 to 24 hours) are recommended when the gallbladder is not visualized on the 60-minute view. If the gallbladder is visualized, cystic duct obstruction can be excluded and diagnoses such as pancreatitis, acalculous cholecystitis, and acute appendicitis should be investigated.

  17. Clinical significance of de Garengeot's hernia: A case of acute appendicitis and review of the literature

    PubMed Central

    Piperos, Theodoros; Kalles, Vasileios; Al Ahwal, Yousef; Konstantinou, Evangelos; Skarpas, George; Mariolis-Sapsakos, Theodoros

    2011-01-01

    Introduction The presence of the appendix in a femoral hernia sac is known as de Garengeot's hernia. We report a rare case of an elderly woman with femoral hernia appendicitis and discuss the surgical pitfalls and considerations through a literature review. Presentation of case An 83-year-old woman presented with fever and right lower quadrant abdominal pain. Clinical examination revealed a femoral hernia. Ultrasonography confirmed bowel was present in the hernia sac. In the operation room, an acutely inflamed appendix was recognized within the sac. The patient underwent appendectomy and hernia repair with sutures. Discussion Acute appendicitis within a femoral hernia is rare and multiple dilemmas exist regarding its treatment. An incision below the inguinal ligament is a reasonable choice in order to access the hernia sac. A mesh should be placed in non-infectious appendectomy while herniorrhaphy is preferred in cases of appendicitis. Conclusion The presence of the vermiform appendix in a femoral hernia sac is rare but the surgeon should be aware of this clinical entity. Prompt diagnosis and appropriate surgical treatment is the key to avoid complications. PMID:22288062

  18. [BACTERIOLOGICAL ASPECTS OF AN ACUTE APPENDICITIS].

    PubMed

    Zhuchenko, O P

    2016-03-01

    Peculiarities of microflora in the appendix mucosa and abdominal exudate in different morphological forms of an acute appendicitis (AA) were studied up. In accordance to the bacteriological investigations data, anaerobic, and aerobic microorganisms in AA were revealed in a monoculture and in association, more frequently--obligate anaer- obes (bacteroids) with E. coli--in 82 (80.39%) observations, staphylococcus--in 52 (50.98%), fecal streptococcus--in 19 (18.63%). With progression of inflammatory process and destructive changes in the appendix wall the quantity of bacteroids and enterobacteria have had enhanced, while the quantity of lacto- and bifidumflora-- reduced. PMID:27514082

  19. [Change in pancreatic exocrine function in acute appendicitis].

    PubMed

    Ivanov, Iu A

    1979-10-01

    In order to study changes in the functional state of the pancreas 1572 investigations of the blood and urine amylase, atoxylresistant lipase of the blood serum before operation were performed in different postoperative periods in 131 patients with acute appendicitis. The enzyme activity was established to increase, especially in destructive forms of appendicitis and in elderly patients. PMID:505800

  20. Mimickers of lumbar radiculopathy.

    PubMed

    Grimm, Bennett Douglas; Blessinger, Brian Joseph; Darden, Bruce Vaiden; Brigham, Craig D; Kneisl, Jeffrey S; Laxer, Eric B

    2015-01-01

    Orthopaedic surgeons frequently treat patients who report pain that radiates from the back into the lower extremity. Although the most common etiology is either a herniated disk or spinal stenosis, a myriad of pathologies can mimic the symptoms of radiculopathy, resulting in differences in the clinical presentation and the workup. Therefore, the clinician must be able to distinguish the signs and symptoms of lumbar radiculopathy from pathologies that may have a similar presentation. Being cognizant of these other possible conditions enables the physician to consider a breadth of alternative diagnoses when a patient presents with radiating lower extremity pain. PMID:25538126

  1. Non-surgical contraindication for acute appendicitis with secondary thrombocytopenia: a case report.

    PubMed

    Zhang, Hai-Hong; Gu, Guo-Li; Zhang, Xiang-Yang; Fan, Qin; Wang, Xin-Yan; Wei, Xue-Ming

    2015-03-01

    A 26-year-old man presented with migrated right lower abdominal pain and without any history of hematological systemic diseases. Blood routine test showed a leukocyte count of 22.74 × 10(9)/L, with 91.4% neutrophils, and a platelet count of 4 × 10(9)/L before admission. The case question was whether the team should proceed with surgery. Obviously, a differential diagnosis is essential before making such a decision. Acute appendicitis was easily diagnosed based on clinical findings, including migrating abdominal pain, a leukocyte count of 22.74 × 10(9)/L and the result of abdominal computed tomography scan. However, it was not clear whether the severe thrombocytopenia was primary or secondary. So smear of peripheral blood and aspiration of bone marrow were ordered to exclude hematological diseases. Neither of the tests indicated obvious pathological hematological changes. There was no hepatosplenomegaly found by ultrasound examination of the liver and spleen. Therefore, operative intervention may be a unique clinical scenario in acute severe appendicitis patients with secondary thrombocytopenia. PMID:25759558

  2. Chronic Pain

    MedlinePlus

    ... adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting ... Institute of Neurological Disorders and Stroke (NINDS). Low Back Pain Fact Sheet Back Pain information sheet compiled by ...

  3. K-Sign in retrocaecal appendicitis: a case series

    PubMed Central

    2009-01-01

    Background Variations in position of the vermiform appendix considerably changes clinical findings. Retrocaecal appendicitis presents with slightly different clinical features from those of classical appendicitis associated with a normally sited appendix. K-sign looks for the presence of tenderness on posterior abdominal wall in the retrocaecal and paracolic appendicitis. This is the first case report of this kind in the literature. The K-sign has been named, as a mark of respect, after the region of origin of this sign, Kashmir, so called as "Kashmir Sign". The sign being present in view of inflamed appendix crossing above its non palpable position above iliac crest on the posterior abdominal wall and the tenderness is by irritation of posterior peritoneum Case presentation The author is reporting a case series of four patients in whom a K-sign, a clinical sign, was elicited and found positive on the posterior abdominal wall for presence of tenderness in a specific area bound by the 12th rib superiorly, spine medially, lateral margin of posterior abdominal wall laterally and iliac crest inferiorly and was found to be present in three retrocaecal and one paracolic appendicitis. Each case had tenderness in this specific area on posterior abdominal wall. All had appendectomy and having histopathological evidence of appendicitis. Conclusion K-sign can be useful in diagnosis of retrocaecal and paracolic appendicitis. Significance of K-sign being in view of difficulty in diagnosis of retrocaecal appendicitis and its subsequent complications. PMID:19946528

  4. Right Hydronephrosis as a Complication of Acute Appendicitis

    PubMed Central

    Okur, Selahattin Koray; Koca, Yavuz Savaş; Yıldız, İhsan; Barut, İbrahim

    2016-01-01

    Introduction. Acute appendicitis is the most common cause of acute abdomen, but atypical appendicitis may lead to delayed diagnosis and related complications. In this report, we present a very rare case of acute appendicitis causing right hydronephrosis. Case Report. A 54-year-old male patient who had been receiving antibiotic therapy due to the diagnosis of urinary tract infection for the last one week but had no clinical improvement was admitted to the emergency service. Abdominal computed tomography (CT) showed right hydronephrosis and a pelvic abscess. After appendectomy and abscess drainage had been performed, hydronephrosis was completely recovered. Discussion. The use of appendicitis scoring systems, abdominal ultrasonography (USG), abdominal CT, and diagnostic laparoscopy can be useful for the diagnostic process in patients presenting with acute abdomen. In our patient, we considered that the surgical treatment was delayed since the symptoms of acute appendicitis were suppressed by the antibiotic therapy that was being administered due to the complaints including symptoms of urinary tract infections. Conclusion. Atypical appendicitis may cause a delay in the diagnosis of acute appendicitis and thus may lead to serious complications such as right hydronephrosis, prolonged hospital stay, increased morbidity and mortality, and increased antibiotic resistance. PMID:27069699

  5. Indium-/sup 111/ leukocyte imaging in appendicitis

    SciTech Connect

    Navarro, D.A.; Weber, P.M.; Kang, I.Y.; dos Remedios, L.V.; Jasko, I.A.; Sawicki, J.E.

    1987-04-01

    Indium-/sup 111/-labeled leukocyte scintigraphy was applied to the diagnosis of acute appendicitis. Thirty-two patients observed in the hospital for possible appendicitis were prospectively studied. Scanning was done 2 hr after radiopharmaceutical injection. Thirteen scans were positive for acute appendicitis, and all but one were confirmed at laparotomy. In addition, two cases of colitis and two cases of peritonitis were detected. Of 15 negative studies, 11 had a benign course. Four patients with negative studies had laparotomy; two were found to have appendicitis and two had a normal appendix. Of 14 proven cases of appendicitis, 12 scans were positive for appendicitis with one false-positive scan, providing a sensitivity of 86%. Specificity was 93%: all negative cases except one had negative scans. Overall accuracy was 91% (29 of 32), comparing favorably with the accepted false-positive laparotomy rate of 25%. Use of In-/sup 111/-labeled leukocyte scintigraphy serves to reduce the false-positive laparotomy rate and to shorten the clinical observation time in patients with acute appendicitis.

  6. Suppurative appendicitis presenting as acute scrotum confounded by a testicular appendage

    PubMed Central

    Shumon, Syed; Bennett, John; Lawson, Geoffrey; Small, Peter

    2016-01-01

    Patients presenting with testicular pain and swelling mandate an urgent urology review and scrotal exploration to prevent testicle loss due to torsion. Other pathology masquerading as torsion is extremely rare but can occur. We present one such case. A 14-year-old male presented with a 1-day history of right testicular swelling and tenderness. He was apyrexial and denied any other symptoms. Blood tests demonstrated raised inflammatory markers. He had lower left-sided abdominal tenderness with a swollen, erythematous right hemiscrotum. During an urgent scrotal exploration for testicular torsion, a purulent hydrocele with a patent process vaginalis was noted, but no torsion. Post-operative abdominal pain mandated a general surgical review and subsequent appendicectomy. The patient made a full recovery. Acute suppurative appendicitis presenting as a urological emergency is extremely rare. To make a correct diagnosis and prevent multiple surgeries, a joint urological and general surgical assessment with a high index of suspicion is required. PMID:26966225

  7. Suppurative appendicitis presenting as acute scrotum confounded by a testicular appendage.

    PubMed

    Shumon, Syed; Bennett, John; Lawson, Geoffrey; Small, Peter

    2016-01-01

    Patients presenting with testicular pain and swelling mandate an urgent urology review and scrotal exploration to prevent testicle loss due to torsion. Other pathology masquerading as torsion is extremely rare but can occur. We present one such case. A 14-year-old male presented with a 1-day history of right testicular swelling and tenderness. He was apyrexial and denied any other symptoms. Blood tests demonstrated raised inflammatory markers. He had lower left-sided abdominal tenderness with a swollen, erythematous right hemiscrotum. During an urgent scrotal exploration for testicular torsion, a purulent hydrocele with a patent process vaginalis was noted, but no torsion. Post-operative abdominal pain mandated a general surgical review and subsequent appendicectomy. The patient made a full recovery. Acute suppurative appendicitis presenting as a urological emergency is extremely rare. To make a correct diagnosis and prevent multiple surgeries, a joint urological and general surgical assessment with a high index of suspicion is required. PMID:26966225

  8. Rhinolith mimicking a toothache

    PubMed Central

    Girgis, Sandra; Cheng, Leo; Gillett, Darren

    2015-01-01

    Introduction A rhinolith is a calcified mass formed as a result of solidification of mucous foreign objects and gradual accretion of mineral salts. Toothache is not known to be the typical presenting symptom, and to our knowledge, has yet to be reported. Case report A 42-year old female referred by her general dental practitioner with a four month history of constant pain of the unrestored upper right central incisor tooth. Incidentally, she also gave a one year history of right-sided sinonasal congestion and intermittent blood stained rhinorrhea. Discussion Rhinoliths are uncommon and rarely encountered in clinical practice. This is due to the fact that they remain asymptomatic, and undetected for many years. They may present as incidental radio-opaque lesions in the nasal maxillary antrum on routine dental panoramic radiographs. Conclusion Rhinolith should be part of the differential diagnosis of atypical anterior maxillary dental pain in the absence of obvious clinical dental pathology. PMID:26232741

  9. [Anaerobic-aerobic infection in acute appendicitis].

    PubMed

    Mamchich, V I; Ulitovskiĭ, I V; Savich, E I; Znamenskiĭ, V A; Beliaeva, O A

    1998-01-01

    362 patients with acute appendicitis (AA) were examined. For microbiological diagnosis of aerobic and anaerobic nonclostridial microflora we used complex accelerated methods (including evaluation of gram-negative microorganisms in comparison with tinctorial-fermentative method of differential staining according to oxygen sensitivity of catalasopositive together with aerobic and cathalasonegative anaerobic microorganisms) as well as complete bacteriologic examination with determination of sensitivity of the above microorganism to antimicrobial remedies. High rate of aerobic-anaerobic microbial associations and substantial identity of microflora from appendicis and exudate from abdominal cavity was revealed, which evidenced the leading role of endogenous microorganisms in etiology and pathogenesis of AA and peritonitis i. e. autoinfection. In patients with destructive forms of AA, complicated by peritonitis it is recommended to use the accelerated method of examination of pathologic material as well as the complete scheme of examination with the identification of the isolated microorganisms and the correction of antibiotic treatment. PMID:9511291

  10. Myositis ossificans: the mimicker

    PubMed Central

    Govindarajan, Arunkumar; Sarawagi, Radha; Prakash, Manikka Lakshmanan

    2013-01-01

    A 14-year-old boy presented with upper backache and a painful swelling in the right paraspinal region for 7 days. He had no history of trauma. MRI showed a non-specific ill-defined heterogeneous lesion, which showed intense postcontrast enhancement. Ultrasonogram showed a peripheral sheet of calcification around the lesion. A CT scan showed a faint rim of calcification, which increased in thickness over weeks, confirming the diagnosis as myositis ossificans. We present our approach to the case and also review the imaging features of different stages of the disease process and their differentials. PMID:24326436

  11. New synthetic strategies for xanthene-dye-appended cyclodextrins.

    PubMed

    Malanga, Milo; Darcsi, Andras; Balint, Mihaly; Benkovics, Gabor; Sohajda, Tamas; Beni, Szabolcs

    2016-01-01

    Xanthene dyes can be appended to cyclodextrins via an ester or amide bridge in order to switch the fluorescence on or off. This is made possible through the formation of nonfluorescent lactones or lactams as the fluorophore can reversibly cyclize. In this context we report a green approach for the synthesis of switchable xanthene-dye-appended cyclodextrins based on the coupling agent 4-(4,6-dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholinium chloride (DMT-MM). By using 6-monoamino-β-cyclodextrin and commercially available inexpensive dyes, we prepared rhodamine- and fluorescein-appended cyclodextrins. The compounds were characterized by NMR and IR spectroscopy and MS spectrometry, their UV-vis spectra were recorded at various pH, and their purity was determined by capillary electrophoresis. Two potential models for the supramolecular assembly of the xanthene-dye-appended cyclodextrins were developed based on the set of data collected by the extensive NMR characterization. PMID:27340446

  12. Unusual presentation of a perforated appendicitis in a four-year-old girl - a case report from Yazd, Iran

    PubMed Central

    Afrand, Mohammadhosain; Modaresi, Vajiheh

    2014-01-01

    Difficulties in the early diagnosis of appendicitis, particularly in children, often lead to complications, such as perforation of the appendix, within 36 hours of the onset of symptoms. A four-year-old girl presented to the Emergency Department at Shohadaye Kargar Hospital in Yazd (a city in central Iran) in February 2013 with a history of chronic abdominal pain that began 20 days before admission. Her physical examination revealed a low-grade fever, conjunctivitis, dysuria with malodorous urine, and a mass in right, lower quadrant without localized tenderness in that area. Intestinal intussusception was suggested as the most likely diagnosis, and a laparotomy was performed. The appendix was perforated and an appendicular abscess had caused intestinal obstruction. The rarity of this case, with its unusual presentation and findings, which included unexplained chronic pain, necessitated an immediate operation that revealed the acute presentation of a mechanical obstruction of the intestine. Appendicitis must be kept in the differential diagnosis of any child who presents with chronic abdominal pain. In conclusion, chronic abdominal pain in children is not always of functional origin, and discerning the correct diagnosis can be very challenging. Therefore, clinicians should think broadly since multi-disciplinary input may be inevitable. PMID:25763147

  13. BODIPY atropisomer interconversion, face discrimination, and superstructure appending.

    PubMed

    Doulain, Pierre-Emmanuel; Goze, Christine; Bodio, Ewen; Richard, Philippe; Decréau, Richard A

    2016-03-25

    A strategy was developed to append sterically hindered apical pickets on both faces of the BODIPY platform to prevent stacking and aggregation. Ortho-substitution of both the meso-phenyl ring and the boron-bound catechol affords the right directionality to append pickets, achieve face discrimination, featuring two interconvertible atropisomers, and is reminiscent of the picket-fence strategy in porphyrins. PMID:26927530

  14. Iterative reconstruction technique with reduced volume CT dose index: diagnostic accuracy in pediatric acute appendicitis

    PubMed Central

    Didier, Ryne A.; Vajtai, Petra L.

    2014-01-01

    Background Iterative reconstruction technique has been proposed as a means of reducing patient radiation dose in pediatric CT. Yet, the effect of such reductions on diagnostic accuracy has not been thoroughly evaluated. Objective This study compares accuracy of diagnosing pediatric acute appendicitis using contrast-enhanced abdominopelvic CT scans performed with traditional pediatric weight-based protocols and filtered back projection reconstruction versus a filtered back projection/iterative reconstruction technique blend with reduced volume CT dose index (CTDIvol). Materials and methods Results of pediatric contrast-enhanced abdominopelvic CT scans done for pain and/or suspected appendicitis were reviewed in two groups: A, 192 scans performed with the hospital’s established weight-based CT protocols and filtered back projection reconstruction; B, 194 scans performed with iterative reconstruction technique and reduced CTDIvol. Reduced CTDIvol was achieved primarily by reductions in effective tube current-time product (mAseff) and tube peak kilovoltage (kVp). CT interpretation was correlated with clinical follow-up and/or surgical pathology. CTDIvol, size specific dose estimates (SSDE) and performance characteristics of the two CT techniques were then compared. Results Between groups A and B, mean CTDIvol was reduced by 45%, and mean SSDE was reduced by 46%. Sensitivity, specificity and diagnostic accuracy were 96%, 97% and 96% in group A vs. 100%, 99% and 99% in group B. Conclusion Accuracy in diagnosing pediatric acute appendicitis was maintained in contrast-enhanced abdominopelvic CT scans that incorporated iterative reconstruction technique, despite reductions in mean CTDIvol and SSDE by nearly half as compared to the hospital’s traditional weight-based protocols. PMID:24996812

  15. An Extremely Rare Coexistence: Acute Appendicitis and Multiple Intussusceptions in an Adult

    PubMed Central

    Ozan, Ebru; Atac, Gokce Kaan

    2016-01-01

    Summary Background Adult intussusception is a rare phenomenon, acute appendicitis accompanying multiple transient intussusceptions are much more uncommon. Satisfaction and quiting imaging studies after finding an intussusception on ultrasound, may lead diagnostic errors. Radiologists should raise their awareness of imaging findings in intussusception and keep in their mind coexistent troubles in the belly. This unique case presents unusual imaging findings of a rare dual abdominal emergency condition, particularly highlighting the value of abdominal computed tomography. Case Report 32-year-old female was admitted to Emergency Department with complaints of epigastric abdominal pain and vomiting. US identified ‘target’ appereance on left paramedian location at umbilical level. Contrast enhanced abdominal CT not only confirmed the enteric intussusception that was demonstrated on previos US, but also showed additional concomitant intussusceptions and inflamed appendix. Conclusions Adult intussusception is a rare phenomenon, multiple transient intussusceptions are even more uncommon. This unique report adds, precious clinical and imaging findings of acute appendicitis coexisting with multiple spontaneously resolving intussusceptions, to the literature. Physicians should be alerted for accompanying multiple abdominal pathologies and use justification essentials to make their decisions about the selection of the appropriate imaging modality. PMID:27354879

  16. Is single port incisionless-intracorporeal conventional equipment-endoscopic surgery feasible in patients with retrocecal acute appendicitis?

    PubMed Central

    Karakus, Suleyman Cuneyt; Koku, Naim; Ertaskin, Idris

    2013-01-01

    Purpose Since laparoscopic appendectomy was first described, various modifications, such as single port incisionless-intracorporeal conventional equipment-endoscopic surgery (SPICES), have been described for reducing pain and improving cosmetic results. In the retrocecal and retrocolic positions, attachments to the lateral peritoneum and cecum may lead to difficulties during SPICES, which is performed with only one port. Here, we present the effects of variations in the position of the vermiform appendix in treating acute appendicitis with SPICES. Methods We retrospectively reviewed 52 children who underwent SPICES for acute appendicitis between March 2010 and November 2011 in our institution. One group (group A) consisted of 30 patients (mean age, 10.5 ± 2.5 years) with retrocecal appendix, while the other group (group B) included 22 patients (mean age, 10.9 ± 2.3 years) with the appendix lying free in the peritoneal cavity. Results There were no significant differences between groups in terms of patient age, gender, success rate of SPICES, mean operating time, mean follow-up period, overall complication rates or mean postoperative hospitalization period. Conclusion These results suggest that SPICES is a safe and feasible approach even in patients with retrocecal acute appendicitis. PMID:23908965

  17. Xanthogranulomatous cholecystitis mimicking gallbladder cancer.

    PubMed

    Ewelukwa, Ofor; Ali, Omair; Akram, Salma

    2014-01-01

    Xanthogranulomatous cholecystitis (XGC) is a benign, uncommon variant of chronic cholecystitis characterised by focal or diffuse destructive inflammatory process of the gallbladder (GB). Macroscopically, it appears like yellowish tumour-like masses in the wall of the GB. This article reports on a 74-year-old woman with XGC mimicking GB cancer. PMID:24811556

  18. Xanthogranulomatous cholecystitis mimicking gallbladder cancer

    PubMed Central

    Ewelukwa, Ofor; Ali, Omair; Akram, Salma

    2014-01-01

    Xanthogranulomatous cholecystitis (XGC) is a benign, uncommon variant of chronic cholecystitis characterised by focal or diffuse destructive inflammatory process of the gallbladder (GB). Macroscopically, it appears like yellowish tumour-like masses in the wall of the GB. This article reports on a 74-year-old woman with XGC mimicking GB cancer. PMID:24811556

  19. Atypical Cogan's syndrome mimicking encephalitis.

    PubMed

    Lepur, Dragan; Vranjican, Zoran; Himbele, Josip; Barsić, Bruno; Klinar, Igor

    2004-01-01

    Cogan's syndrome is a rare autoimmune multisystem disease. The main clinical features of typical Cogan's syndrome are vestibuloauditory dysfunction and interstitial keratitis. The authors present a case of atypical Cogan's syndrome with headache, fever, deafness, trigeminal neuralgia and electroencephalographic abnormality which mimicked viral encephalitis. PMID:15307593

  20. Kawasaki Disease Mimicking Retropharyngeal Abscess

    PubMed Central

    Srividhya, Vazhkudai Sridharan; Vasanthi, Thiruvengadam; Shivbalan, Somu

    2010-01-01

    Kawasaki disease is an acute, self-limiting febrile mucocutaneous vasculitis of infants and young children. Retropharyngeal lymphadenopathy is a rare presentation of Kawasaki disease. We present a case of Kawasaki disease mimicking a retropharyngeal abscess, with upper airway obstruction resulting in delayed diagnosis. PMID:20635457

  1. Acute Abdominal Pain in Children.

    PubMed

    Reust, Carin E; Williams, Amy

    2016-05-15

    Acute abdominal pain accounts for approximately 9% of childhood primary care office visits. Symptoms and signs that increase the likelihood of a surgical cause for pain include fever, bilious vomiting, bloody diarrhea, absent bowel sounds, voluntary guarding, rigidity, and rebound tenderness. The age of the child can help focus the differential diagnosis. In infants and toddlers, clinicians should consider congenital anomalies and other causes, including malrotation, hernias, Meckel diverticulum, or intussusception. In school-aged children, constipation and infectious causes of pain, such as gastroenteritis, colitis, respiratory infections, and urinary tract infections, are more common. In female adolescents, clinicians should consider pelvic inflammatory disease, pregnancy, ruptured ovarian cysts, or ovarian torsion. Initial laboratory tests include complete blood count, erythrocyte sedimentation rate or C-reactive protein, urinalysis, and a pregnancy test. Abdominal radiography can be used to diagnose constipation or obstruction. Ultrasonography is the initial choice in children for the diagnosis of cholecystitis, pancreatitis, ovarian cyst, ovarian or testicular torsion, pelvic inflammatory disease, pregnancy-related pathology, and appendicitis. Appendicitis is the most common cause of acute abdominal pain requiring surgery, with a peak incidence during adolescence. When the appendix is not clearly visible on ultrasonography, computed tomography or magnetic resonance imaging can be used to confirm the diagnosis. PMID:27175718

  2. Accuracy of Unenhanced MR Imaging in the Detection of Acute Appendicitis: Single-Institution Clinical Performance Review.

    PubMed

    Petkovska, Iva; Martin, Diego R; Covington, Matthew F; Urbina, Shannon; Duke, Eugene; Daye, Z John; Stolz, Lori A; Keim, Samuel M; Costello, James R; Chundru, Surya; Arif-Tiwari, Hina; Gilbertson-Dahdal, Dorothy; Gries, Lynn; Kalb, Bobby

    2016-05-01

    Purpose To determine the accuracy of unenhanced magnetic resonance (MR) imaging in the detection of acute appendicitis in patients younger than 50 years who present to the emergency department with right lower quadrant (RLQ) pain. Materials and Methods The institutional review board approved this retrospective study of 403 patients from August 1, 2012, to July 30, 2014, and waived the informed consent requirement. A cross-department strategy was instituted to use MR imaging as the primary diagnostic modality in patients aged 3-49 years who presented to the emergency department with RLQ pain. All MR examinations were performed with a 1.5- or 3.0-T system. Images were acquired without breath holding by using multiplanar half-Fourier single-shot T2-weighted imaging without and with spectral adiabatic inversion recovery fat suppression without oral or intravenous contrast material. MR imaging room time was measured for each patient. Prospective image interpretations from clinical records were reviewed to document acute appendicitis or other causes of abdominal pain. Final clinical outcomes were determined by using (a) surgical results (n = 77), (b) telephone follow-up combined with review of the patient's medical records (n = 291), or (c) consensus expert panel assessment if no follow-up data were available (n = 35). Logistic regression analysis was performed to evaluate the sensitivity and specificity of MR imaging in the detection of acute appendicitis, and corresponding 95% confidence intervals were determined. Results Of the 403 patients, 67 had MR imaging findings that were positive for acute appendicitis, and 336 had negative findings. MR imaging had a sensitivity of 97.0% (65 of 67) and a specificity of 99.4% (334 of 336). The mean total room time was 14 minutes (range, 8-62 minutes). An alternate diagnosis was offered in 173 (51.5%) of 336 patients. Conclusion MR imaging is a highly sensitive and specific test in the evaluation of patients younger than 50 years

  3. Laparoscopic Appendectomy versus Mini-Incision Appendectomy in Patients with Lower Body Mass Index and Noncomplicated Appendicitis

    PubMed Central

    Özsan, İsmail; Yoldaş, Ömer; Alpdoğan, Özcan; Aydın, Ünal

    2014-01-01

    Laparoscopic appendectomy has become favored over open surgical methods for its association with decreased postoperative pain, more rapid return to daily activities, and improved cosmetic results. Mini-incision appendectomy was being performed in our clinic for a long time especially in patients with noncomplicated appendicitis and in patients with appropriate body mass index. Although laparoscopy presents obvious advantages especially for obese patients and young women, with respect to the results of our study, mini-incision appendectomy seems to be an alternative for selected patient groups. PMID:25580110

  4. Henoch-Schönlein purpura complicated by acalculous cholecystitis and intussusception, and following recurrence with appendicitis.

    PubMed

    Özkaya, Ahmet Kağan; Güler, Ekrem; Çetinkaya, Ahmet; Karakaya, Ali Erdal; Göksügür, Yalçın; Katı, Ömer; Güler, Ahmet Gökhan; Davutoğlu, Mehmet

    2016-05-01

    Henoch-Schönlein purpura (HSP) is the most common childhood systemic vasculitis. Gastro-intestinal involvement occurs in two-thirds of patients. The characteristic skin lesions generally precede abdominal symptoms or present concurrently. A 7-year-old boy presented with intussusception and acalculous cholecystitis and had a cholecystectomy. Two weeks later he was re-admitted with features typical of HSP which responded to corticosteroids. Eleven months later he presented with abdominal pain and recurrence of HSP and, at laparotomy, there was acute appendicitis. This is the first case of a child presenting with HSP complicated by acalculous cholecystitis. PMID:27077617

  5. Parasitic Infestation in Pediatric and Adolescent Appendicitis: A Local Experience

    PubMed Central

    Zakaria, Ossama M.; Zakaria, Hazem M.; Daoud, Mohamed Yasser; Al Wadaani, Hamed; Al Buali, Waleed; Al-Mohammed, Hamdan; Al Mulhim, Abdulrahman S.; Zaki, Wafaa

    2013-01-01

    Objective The relationship between parasites and pediatric appendicitis is a highly debatable issue. This study aims to investigate the role of parasitic infestation in the etiology of acute pediatric appendicitis. Methods A retrospective study including 1600 pediatric and adolescent patients who had undergone surgical therapy for a diagnosis of acute appendicitis over a period of ten years from Jan 2001 to Dec 2010. Demographic data were retrieved including the patient's age, sex, clinical data, clinical presentations, laboratory investigations, operative data and pathological findings to identify the presence and type of parasites. Patients were divided into two groups according to the presence or absence of parasites in the appendix lumen. In group I (n: 88), parasitic infestation was observed, whereas in group II (n: 1502), no parasitic infestation was present. Results Parasites were present in 5.5% (88 patients), and of those 88 parasitic infestations, 45 (51.1%) were Enterobaisis, 8 (9.1%) were Schistosomiasis, 23 (26.1%) were Ascariasis, 7 (8%) Trichuriasis, and 5 (5.7%) were Teania Saginata. The percentage of patients with suppurative, gangrenous or perforated appendicitis was similar in both groups with no statistical significance, irrespective of the presence or absence of parasitic infestation. Conclusion The low prevalence of parasites among the appendectomy specimens did not support the notion that parasites were a major cause of appendicitis in pediatric patients. PMID:23599875

  6. Appendicitis and abscess in an adult patient with intestinal nonrotation: Case report.

    PubMed

    Assenza, M; Reali, C; Valesini, L; Marenga, G; Bartolucci, P; Rossi, D; Modini, C

    2015-01-01

    The aim of the article is showing a particular case of midgut nonrotation. It is a congenital defect of the bowel development, during which fails the rotation of 270° around the vascular pedicle. This anomaly causes a different intestinal arrangement: the small bowel is located in the right side of abdominal cavity while the large bowel is situated in the left side. We present a case of acute appendicitis and abscess treated successfully with urgent surgical intervention in a patient completely asymptomatic for nonrotation. Nonrotation may lead to acute symptoms, vague abdominal pain or may remain asymptomatic throughout all life and be discovered only accidentally. Radiological exams and laparoscopy can help to make a correct diagnosis. A conservative treatment could be preferred in asymptomatic patients and Ladd's surgical procedure should be performed in selected cases. PMID:25945440

  7. Comparison of Laparoscopic Appendectomy with open appendectomy in Treating Children with Appendicitis

    PubMed Central

    Yu, Guoqing; Han, Aihua; Wang, Wenjuan

    2016-01-01

    Objective: To analyze feasibility and curative effect of laparoscopic appendectomy in the treatment of pediatric appendicitis and compare it with open appendectomy. Methods: Two hundred and sixty patients were selected for this study and randomly divided into open appendectomy group (130 cases) and laparoscopic appendectomy group (130 cases). Patients in open appendectomy group underwent traditional open appendectomy, while patients in laparoscopic appendectomy were treated with laparoscopic appendectomy. Incision length, blood loss during operation, duration of operation, time to leave bed, anus exhausting time, time to take food, catheter drainage time, urinary catheterization time, time of using antibiotics, use of pain killer and incidence of complications such as incision infection, residual abscess and intestinal obstruction were compared between two groups. Results: We found relevant indexes including length of incision, amount of bleeding and duration of operation in laparoscopic appendectomy group were better than open appendectomy group after surgery; and differences were statistically significant (P<0.05). Indexes such as time to out of bed, time to take food, exhaust time, drainage time, catheterization time and application time and use of antibiotics in laparoscopic appendectomy group were all superior to open appendectomy group, and differences had statistical significance (P<0.05). Incidence of complications in laparoscopic appendectomy group was much lower than open appendectomy group and the difference was statistically significant (P<0.05). Conclusion: Laparoscopic appendectomy has advantages of small trauma, sound curative effect, low incidence of complications and rapid recovery and can effectively relieve pain of children suffering from appendicitis. Hence it is worth promotion and should be preferred. PMID:27182227

  8. Appendicitis associated with intestinal malrotation: imaging diagnosis features. Case report.

    PubMed

    Badea, Radu; Al Hajjar, Nadim; Andreica, Vasile; Procopeţ, Bogdan; Caraiani, Cosmin; Tamas-Szora, Attila

    2012-06-01

    Intestinal malrotation is a rare pathological situation consisting of non-rotation or incomplete rotation of the primitive intestine. Due to the abnormal caecal position inflicted by malrotation, diagnosis of acute appendicitis is difficult. Ultrasonography (US) and Computed Tomography (CT) are relevant and complementary imaging techniques for establishing an otherwise elusive diagnosis. We present the case of 54 year old male presenting with nonspecific abdominal complaints in which US (standard and contrast enhanced) and CT scans identified acute appendicitis associated with malrotated caecum and ascending colon, located in the left hipocondrum. PMID:22675720

  9. Abdominal actinomycosis presenting as appendicitis: two case reports and review.

    PubMed

    Liu, Ken; Joseph, David; Lai, Ken; Kench, James; Ngu, Meng Chong

    2016-01-01

    Abdominal actinomycosis (AA) is a rare infection caused by filamentous Gram-positive anaerobic bacteria Actinomyces. We report two cases of adults with AA who initially presented with clinical and radiological features of appendicitis. Both patients underwent appendicectomy with histopathology diagnostic for actinomycosis of the appendix and subsequently completed prolonged courses of oral penicillin. AA is a rare differential diagnosis for appendicitis and should be considered especially in patients with a chronic, indolent course and nonspecific abdominal symptoms. A high index of suspicion may avoid unnecessary surgery, as treatment with prolonged antibiotic therapy is very effective. PMID:27147718

  10. Abdominal actinomycosis presenting as appendicitis: two case reports and review

    PubMed Central

    Liu, Ken; Joseph, David; Lai, Ken; Kench, James; Ngu, Meng Chong

    2016-01-01

    Abdominal actinomycosis (AA) is a rare infection caused by filamentous Gram-positive anaerobic bacteria Actinomyces. We report two cases of adults with AA who initially presented with clinical and radiological features of appendicitis. Both patients underwent appendicectomy with histopathology diagnostic for actinomycosis of the appendix and subsequently completed prolonged courses of oral penicillin. AA is a rare differential diagnosis for appendicitis and should be considered especially in patients with a chronic, indolent course and nonspecific abdominal symptoms. A high index of suspicion may avoid unnecessary surgery, as treatment with prolonged antibiotic therapy is very effective. PMID:27147718

  11. Lepra reaction with lucio phenomenon mimicking cutaneous vasculitis.

    PubMed

    Misra, Durga Prasanna; Parida, Jyoti Ranjan; Chowdhury, Abhra Chandra; Pani, Krushna Chandra; Kumari, Niraj; Krishnani, Narendra; Agarwal, Vikas

    2014-01-01

    Leprosy is a disease typically found in the tropics. Patients with leprosy can have varying presentation with constitutional symptoms, joint pains, skin nodules, and rarely a vasculitis-like picture with skin ulcers and neuropathy. We present a young lady who presented with the rare manifestation of skin infarcts mimicking cutaneous vasculitis, diagnosed on histopathology to have Lucio phenomenon on a background of lepromatous leprosy. With increasing migration and widespread use of biologic response modifiers, clinicians all over the world need to be aware of various presentations of leprosy as well as needing to keep an open mind while considering the differential diagnoses of vasculitis. PMID:25580317

  12. Lepra Reaction with Lucio Phenomenon Mimicking Cutaneous Vasculitis

    PubMed Central

    Misra, Durga Prasanna; Parida, Jyoti Ranjan; Chowdhury, Abhra Chandra; Pani, Krushna Chandra; Kumari, Niraj; Krishnani, Narendra

    2014-01-01

    Leprosy is a disease typically found in the tropics. Patients with leprosy can have varying presentation with constitutional symptoms, joint pains, skin nodules, and rarely a vasculitis-like picture with skin ulcers and neuropathy. We present a young lady who presented with the rare manifestation of skin infarcts mimicking cutaneous vasculitis, diagnosed on histopathology to have Lucio phenomenon on a background of lepromatous leprosy. With increasing migration and widespread use of biologic response modifiers, clinicians all over the world need to be aware of various presentations of leprosy as well as needing to keep an open mind while considering the differential diagnoses of vasculitis. PMID:25580317

  13. Femoroacetabular impingement mimicking avascular osteonecrosis on bone scintigraphy

    PubMed Central

    Suarez, Juan Pablo; Domínguez, María Luz; Nogareda, Zulema; Gómez, María Asunción; Muñoz, Jose

    2016-01-01

    Femoroacetabular impingement (FAI) is a structural abnormality of proximal femur and/or acetabulum. It has been recently described, and there are limited reports in nuclear medicine literature because bone scintigraphy is not listed in its diagnostic protocol, but it should be included on differential diagnosis when evaluating patients, with hip-related symptoms because it may be misinterpreted as degenerative changes or avascular necrosis, and its early treatment avoid progression to osteoarthritis. We describe the case of a male who suffered from hip pain. Bone planar scintigraphic appearance mimicked avascular necrosis, but single photon emission computed tomography (CT) imaging and CT examination confirmed the diagnosis of FAI. PMID:27095871

  14. A Giant Mature Cystic Teratoma Mimicking a Pleural Effusion

    PubMed Central

    Dorterler, Mustafa Erman; Boleken, Mehmet Emin; Koçarslan, Sezen

    2016-01-01

    The vast majority of teratomas originating from more than a single germ layer are benign. Often, such teratomas are initially asymptomatic. Later symptoms are caused by the weight per se of the teratoma and include chest pain, cough, dyspnea, and/or recurrent attacks of pneumonia. A mediastinal teratoma is treated by total surgical resection of the mass. Here, we report a case of giant mature cystic teratoma mimicking a pleural effusion in the thorax at the 7-month-old female patient with a symptom of persistent pulmonary infection and tachypnea. PMID:26942032

  15. Disseminated histoplasmosis mimicking secondary syphilis.

    PubMed

    Pastor, Tony A; Holcomb, Maura J; Motaparthi, Kiran; Grekin, Sarah J; Hsu, Sylvia

    2011-01-01

    A 34-year-old, HIV-positive man living in Texas presented with a 2-week history of fever, malaise, myalgias, oral ulcers, and papules on his chest, back, face, and extremities, including the palms. Initially secondary syphilis was suspected. However, RPR was negative. Histopathologic examination revealed a lymphocytic infiltrate with numerous intra-histiocytic fungal organisms. GMS and PAS stains were positive, consistent with the diagnosis of histoplasmosis. We report a case of disseminated histoplasmosis clinically mimicking secondary syphilis. PMID:22136866

  16. Health Outcomes in US Children with Abdominal Pain at Major Emergency Departments Associated with Race and Socioeconomic Status

    PubMed Central

    Wang, Louise; Haberland, Corinna; Thurm, Cary; Bhattacharya, Jay; Park, K. T.

    2015-01-01

    Objective Over 9.6 million ED visits occur annually for abdominal pain in the US, but little is known about the medical outcomes of these patients based on demographics. We aimed to identify disparities in outcomes among children presenting to the ED with abdominal pain linked to race and SES. Methods Data from 4.2 million pediatric encounters of abdominal pain were analyzed from 43 tertiary US children’s hospitals, including 2.0 million encounters in the emergency department during 2004-2011. Abdominal pain was categorized as functional or organic abdominal pain. Appendicitis (with and without perforation) was used as a surrogate for abdominal pain requiring emergent care. Multivariate analysis estimated likelihood of hospitalizations, radiologic imaging, ICU admissions, appendicitis, appendicitis with perforation, and time to surgery and hospital discharge. Results Black and low income children had increased odds of perforated appendicitis (aOR, 1.42, 95% CI, 1.32- 1.53; aOR, 1.20, 95% CI 1.14 – 1.25). Blacks had increased odds of an ICU admission (aOR, 1.92, 95% CI 1.53 - 2.42) and longer lengths of stay (aHR, 0.91, 95% CI 0.86 – 0.96) than Whites. Minorities and low income also had lower rates of imaging for their appendicitis, including CT scans. The combined effect of race and income on perforated appendicitis, hospitalization, and time to surgery was greater than either separately. Conclusions Based on race and SES, disparity of health outcomes exists in the acute ED setting among children presenting with abdominal pain, with differences in appendicitis with perforation, length of stay, and time until surgery. PMID:26267816

  17. Groin pain

    MedlinePlus

    Pain - groin; Lower abdominal pain; Genital pain; Perineal pain ... Common causes of groin pain include: Pulled muscle, tendon, or ligaments in the leg: This problem often occurs in people who play sports such as ...

  18. Acute appendicitis presenting as small bowel obstruction: two case reports

    PubMed Central

    2009-01-01

    Acute appendicitis is a common surgical problem however the diagnosis is often overlooked when it presents as a small bowel obstruction. In this report we present two cases of elderly patients who presented with small bowel obstruction and raised inflammatory markers. Both patients were successfully treated with a laparotomy, adhesiolysis and appendicectomy and went on to make a good recovery. PMID:20062683

  19. Harms of CT scanning prior to surgery for suspected appendicitis.

    PubMed

    Rogers, William; Hoffman, Jerome; Noori, Naudereh

    2015-02-01

    In this brief analysis we compare the risks and benefits of performing a CT scan to confirm appendicitis prior to surgery instead of operating based on the surgeon's clinical diagnosis. We conclude that the benefit of universal imaging is to avoid 12 unnecessary appendectomies but the cost of those 12 avoided surgeries is one cancer death due to the imaging. PMID:25429870

  20. New synthetic strategies for xanthene-dye-appended cyclodextrins

    PubMed Central

    Darcsi, Andras; Balint, Mihaly; Benkovics, Gabor; Sohajda, Tamas; Beni, Szabolcs

    2016-01-01

    Summary Xanthene dyes can be appended to cyclodextrins via an ester or amide bridge in order to switch the fluorescence on or off. This is made possible through the formation of nonfluorescent lactones or lactams as the fluorophore can reversibly cyclize. In this context we report a green approach for the synthesis of switchable xanthene-dye-appended cyclodextrins based on the coupling agent 4-(4,6-dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholinium chloride (DMT-MM). By using 6-monoamino-β-cyclodextrin and commercially available inexpensive dyes, we prepared rhodamine- and fluorescein-appended cyclodextrins. The compounds were characterized by NMR and IR spectroscopy and MS spectrometry, their UV–vis spectra were recorded at various pH, and their purity was determined by capillary electrophoresis. Two potential models for the supramolecular assembly of the xanthene-dye-appended cyclodextrins were developed based on the set of data collected by the extensive NMR characterization. PMID:27340446

  1. Effect of surgical timing and outcomes for appendicitis severity

    PubMed Central

    Kim, Maru; Kim, Sung Jeep

    2016-01-01

    Purpose This study was aimed to evaluate the effect of time of surgery for acute appendicitis on surgical outcomes to optimize the timing of appendectomies. Methods Medical records of patients who underwent an appendectomy were reviewed to obtain data on time of symptom onset, time of hospital presentation, and start times of surgery. Surgical findings were used to define appendicitis as either uncomplicated or complicated. The uncomplicated group included patients with simple, focal, or suppurative appendicitis, and the complicated group included patients with gangrenous, perforated appendicitis or periappendiceal abscess formation. The 2 groups were analyzed by age, sex, and time. Results A total of 192 patients were analyzed. The mean time from symptom onset to start of operation showed a significant difference between both groups (1,652.9 minutes vs. 3,383.8 minutes, P < 0.001). The mean time from hospital visit to start of operation showed no difference between both groups (398.7 minutes vs. 402.0 minutes, P = 0.895). Operating within 24 hours of symptom onset had a relative risk of 1.738 (95% confidence interval, 1.319–2.425) for complications. Operating more than 36 hours after symptom onset was associated with an increased risk of postoperative ileus and a longer hospital stay. Conclusion Complicated appendicitis is associated with a delay in surgery from symptom onset rather than a delay at hospital arrival. Surgeons should take into account the time from symptom onset when deciding on the timing of appendectomy. We recommend that appendectomy be performed within 36 hours from symptom onset. PMID:27478814

  2. Spilled Gallstones Mimicking Peritoneal Metastases

    PubMed Central

    Loan, William; Carey, Declan P.

    2009-01-01

    Background: Spillage of bile and gallstones due to accidental perforation of the gallbladder wall is often encountered during laparoscopic cholecystectomy. Although spilled stones were once considered harmless, there is increasing evidence that they can result in septic or other potential complications. Case Report: We report a case of spilled gallstones mimicking peritoneal metastases on radiological investigations; diagnosis was confirmed by diagnostic laparoscopy. Conclusion: Every effort should be made to retrieve spilled gallstones during laparoscopic cholecystectomy. When all the stones cannot be retrieved, it should be documented in the patient's medical records to avoid delay in the diagnosis of late complications. Diagnostic laparoscopy is useful when the radiological investigations are inconclusive. PMID:19366546

  3. [Severe PERM syndrom mimicking tetanus].

    PubMed

    Wallet, F; Didelot, A; Delannoy, B; Leray, V; Guerin, C

    2014-01-01

    We report the case of a 55-year-old man without significant medical history admitted to the ICU for a progressive paralysis mimicking life-threatening tetanus. Evolution with classical tetanus treatment was negative, with the need for ventilator support and worsening condition being life threatening. Uncommon evolution revealed a rare glycin antibody-associated hyperekplexia (progressive encephalomyelitis with rigidity syndrome). Patient dramatically improved with immunosuppressive therapy including plasmatic exchanges, cyclophasmid and high dose corticoid infusions. Intensivists should be aware of this very rare syndrome whose treatment is the opposite of tetanus while presentation is very close. Optimal and treatment could lead to prolonged survival. PMID:25168299

  4. Appendiceal phlegmon mimicking intussusception on ultrasound: correspondence between sonographic and operative findings.

    PubMed

    Mentessidou, Anastasia; Mirilas, Petros

    2015-07-01

    Little is known about the possibility that ruptured appendicitis may produce a false sonographic appearance of intussusception. We present here a case of a periappendiceal phlegmon mimicking ileocolic intussusception on ultrasound in a 3.5-year-old girl and provide a surgico-anatomic explanation on the basis of the intraoperative findings for the false sonographic image. CT imaging was used to make the diagnosis. Intraoperatively, it was revealed that the cecum and sigmoid, which were adherent to each other with pseudomembranes, formed an intestinal mass around the appendix. Accordingly, the appendicolith at the center of the phlegmon was responsible for the central echogenicity, and the surrounding cecum and sigmoid for the external hypoechoic and hyperechoic rings of the target-sign appearing mass on the preoperative ultrasound. Such an understanding of the etiology of the false sonographic image may help to increase awareness and avoid misdiagnosis. PMID:25858096

  5. Left-sided appendicitis: Review of 95 published cases and a case report

    PubMed Central

    Akbulut, Sami; Ulku, Abdullah; Senol, Ayhan; Tas, Mahmut; Yagmur, Yusuf

    2010-01-01

    AIM: To give an overview of the literature on left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT) and midgut malrotation (MM). METHODS: We present a new case of LSAA with SIT and a literature review of studies published in the English language on LSAA, accessed via PubMed and Google Scholar databases. RESULTS: Ninety-five published cases of LSAA were evaluated and a 25-year-old female, who presented to our clinic with left lower abdominal pain caused by LSAA, is reported. In the reviewed literature, fifty-seven patients were male and 38 were female with an age range of 8 to 82 years and a median age of 29.1 ± 15.9 years. Sixty-six patients had SIT, 23 had MM, three had cecal malrotation, and two had a previously unnoted congenital abnormality. Fifty-nine patients had presented to the hospital with left lower, 14 with right lower and seven with bilateral lower quadrant pain, and seven subjects complained of left upper quadrant pain. The diagnosis was established preoperatively in 49 patients, intraoperatively in 19, and during the postoperative period in five; 14 patients were aware of having this anomaly. The data of eight patients were not unavailable. Eleven patients underwent laparoscopic appendectomy, which was combined with cholecystectomy in two cases. Histopathological examination of the appendix specimens revealed adenocarcinoma in only two of 95 patients. CONCLUSION: The diagnosis of left lower quadrant pain is based on well-established clinical symptoms, physical examination and physician’s experience. PMID:21105193

  6. Acute tuberculous myopericarditis mimicking acute myocardial infarction: A case report and literature review

    PubMed Central

    REN, MANYI; ZHANG, CHUNSHENG; ZHANG, XIAOJUAN; ZHONG, JINGQUAN

    2016-01-01

    A number of cases of acute myopericarditis mimicking acute myocardial infarction (AMI) have previously been reported in the literature. However, to the best of our knowledge, such a case resulting from Mycobacterium tuberculosis infection has not previously been described. The present study reports the case of a 21-year-old male patient presenting with acute chest pain, in whom focal ST-segment elevation and elevated cardiac enzymes mimicked a diagnosis of AMI. However, acute tuberculous myopericarditis was diagnosed on the basis of a variety of imaging examinations, laboratory tests, as well as the changes observed in electrocardiograms (ECGs) and in the cardiac enzyme levels. The case highlights the importance of a detailed collection of medical history, comprehensive explanations of serial ECGs, thoracic computed tomography, echocardiogram and coronary angiography in the diagnosis and differentiation of acute tuberculous myopericarditis mimicking AMI. PMID:27284323

  7. Flank pain

    MedlinePlus

    Pain - side; Side pain ... Flank pain can be a sign of a kidney problem. But, since many organs are in this area, other causes are possible. If you have flank pain and fever , chills, blood in the urine, or ...

  8. Chronic Pain

    MedlinePlus

    ... your pain. Medicines used for chronic pain include pain relievers, antidepressants, and anticonvulsants. Different types of medicines help ... If your doctor recommends an over-the-counter pain reliever, read and follow the instructions on the box. ...

  9. Cecocolic Intussusception in Adult Caused by Acute Appendicitis

    PubMed Central

    Lee, Kang Young; Sohn, Seung-Kook

    2014-01-01

    Intussusception in adult is rare. The etiology is different from that of childhood. The most common cause of intussusception in adult is known as malignancy. When dealing with adult intussusception, surgical resection is usually warranted for correct diagnosis and proper treatment. This is a case report of cecocolic intussusception caused by an acute appendicitis in adult. The causes of cecocolic intussusception were reported as appendiceal adenocarcinoma, appendiceal mucocele, appendiceal adenoma, or idiopathic. Although this patient underwent laparoscopic right hemicolectomy under suspicion of malignancy at cecum base, final pathologic diagnosis revealed only acute appendicitis. Thus, the present case emphasizes the importance of prior thorough examinations including colonoscopy when we encounter this rare kind of intussusception in adult. PMID:24826358

  10. Photoswitchable azobenzene-appended iridium(iii) complexes.

    PubMed

    Pérez-Miqueo, J; Altube, A; García-Lecina, E; Tron, A; McClenaghan, N D; Freixa, Z

    2016-09-21

    Iridium(iii) cyclometalated complexes have been used as models to study the effect that extended conjugation and substitution pattern has on the photochromic behavior of azobenzene-appended 2-phenylpyridyl (ppy) ligands. For this purpose four azobenzene-containing ppy ligands were synthesized. With these ligands, nine iridium(iii) complexes containing up to three appended azobenzenes were synthesized. Analysis of their photochromic behaviour by means of UV-vis and (1)H-NMR spectroscopy permitted us to conclude that the light-induced trans-to-cis isomerization of the azobenzene was strongly inhibited upon coordination to the Ir(iii) cation when the electronic conjugation was extended along the whole ligand. The use of an aliphatic spacer unit (either -CH2- or -OCH2-) between the azobenzene and the ppy fragment of the ligand sufficed to disrupt the electronic communication, and obtain photochromic organometallic complexes. PMID:27460186

  11. The activity of granulocyte alpha-amylase in acute appendicitis.

    PubMed

    Zakrzewska, I; Gajda, R

    1994-01-01

    The activity of alpha-amylase was measured in isolated granulocytes, serum and urine of 35 patients with acute appendicitis. The measurements were performed before operation and on the 7th day after operation. Slightly increased activity of alpha-amylase was found in the serum and urine of 15 patients. On the 7th day after operation the activity of this enzyme reached normal value. The activity of granulocyte alpha-amylase was elevated in 22 patients. In 2 of them the increased activity still maintained on the 7th day after operation. Positive correlation between the serum and granulocyte alpha-amylase activities was found. These observations allow to conclude that granulocytes are the source of increased alpha-amylase activity in the serum of patients with acute appendicitis. PMID:7497089

  12. Black hole mimickers: Regular versus singular behavior

    SciTech Connect

    Lemos, Jose P. S.; Zaslavskii, Oleg B.

    2008-07-15

    Black hole mimickers are possible alternatives to black holes; they would look observationally almost like black holes but would have no horizon. The properties in the near-horizon region where gravity is strong can be quite different for both types of objects, but at infinity it could be difficult to discern black holes from their mimickers. To disentangle this possible confusion, we examine the near-horizon properties, and their connection with far away asymptotic properties, of some candidates to black mimickers. We study spherically symmetric uncharged or charged but nonextremal objects, as well as spherically symmetric charged extremal objects. Within the uncharged or charged but nonextremal black hole mimickers, we study nonextremal {epsilon}-wormholes on the threshold of the formation of an event horizon, of which a subclass are called black foils, and gravastars. Within the charged extremal black hole mimickers we study extremal {epsilon}-wormholes on the threshold of the formation of an event horizon, quasi-black holes, and wormholes on the basis of quasi-black holes from Bonnor stars. We elucidate whether or not the objects belonging to these two classes remain regular in the near-horizon limit. The requirement of full regularity, i.e., finite curvature and absence of naked behavior, up to an arbitrary neighborhood of the gravitational radius of the object enables one to rule out potential mimickers in most of the cases. A list ranking the best black hole mimickers up to the worst, both nonextremal and extremal, is as follows: wormholes on the basis of extremal black holes or on the basis of quasi-black holes, quasi-black holes, wormholes on the basis of nonextremal black holes (black foils), and gravastars. Since in observational astrophysics it is difficult to find extremal configurations (the best mimickers in the ranking), whereas nonextremal configurations are really bad mimickers, the task of distinguishing black holes from their mimickers seems to

  13. Acute appendicitis as a rare complication of gastric band

    PubMed Central

    Petridis, Christos; Neofytou, Kyriakos; Petrou, Athanasios; Georgiou, Chrysanthos

    2013-01-01

    Laparoscopic adjustable gastric banding is a common and effective minimally invasive procedure in the treatment of morbid obesity. Common complications of the procedure include productive burping, ulceration, gastritis, erosion, slippage, problems with the port, bleeding and infection. We report a case of acute appendicitis caused by gastric banding in a female patient. Gastric band encircled the appendix causing lumen obstruction and infection. The patient developed symptoms of topical acute peritonitis and an appendisectomy was performed. PMID:24964326

  14. Odontogenic Keratocyst Mimicking Paradental Cyst

    PubMed Central

    Borgonovo, Andrea Enrico; Bernardini, Luigi; Francinetti, Paola

    2014-01-01

    Objective. The aim of this paper is to present an uncommon clinical and radiographic aspect of odontogenic keratocyst (OKC) mimicking paradental cyst. Methods. A 32-year-old female patient showed a well-delimited radiolucent lesion connected with the root of the left third molar with close anatomical relationship with the mandibular canal. The clinical, radiographic, and anamnestic features lead us to diagnose a paradental cyst that was treated by enucleation after extraction of the partially impacted tooth. Results. Histological analysis showed typical histological features of PKC such as the presence of a lining of stratified squamous epithelium with a well-defined basal layer of palisading columnar of cuboidal cells. Conclusion. Initial X-ray analysis and the position of the lesion related to the third mandibular tooth caused us to mistakenly diagnose a paradental cyst. We were only able to identify the cyst as an PKC rather than a paradental cyst after histological analysis. PMID:25114809

  15. Subaortic membrane mimicking hypertrophic cardiomyopathy.

    PubMed

    Anderson, Mark Joseph; Arruda-Olson, Adelaide; Gersh, Bernard; Geske, Jeffrey

    2015-01-01

    A 34-year-old man was referred for progressive angina and exertional dyspnoea refractory to medical therapy, with a presumptive diagnosis of hypertrophic cardiomyopathy (HCM). Transthoracic echocardiography (TTE) revealed asymmetric septal hypertrophy without systolic anterior motion of the mitral valve leaflet and with no dynamic left ventricular outflow tract (LVOT) obstruction. However, the LVOT velocity was elevated at rest as well as with provocation, without the characteristic late peaking obstruction seen in HCM. Focused TTE to evaluate for suspected fixed obstruction demonstrated a subaortic membrane 2.2 cm below the aortic valve. Coronary CT angiography confirmed the presence of the subaortic membrane and was negative for concomitant coronary artery disease. Surgical resection of the subaortic membrane and septal myectomy resulted in significant symptomatic relief and lower LVOT velocities on postoperative TTE. This case reminds the clinician to carefully evaluate for alternative causes of LVOT obstruction, especially subaortic membrane, as a cause of symptoms mimicking HCM. PMID:26538250

  16. Chronic pain and the thoracic spine.

    PubMed

    Louw, Adriaan; Schmidt, Stephen G

    2015-07-01

    In recent years there has been an increased interest in pain neuroscience in physical therapy.1,2 Emerging pain neuroscience research has challenged prevailing models used to understand and treat pain, including the Cartesian model of pain and the pain gate.2-4 Focus has shifted to the brain's processing of a pain experience, the pain neuromatrix and more recently, cortical reorganisation of body maps.2,3,5,6 In turn, these emerging theories have catapulted new treatments, such as therapeutic neuroscience education (TNE)7-10 and graded motor imagery (GMI),11,12 to the forefront of treating people suffering from persistent spinal pain. In line with their increased use, both of these approaches have exponentially gathered increasing evidence to support their use.4,10 For example, various randomised controlled trials and systematic reviews have shown that teaching patients more about the biology and physiology of their pain experience leads to positive changes in pain, pain catastrophization, function, physical movement and healthcare utilisation.7-10 Graded motor imagery, in turn, has shown increasing evidence to help pain and disability in complex pain states such as complex regional pain syndrome (CRPS).11,12 Most research using TNE and GMI has focussed on chronic low back pain (CLBP) and CRPS and none of these advanced pain treatments have been trialled on the thoracic spine. This lack of research and writings in regards to the thoracic spine is not unique to pain science, but also in manual therapy. There are, however, very unique pain neuroscience issues that skilled manual therapists may find clinically meaningful when treating a patient struggling with persistent thoracic pain. Utilising the latest understanding of pain neuroscience, three key clinical chronic thoracic issues will be discussed - hypersensitisation of intercostal nerves, posterior primary rami nerves mimicking Cloward areas and mechanical and sensitisation issues of the spinal dura in the

  17. Chronic pain and the thoracic spine

    PubMed Central

    Louw, Adriaan; Schmidt, Stephen G.

    2015-01-01

    In recent years there has been an increased interest in pain neuroscience in physical therapy.1,2 Emerging pain neuroscience research has challenged prevailing models used to understand and treat pain, including the Cartesian model of pain and the pain gate.2–4 Focus has shifted to the brain's processing of a pain experience, the pain neuromatrix and more recently, cortical reorganisation of body maps.2,3,5,6 In turn, these emerging theories have catapulted new treatments, such as therapeutic neuroscience education (TNE)7–10 and graded motor imagery (GMI),11,12 to the forefront of treating people suffering from persistent spinal pain. In line with their increased use, both of these approaches have exponentially gathered increasing evidence to support their use.4,10 For example, various randomised controlled trials and systematic reviews have shown that teaching patients more about the biology and physiology of their pain experience leads to positive changes in pain, pain catastrophization, function, physical movement and healthcare utilisation.7–10 Graded motor imagery, in turn, has shown increasing evidence to help pain and disability in complex pain states such as complex regional pain syndrome (CRPS).11,12 Most research using TNE and GMI has focussed on chronic low back pain (CLBP) and CRPS and none of these advanced pain treatments have been trialled on the thoracic spine. This lack of research and writings in regards to the thoracic spine is not unique to pain science, but also in manual therapy. There are, however, very unique pain neuroscience issues that skilled manual therapists may find clinically meaningful when treating a patient struggling with persistent thoracic pain. Utilising the latest understanding of pain neuroscience, three key clinical chronic thoracic issues will be discussed – hypersensitisation of intercostal nerves, posterior primary rami nerves mimicking Cloward areas and mechanical and sensitisation issues of the spinal dura in

  18. Accuracy of the new radiographic sign of fecal loading in the cecum for differential diagnosis of acute appendicitis in comparison with other inflammatory diseases of right abdomen: a prospective study

    PubMed Central

    Petroianu, A; Alberti, LR

    2012-01-01

    Rationale: To assess the importance of the new radiographic sign of faecal loading in the cecum for the diagnosis of acute appendicitis, in comparison with other inflammatory diseases, and to verify the maintenance of this radiographic sign after surgical treatment of appendicitis. Methods: 470 consecutive patients admitted to the hospital due to acute abdomen were prospectively studied: Group 1 [n=170] – diagnosed with acute appendicitis, subdivided into: Subgroup 1A – [n=100] – submitted to an abdominal radiographic study before surgical treatment, Subgroup 1B – [n=70] – patients who had plain abdominal X-rays done before the surgical procedure and also the following day; Group 2 [n=100] – right nephrolithiasis; Group 3 [n=100] – right acute inflammatory pelvic disease; Group 4 [n=100] – acute cholecystitis. The patients of Groups 2,3 and 4 were submitted to abdominal radiography during the pain episode. Results: The sign of faecal loading in the cecum, characterized by hypo transparency interspersed with multiple small foci of hyper transparent images, was present in 97 patients of Subgroup 1A, in 68 patients of Subgroup 1B, in 19 patients of Group 2, in 12 patients of Group 3 and in 13 patients of Group 4. During the postoperative period the radiographic sign disappeared in 66 of the 68 cases that had presented with the sign. The sensitivity of the radiographic sign for acute appendicitis was 97.05% and its specificity was 85.33%. The positive predictive value for acute appendicitis was 78.94% and its negative predictive value was 98. 08%. Discussion: The radiographic image of faecal loading in the cecum is associated with acute appendicitis and disappears after appendectomy. This sign is uncommon in other acute inflammatory diseases of the right side of the abdomen. PMID:22574093

  19. Clinical outcome of Fitz-Hugh-Curtis syndrome mimicking acute biliary disease

    PubMed Central

    Woo, Seong Yong; Kim, Jin Il; Cheung, Dae Young; Cho, Se Hyun; Park, Soo-Heon; Han, Joon-Yeol; Kim, Jae Kwang

    2008-01-01

    AIM: To analyze the clinical characteristics of patients diagnosed with Fitz-Hugh-Curtis syndrome. METHODS: The clinical courses of patients that visited St. Mary’s Hospital with abdominal pain from January 2005 to December 2006 and were diagnosed with Fitz-Hugh-Curtis syndrome were examined. RESULTS: Fitz-Hugh-Curtis syndrome was identified in 22 female patients of childbearing age; their mean age was 31.0 ± 8.1 years. Fourteen of these cases presented with pain in the upper right abdomen alone or together with pain in the lower abdomen, and six patients presented with pain only in the lower abdomen. The first impression at the time of visit was acute cholecystitis or cholangitis in 10 patients and acute appendicitis or pelvic inflammatory disease in eight patients. Twenty-one patients were diagnosed by abdominal computer tomography (CT), and the results of abdominal sonography were normal for 10 of these patients. Chlamydia trichomatis was isolated from 18 patients. Two patients underwent laparoscopic adhesiotomy and 20 patients were completely cured by antibiotic treatment. CONCLUSION: For women of childbearing age with acute pain in the upper right abdomen alone or together with pain in the lower abdomen, Fitz-Hugh-Curtis syndrome should be considered during differential diagnosis. Moreover, in cases suspected to be Fitz-Hugh-Curtis syndrome, abdominal CT, rather than abdominal sonography, assists in the diagnosis. PMID:19058334

  20. Bone tumor mimickers: A pictorial essay

    PubMed Central

    Mhuircheartaigh, Jennifer Ni; Lin, Yu-Ching; Wu, Jim S

    2014-01-01

    Focal lesions in bone are very common and many of these lesions are not bone tumors. These bone tumor mimickers can include numerous normal anatomic variants and non-neoplastic processes. Many of these tumor mimickers can be left alone, while others can be due to a significant disease process. It is important for the radiologist and clinician to be aware of these bone tumor mimickers and understand the characteristic features which allow discrimination between them and true neoplasms in order to avoid unnecessary additional workup. Knowing which lesions to leave alone or which ones require workup can prevent misdiagnosis and reduce patient anxiety. PMID:25114385

  1. Evaluation of acute pelvic pain in women.

    PubMed

    Kruszka, Paul S; Kruszka, Stephen J

    2010-07-15

    Diagnosis of pelvic pain in women can be challenging because many symptoms and signs are insensitive and nonspecific. As the first priority, urgent life-threatening conditions (e.g., ectopic pregnancy, appendicitis, ruptured ovarian cyst) and fertility-threatening conditions (e.g., pelvic inflammatory disease, ovarian torsion) must be considered. A careful history focusing on pain characteristics, review of systems, and gynecologic, sexual, and social history, in addition to physical examination helps narrow the differential diagnosis. The most common urgent causes of pelvic pain are pelvic inflammatory disease, ruptured ovarian cyst, and appendicitis; however, many other diagnoses in the differential may mimic these conditions, and imaging is often needed. Transvaginal ultrasonography should be the initial imaging test because of its sensitivities across most etiologies and its lack of radiation exposure. A high index of suspicion should be maintained for pelvic inflammatory disease when other etiologies are ruled out, because the presentation is variable and the prevalence is high. Multiple studies have shown that 20 to 50 percent of women presenting with pelvic pain have pelvic inflammatory disease. Adolescents and pregnant and postpartum women require unique considerations. PMID:20642266

  2. Back Pain

    MedlinePlus

    ... Back Pain Find a Clinical Trial Journal Articles Back Pain March 2015 Handout on Health: Back Pain This publication is for people who have back ... to discuss them with your doctor. What Is Back Pain? Back pain is an all-too-familiar problem ...

  3. Cancer pain

    SciTech Connect

    Swerdlow, M.; Ventafridda, V.

    1987-01-01

    This book contains 13 chapters. Some of the chapter titles are: Importance of the Problem; Neurophysiology and Biochemistry of Pain; Assessment of Pain in Patients with Cancer; Drug Therapy; Chemotherapy and Radiotherapy for Cancer Pain; Sympton Control as it Relates to Pain Control; and Palliative Surgery in Cancer Pain Treatment.

  4. Mesenteric cystic lymphangioma mimicking malignancy.

    PubMed

    Hureibi, Khalid; Sunidar, Osama A

    2014-01-01

    Mesenteric cystic lymphangiomas are benign tumours arising from the mesentery, and have no known aetiology. Patients might be discovered incidentally to have asymptomatic mesenteric cysts, or they can present with symptoms such as pain, nausea and vomiting. A 27-year-old man presented with vague abdominal pain, loss of appetite, postprandial fullness and significant weight loss. There was no lymphadenopathy, and abdominal examination was unremarkable. CT showed a mesenteric mass and a diagnosis of abdominal lymphoma was suggested. There was no evidence of pulmonary tuberculosis on chest X-ray and the purified protein derivative test was negative. On laparotomy, a 5×9×7 cm sessile cyst containing thick white fluid and arising from the ileal mesentery was found and completely removed. Histopathology proved a diagnosis of mesenteric cystic lymphangioma. The patient made uneventful recovery, and was asymptomatic on clinical follow-up after 6 weeks. PMID:25178885

  5. Mesenteric cystic lymphangioma mimicking malignancy

    PubMed Central

    Hureibi, Khalid; Sunidar, Osama A

    2014-01-01

    Mesenteric cystic lymphangiomas are benign tumours arising from the mesentery, and have no known aetiology. Patients might be discovered incidentally to have asymptomatic mesenteric cysts, or they can present with symptoms such as pain, nausea and vomiting. A 27-year-old man presented with vague abdominal pain, loss of appetite, postprandial fullness and significant weight loss. There was no lymphadenopathy, and abdominal examination was unremarkable. CT showed a mesenteric mass and a diagnosis of abdominal lymphoma was suggested. There was no evidence of pulmonary tuberculosis on chest X-ray and the purified protein derivative test was negative. On laparotomy, a 5×9×7 cm sessile cyst containing thick white fluid and arising from the ileal mesentery was found and completely removed. Histopathology proved a diagnosis of mesenteric cystic lymphangioma. The patient made uneventful recovery, and was asymptomatic on clinical follow-up after 6 weeks. PMID:25178885

  6. Tracheobronchial Amyloidosis Mimicking Tracheal Tumor.

    PubMed

    Tanrıverdi, Elif; Özgül, Mehmet Akif; Uzun, Oğuz; Gül, Şule; Çörtük, Mustafa; Yaşar, Zehra; Acat, Murat; Arda, Naciye; Çetinkaya, Erdoğan

    2016-01-01

    Tracheobronchial amyloidosis is a rare presentation and accounts for about 1% of benign tumors in this area. The diagnosis of disease is delayed due to nonspecific pulmonary symptoms. Therapeutic approaches are required to control progressive pulmonary symptoms for most of the patients. Herein, we report a case of a 68-year-old man admitted with progressive dyspnea to our institution for further evaluation and management. He was initially diagnosed with and underwent management for bronchial asthma for two years but had persistent symptoms despite optimal medical therapy. Pulmonary computed tomography scan revealed severe endotracheal stenosis. Bronchoscopy was performed and showed endotracheal mass obstructing 70% of the distal trachea and mimicking a neoplastic lesion. The mass was successfully resected by mechanical resection, argon plasma coagulation (APC), and Nd-YAG laser during rigid bronchoscopy. Biopsy materials showed deposits of amorphous material by hematoxylin and eosin staining and these deposits were selectively stained with Congo Red. Although this is a rare clinical condition, this case indicated that carrying out a bronchoscopy in any patient complaining of atypical bronchial symptoms or with uncontrolled asthma is very important. PMID:27594885

  7. Tracheobronchial Amyloidosis Mimicking Tracheal Tumor

    PubMed Central

    Özgül, Mehmet Akif; Uzun, Oğuz; Yaşar, Zehra; Acat, Murat; Arda, Naciye; Çetinkaya, Erdoğan

    2016-01-01

    Tracheobronchial amyloidosis is a rare presentation and accounts for about 1% of benign tumors in this area. The diagnosis of disease is delayed due to nonspecific pulmonary symptoms. Therapeutic approaches are required to control progressive pulmonary symptoms for most of the patients. Herein, we report a case of a 68-year-old man admitted with progressive dyspnea to our institution for further evaluation and management. He was initially diagnosed with and underwent management for bronchial asthma for two years but had persistent symptoms despite optimal medical therapy. Pulmonary computed tomography scan revealed severe endotracheal stenosis. Bronchoscopy was performed and showed endotracheal mass obstructing 70% of the distal trachea and mimicking a neoplastic lesion. The mass was successfully resected by mechanical resection, argon plasma coagulation (APC), and Nd-YAG laser during rigid bronchoscopy. Biopsy materials showed deposits of amorphous material by hematoxylin and eosin staining and these deposits were selectively stained with Congo Red. Although this is a rare clinical condition, this case indicated that carrying out a bronchoscopy in any patient complaining of atypical bronchial symptoms or with uncontrolled asthma is very important. PMID:27594885

  8. Humanlike Robots - Synthetically Mimicking Humans

    NASA Technical Reports Server (NTRS)

    Bar-Cohen, Yoseph

    2012-01-01

    Nature inspired many inventions and the field of technology that is based on the mimicking or inspiration of nature is widely known as Biomimetics and it is increasingly leading to many new capabilities. There are numerous examples of biomimetic successes including the copying of fins for swimming, and the inspiration of the insects and birds flight. More and more commercial implementations of biomimetics are appearing and behaving lifelike and applications are emerging that are important to our daily life. Making humanlike robots is the ultimate challenge to biomimetics and, for many years, it was considered science fiction, but such robots are becoming an engineering reality. Advances in producing such robot are allowing them to perform impressive functions and tasks. The development of such robots involves addressing many challenges and is raising concerns that are related to fear of their application implications and potential ethical issues. In this paper, the state-of-the-art of humanlike robots, potential applications and challenges will be reviewed.

  9. Multidetector computed tomography in the evaluation of pediatric acute abdominal pain in the emergency department.

    PubMed

    Lin, Wei-Ching; Lin, Chien-Heng

    2016-06-01

    The accurate diagnosis of pediatric acute abdominal pain is one of the most challenging tasks in the emergency department (ED) due to its unclear clinical presentation and non-specific findings in physical examinations, laboratory data, and plain radiographs. The objective of this study was to evaluate the impact of abdominal multidetector computed tomography (MDCT) performed in the ED on pediatric patients presenting with acute abdominal pain. A retrospective chart review of children aged <18 years with acute abdominal pain who visited the emergency department and underwent MDCT between September 2004 and June 2007 was conducted. Patients with a history of trauma were excluded. A total of 156 patients with acute abdominal pain (85 males and 71 females, age 1-17 years; mean age 10.9 ± 4.6 years) who underwent abdominal MDCT in the pediatric ED during this 3-year period were enrolled in the study. One hundred and eighteen patients with suspected appendicitis underwent abdominal MDCT. Sixty four (54.2%) of them had appendicitis, which was proven by histopathology. The sensitivity of abdominal MDCT for appendicitis was found to be 98.5% and the specificity was 84.9%. In this study, the other two common causes of nontraumatic abdominal emergencies were gastrointestinal tract (GI) infections and ovarian cysts. The most common etiology of abdominal pain in children that requires imaging with abdominal MDCT is appendicitis. MDCT has become a preferred and invaluable imaging modality in evaluating uncertain cases of pediatric acute abdominal pain in ED, in particular for suspected appendicitis, neoplasms, and gastrointestinal abnormalities. PMID:27154197

  10. A case of giant nodular posterior scleritis mimicking choroidal malignancy

    PubMed Central

    Liu, Andrea T; Luk, Fiona O; Chan, Carmen K

    2015-01-01

    To report a case of giant nodular posterior scleritis mimicking a choroidal tumor. A 42-year-old lady with systemic hypertension presented with a 1-week history of unilateral visual loss, pain and redness in her left eye. Examination showed sectoral anterior episcleritis in her left eye as well as a dome-shaped choroidal mass at the inferior-temporal periphery, associated with retinal hemorrhages and subretinal fluid. Systemic evaluation and imaging of the choroidal mass were performed and could not rule out amelanotic choroidal melanoma. At the same time, she was prescribed a 2-week course of oral nonsteroidal anti-inflammatory drug (NSAID) for her sectoral anterior episcleritis. The choroidal mass was found to have resolved completely right before her scheduled fine needle biospy. Diagnosis of nodular posterior scleritis and a trial of oral NSAID can be considered in patients presenting with a choroidal mass before any invasive procedure. PMID:26862098

  11. Spilled gallstones mimicking a retroperitoneal sarcoma following laparoscopic cholecystectomy.

    PubMed

    Kim, Bum-Soo; Joo, Sun-Hyung; Kim, Hyun-Cheol

    2016-05-01

    Laparoscopic cholecystectomy has become a standard treatment of symptomatic gallstone disease. Although spilled gallstones are considered harmless, unretrieved gallstones can result in intra-abdominal abscess. We report a case of abscess formation due to spilled gallstones after laparoscopic cholecystectomy mimicking a retroperitoneal sarcoma on radiologic imaging. A 59-year-old male with a surgical history of a laparoscopic cholecystectomy complicated by gallstones spillage presented with a 1 mo history of constant right-sided abdominal pain and tenderness. Computed tomography and magnetic resonance imaging demonstrated a retroperitoneal sarcoma at the sub-hepatic space. On open exploration a 5 cm × 5 cm retroperitoneal mass was excised. The mass contained purulent material and gallstones. Final pathology revealed abscess formation and foreign body granuloma. Vigilance concerning the possibility of lost gallstones during laparoscopic cholecystectomy is important. If possible, every spilled gallstone during surgery should be retrieved to prevent this rare complication. PMID:27158213

  12. Spilled gallstones mimicking a retroperitoneal sarcoma following laparoscopic cholecystectomy

    PubMed Central

    Kim, Bum-Soo; Joo, Sun-Hyung; Kim, Hyun-Cheol

    2016-01-01

    Laparoscopic cholecystectomy has become a standard treatment of symptomatic gallstone disease. Although spilled gallstones are considered harmless, unretrieved gallstones can result in intra-abdominal abscess. We report a case of abscess formation due to spilled gallstones after laparoscopic cholecystectomy mimicking a retroperitoneal sarcoma on radiologic imaging. A 59-year-old male with a surgical history of a laparoscopic cholecystectomy complicated by gallstones spillage presented with a 1 mo history of constant right-sided abdominal pain and tenderness. Computed tomography and magnetic resonance imaging demonstrated a retroperitoneal sarcoma at the sub-hepatic space. On open exploration a 5 cm × 5 cm retroperitoneal mass was excised. The mass contained purulent material and gallstones. Final pathology revealed abscess formation and foreign body granuloma. Vigilance concerning the possibility of lost gallstones during laparoscopic cholecystectomy is important. If possible, every spilled gallstone during surgery should be retrieved to prevent this rare complication. PMID:27158213

  13. Primary oral leishmaniasis mimicking oral cancer: a case report.

    PubMed

    Celentano, A; Ruoppo, E; Mansueto, G; Mignogna, M D

    2015-04-01

    Primary mucosal leishmaniasis is a rare infectious disease, particularly in immunocompetent patients. We present a 50-year-old patient with a 6-week history of a painful lesion of the left buccal mucosa that mimicked cancer. The exophytic lesion looked invasive, and we took an incisional biopsy specimen to exclude cancer. The diagnosis of leishmaniasis was unexpected, and the patient was successfully treated with amphotericin B for five weeks. After five months the patient had a visceral recurrence. Chronic exophytic and ulcerated mucosal lesions that do not heal within 3-4 weeks should be regarded as the first signs of oral cancer, but primary oral leishmaniasis can easily mimic it. PMID:25701438

  14. A drawing pin, drill bit, several staples and a magnet: definitely not a simple case of appendicitis.

    PubMed

    Coles, Claire

    2015-01-01

    The sequalae of foreign body ingestion may present in a number of manners and are even more prone to difficulties when a history of foreign body ingestion is not apparent. An 8-year-old boy with a short history of abdominal pain and vomiting presented to the hospital after seeing his general practitioner. He had a history of developmental delay. Examination revealed lower abdominal peritonism and his blood tests revealed elevated inflammatory markers. The patient was initially diagnosed with acute appendicitis and proceeded to theatre. At operation, the patient had a normal appendix but two perforations of the small bowel were incidentally discovered. After theatre, the patient underwent an abdominal X-ray, which revealed a number of radiopaque objects in the rectum. He returned to theatre where a number of metallic objects and a magnet were manually retrieved from the patient's rectum. He made a full recovery and was discharged home a few days later. PMID:26220986

  15. Diagnostic value of procalcitonin for acute complicated appendicitis

    PubMed Central

    Yamashita, Hiromasa; Yuasa, Norihiro; Takeuchi, Eiji; Goto, Yasutomo; Miyake, Hideo; Miyata, Kanji; Kato, Hideki; Ito, Masafumi

    2016-01-01

    ABSTRACT A rapid and reliable test for detection of complicated appendicitis would be useful when deciding whether emergency surgery is required. We investigated the clinical usefulness of procalcitonin for identifying acute complicated appendicitis. We retrospectively analyzed 63 patients aged ≥15 years who underwent appendectomy without receiving antibiotics before admission and had preoperative data on the plasma procalcitonin level (PCT), body temperature (BT), white blood cell count (WBC), neutrophil / lymphocyte ratio (N/L ratio), and C-reactive protein level (CRP). Patients were classified into 3 groups: group A (inflammatory cell infiltration of the appendix with intact mural architecture), group B (inflammatory cell infiltration with destruction of mural architecture, but without abscess or perforation), and group C (macroscopic abscess and/or perforation). For identifying destruction of mural architecture, the diagnostic accuracy of PCT was similar to that of BT or CRP. However, the diagnostic accuracy of PCT was highest among the five inflammatory indices for identifying abscess and/or perforation, with the positive predictive value of PCT for abscess and/or perforation being higher than that of CRP (73% vs. 48%). Univariate analysis of the predictors of abscess and/or perforation revealed that a plasma PCT level ≥0.46 ng/mL had the highest odds ratio (30.3 [95% confidence interval: 6.5–140.5] versus PCT <0.46 ng/mL). These findings indicate that procalcitonin is a useful marker of acute appendicitis with abscess and/or perforation. PMID:27019529

  16. A rare case of appendicitis incarcerated in an inguinal hernia.

    PubMed

    Smith-Singares, Eduardo; Boachie, Joseph Adjei; Iglesias, Izaskun Melania

    2016-01-01

    Amyand's hernia was coined after Claudius Amyand (1660-1740), who was the first to describe the presence of a perforated appendix in a hernial sac and also was the first to perform a successful appendectomy in 1735. It is an exceptionally rare condition in which the hernia itself contains the appendix, which may not necessarily be inflamed. The presence of an inflamed appendix further contributes to the rarity of this case. We report a case of acute appendicitis brought on by its incarceration in the inguinal hernia. PMID:27273683

  17. A rare case of appendicitis incarcerated in an inguinal hernia

    PubMed Central

    Smith-Singares, Eduardo; Boachie, Joseph Adjei; Iglesias, Izaskun Melania

    2016-01-01

    Amyand's hernia was coined after Claudius Amyand (1660–1740), who was the first to describe the presence of a perforated appendix in a hernial sac and also was the first to perform a successful appendectomy in 1735. It is an exceptionally rare condition in which the hernia itself contains the appendix, which may not necessarily be inflamed. The presence of an inflamed appendix further contributes to the rarity of this case. We report a case of acute appendicitis brought on by its incarceration in the inguinal hernia. PMID:27273683

  18. Back Pain

    MedlinePlus

    ... BACK PAIN? There are many possible causes of low back pain, including stretched (strained) muscles, torn or stretched (sprained) ... appear to be at an increased risk for low back pain in comparison to the general population (estimates range ...

  19. Neck pain

    MedlinePlus

    ... Alternative Names Pain - neck; Neck stiffness; Cervicalgia; Whiplash Images Neck pain Whiplash Location of whiplash pain References ... pubmed/19272509 . Read More Diskectomy Foraminotomy Laminectomy Spinal fusion Patient Instructions Spine surgery - discharge Update Date 3/ ...

  20. Pain Relievers

    MedlinePlus

    Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There ... also have a slightly different response to a pain reliever. Over-the-counter (OTC) medicines are good for ...

  1. Elbow pain

    MedlinePlus

    Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is inflammation and ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

  2. Eye pain

    MedlinePlus

    Ophthalmalgia; Pain - eye ... Pain in the eye can be an important symptom of a health problem. Make sure you tell your health care provider if you have eye pain that does not go away. Tired eyes or ...

  3. Heel pain

    MedlinePlus

    Pain - heel ... Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: When the tendon that connects the back ...

  4. Wrist pain

    MedlinePlus

    Pain - wrist; Pain - carpal tunnel; Injury - wrist; Arthritis - wrist; Gout - wrist; Pseudogout - wrist ... Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome . You may feel aching, ...

  5. Depression, Pain, and Pain Behavior.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1986-01-01

    Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status…

  6. Strangulated internal hernia by giant Meckel diverticulum presented as acute appendicitis

    PubMed Central

    Fuentes-Diaz, Jhonny Mauricio; Trujillo-Vasquez, Camilo Andrés; Parra-Vargas, Ana María; Rovira-Chaves, Andrea Sofía; Tinoco-Guzman, Laura Viviana; Garcia-Garcia, Johana Marcela

    2015-01-01

    Introduction Internal hernia due to a Meckel diverticulum is a common presentation of bowel obstruction mostly seen in pediatric population. However, it has been stated that among 5% of the patients had a giant Meckel diverticulum (defined as a Meckel diverticulum with increased dimensions than the ones commonly found), being this condition very unusual. Presentation of case We presented a 19 year old male with acute abdominal pain suggestive of appendicitis. During appendectomy we discovered ischemic and necrotic signs in a bowel segment, leading us to perform a laparotomy that revealed a portion of ischemic and necrotic jejunum, and another bowel segment with a strong adherence to the mesentery root that created an internal hernia. The internal hernia was reduced and the injured bowel portions were resected. Necrotic bowel samples were sent to the pathology department who posteriorly reported a giant Meckel diverticulum. The patient had an excellent recovery after procedure. Discussion After searching in PubMed for a similar association between Meckel diverticulum and internal hernia, we found few cases that reported a giant Meckel diverticulum and a low occurrence with internal hernias making our case not so common to find. Conclusion We concluded that a giant Meckel diverticulum in association with mesenteric defects producing internal hernias are not common pathologies to find together in a patient as our research and case suggest. PMID:26117448

  7. Granulomatous appendicitis: is it Crohn's disease? Report of a case and review of the literature.

    PubMed

    Timmcke, A E

    1986-04-01

    Primary granulomatous inflammation of the appendix is a rare entity. When fungi, parasites, foreign bodies, and obstruction secondary to fecalith, mucocele, or tumor have been eliminated histologically as causes, fewer than 80 cases have been reported in the literature since 1932. Various diseases have also been suggested, including tuberculosis, sarcoidosis, Crohn's disease, and Yersinia pseudotuberculosis. A case of primary granulomatous inflammation of the appendix is presented, and 61 cases reported in the literature since 1953 are reviewed. Patients presented with pain in the right lower quadrant of the abdomen frequently associated with a mass and a protracted preoperative course. Of the 61 patients, 31 were men, 24 were women, and the sex of six of the patients was not reported. The median age of patients was 21 yr. The majority (77%) underwent simple appendectomy. Of patients undergoing ileocolectomy, five of 14 (36%) had concurrent granulomatous ileal involvement. The majority of specimens exhibited appreciable transmural thickening with fibrosis, noncaseating granulomas, formation of Langhans giant cells, and mucosal ulceration. No operative deaths and no postoperative fecal fistulas occurred. In patients without concurrent or synchronous granulomatous disease elsewhere who were followed from 1 to 16.8 yr (mean 5.2 yr), the incidence of recurrence approximated 14%. Therefore, patients with granulomatous appendicitis appear to have a favorable prognosis but require careful long-term observation. PMID:3962954

  8. Lessons to be learned: a case study approach--acute appendicitis masquerading as macroamylasaemia.

    PubMed

    Ganesh, Muniappan; Salam, Imroz

    2008-05-01

    Macroamylasaemia is a condition in which serum amylase is elevated in the presence of a low to normal urinary amylase and normal renal function. It is rare but can masquerade as other clinical disorders. Discussed here is a case report of a patient who presented initially with abdominal pain (later recognized as being due to gangrenous appendicitis) and in whom there was a very high serum amylase level, leading to an erroneous initial diagnosis and management as acute pancreatitis. The CT scan of the abdomen was normal without any evidence of pancreatitis. Subsequently, the renal amylase:creatinine clearance ratio (C(am)/C(cr)) was found to be low, being characteristic and diagnostic of macroamylasaemia; the latter was, in turn, the cause for the elevated serum amylase level. The underlying macroamylasaemia had thus masqueraded as pancreatitis. The patient underwent appendicectomy and hence made an excellent recovery. It is vitally important to recognize this condition in order to avoid both an incorrect diagnosis and inappropriate treatment/management. PMID:18595630

  9. Acute appendicitis with intestinal non-rotation presenting with partial small bowel obstruction diagnosed on CT.

    PubMed

    Zissin, R; Kots, E; Shpindel, T; Shapiro-Feinberg, M

    2000-05-01

    The findings of acute appendicitis on CT have been extensively described in the literature. This is a report of a case of acute appendicitis in a patient with intestinal non-rotation presenting with partial small bowel obstruction. Analysis of the CT findings allowed a correct diagnosis. PMID:10884757

  10. Bispecific antibody mimicking factor VIII.

    PubMed

    Nogami, Keiji

    2016-05-01

    There are some issues in the current factor (F)VIII replacement therapy for severe hemophilia A. One is mental and physical burden for the multiple intravenous infusions, and the other is difficulty in the hemostatic treatment for the patients with FVIII inhibitor. The development of novel drug with fully hemostatic effect, simply procedure, and long-acting reaction has been expected. Recently, FVIIIa-mimicking humanized recombinant bispecific antibody (ACE910) against FIXa and FX was developed. In the non-human clinical study, primate model of acquired hemophilia A demonstrated that the ACE910 was effective on both on-going and spontaneous bleedings. A phase I clinical study was conducted in healthy adults by single subcutaneous infusion of ACE910, followed by the patients' part study, Japanese patients with severe hemophilia A without or with inhibitor were treated with once-weekly subcutaneous injection of ACE910 at three dose levels for 12 successive weeks. There was no significant adverse event related to ACE910 in the clinical and laboratorial findings, and t1/2 of ACE910 was ∼30 days. The median annual bleeding rates were reduced very markedly dose-dependently, independently of inhibitor. Furthermore, among the patients with dose escalation, bleeding rate was decreased as ACE910 dose was increased. In conclusion, ACE910 would have a number of promising features: its high subcutaneous bioavailability and long half-life make the patients possible to be injected subcutaneously with a once-a-week or less frequency. In addition, ACE910 would provide the bleeding prophylactic efficacy, independently of inhibitor. PMID:27207420

  11. Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis

    PubMed Central

    Yilmaz, Mehmet; Akbulut, Sami; Kutluturk, Koray; Sahin, Nurhan; Arabaci, Ebru; Ara, Cengiz; Yilmaz, Sezai

    2013-01-01

    AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gangrenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out. RESULTS: A total of 912 males and 709 females, from 16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell non-hodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy. CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases. PMID:23840147

  12. Application of scoring systems with point-of-care ultrasonography for bedside diagnosis of appendicitis

    PubMed Central

    Ünlüer, Erden Erol; Urnal, Rıfat; Eser, Utku; Bilgin, Serkan; Hacıyanlı, Mehmet; Oyar, Orhan; Akoğlu, Haldun; Karagöz, Arif

    2016-01-01

    BACKGROUND: Appendicitis is a common disease requiring surgery. Bedside ultrasound (BUS) is a core technique for emergency medicine (EM). The Alvarado score is a well-studied diagnostic tool for appendicitis. This study aimed to investigate the relationship between patients’ symptoms, Alvarado score and ultrasound (US) findings, as performed by emergency physicians (EPs) and radiologists, of patients with suspected appendicitis. METHODS: Three EM specialists underwent the BUS course and core course for appendicitis assessment. Patients suspected of having appendicitis were selected and their Alvarado and modified (m) Alvarado scores calculated. The specialists performed the BUS. Then, patients were given a formal US and surgery consultation if necessary. Preliminary diagnoses, admission or discharge from the emergency department (ED) and final diagnosis were documented. The patients were also followed up after discharge from the hospital. RESULTS: The determined cut-off value was 2 for Alvarado and 3 for mAlvarado scores. The sensitivities of the two scores were 100%. Each score was used to rule out appendicitis. The results of EP-performed BUS were as follows: accuracy 70%, sensitivity 0.733, specificity 0.673, + LR 2.24, and – LR 0.40 (95%CI). Radiologists were better than EPs at diagnosing appendicitis and radiologists and EPs were equally strong at ruling out appendicitis by US. When US was combined with Alvarado and mAlvarado scores, EP US+Alvarado/mAlvarado scores <3 and radiology US+Alvarado/mAlvarado scores <4 perfectly ruled out appendicitis. CONCLUSION: BUS performed by EPs is moderately useful in detecting appendicitis. Combined with scoring systems, BUS may be a perfect tool for ruling out decisions in EDs. PMID:27313807

  13. Back Pain

    MedlinePlus

    ... Awards Enhancing Diversity Find People About NINDS NINDS Back Pain Information Page Condensed from Low Back Pain Fact ... en Español Additional resources from MedlinePlus What is Back Pain? Acute or short-term low back pain generally ...

  14. Pelvic Pain

    MedlinePlus

    Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

  15. Pulmonary Paragonimiasis Mimicking Tuberculous Pleuritis

    PubMed Central

    Luo, Jian; Wang, Mao-Yun; Liu, Dan; Zhu, Hui; Yang, Sai; Liang, Bin-Miao; Liang, Zong-An

    2016-01-01

    Abstract Pulmonary paragonimiasis is a food-borne zoonosis with a wide variety of radiologic findings, which sometimes can be confused with tuberculosis and carcinoma. Therefore, differential diagnosis is always warranted. A 43-year-old male farmer, with productive cough, blood-tinged sputum and chest pain, as well as patchy consolidation and pleural effusions in chest computer tomography, was misdiagnosed of community-acquired pneumonia and tuberculosis. Complete blood cell count, sputum smear and culture, chest computer tomography, thoracoscopy, and biopsy. The diagnosis of pulmonary paragonimiasis was established due to the finding of Charcot–Leyden crystals in the pleural necrosis, and antibodies against Paragonimus westermani in enzyme-linked immunosorbent assay. Paragonimiasis should be considered as a possibility in the differential diagnosis of tuberculosis. Thoracoscopy is an effective and valuable technology that can help make an accurate diagnosis. PMID:27082624

  16. Endometriosis mimicking colonic stromal tumor

    PubMed Central

    Wadhwa, Vaibhav; Slattery, Eoin; Garud, Sagar; Sethi, Saurabh; Wang, Helen; Poylin, Vitaliy Y.; Berzin, Tyler M.

    2016-01-01

    Endometriosis is defined as the presence of endometrial glands and stroma at extra-uterine sites; it is a common disease affecting women of reproductive age. Endometrial tissue can implant itself to various organs, including the gastrointestinal tract, and can cause significant gastrointestinal symptoms. These ectopic endometrial tissue implants are usually located in the pelvis but can be present almost anywhere in the body. Endometriosis seems to be the most frequent cause of chronic pelvic pain in women of reproductive age and may cause prolonged suffering and disability that negatively affect health-related quality of life. We report a case in a generally healthy young female patient who presented for evaluation of diarrhea. PMID:25725039

  17. Pleuropulmonary paragonimiasis: mimicker of tuberculosis.

    PubMed

    Lall, Mahima; Sahni, Ajay Kumar; Rajput, A K

    2013-01-01

    Infection caused by the lung fluke is endemic in north eastern parts of India. Paragonimus westermani and Paragonimus heterotremus are known to be endemic in eastern Indian states of Manipur and Nagaland. The infection is related to eating habits of the locals and is acquired by ingestion of raw, inadequately cooked crabs or crayfish containing encysted metacercariae which act as second intermediate hosts during the life cycle of the lung fluke. Diagnosis is generally delayed due to lack of suspicion and presentation similar to tuberculosis which is endemic in the population. We report pleuropulmonary paragonimiasis in a soldier from eastern India who presented with chest pain, haemoptysis, and eosinophilia. He gave history of consumption of raw crabs while on leave at his native village in Nagaland. Ova morphologically resembling Paragonimus heterotremus were detected in sputum and bronchoalveolar lavage specimen. Symptoms resolved with praziquantel treatment. PMID:23432864

  18. [Ultrasound study of "acute appendicitis," an elective procedure or obligation in general surgery. A prospective study].

    PubMed

    Meiser, G; Meissner, K; Sattlegger, P

    1987-08-01

    576 patients admitted for suspected acute appendicitis were prospectively assessed by sonography following physical examination. The collective comprised - as proven by operation - 156 patients with acute appendicitis, 178 patients with chronic appendicitis or mesenteric lymphadenitis, as proven by observation, 186 patients suffering from gastroenteritis. 56 patients suffered from other diseases and 21 of them required urgent surgery. Based on clinical symptoms, correct diagnosis had been made in 433 patients (75%): gastroenteritis n = 186, chronic appendicitis or lymphadenitis n = 111 and acute appendicitis n = 136 (87%). In 123 patients the diagnosis was false positive, in 20 patients false negative. Based on sonographic assessment, 537 patients (93%) were correctly diagnosed; thus, in 129 patients (83%) an inflamed appendix was confirmed, in 56 patients; diagnosis of unrelated entities requiring urgent surgery correct in 21 cases. In 12 patients with mesenteric lymphadenitis - as proven by operation-a false positive, in another 27 patients with acute appendicitis a false negative diagnosis was made. The combination of clinical assessment and sonographic diagnosis yielded a correct diagnosis in 97% (560/576) comprising 414 true negative and 146 true positive results (94%) in respect of acute appendicitis. PMID:3313723

  19. Association between Gastroesophageal Reflux Disease and Appendicitis: A Population-Based Case-Control Study

    PubMed Central

    Kao, Li-Ting; Tsai, Ming-Chieh; Lin, Herng-Ching; Lee, Cha-Ze

    2016-01-01

    Appendicitis and gastroesophageal reflux disease (GERD) are both prevalent diseases and might share similar pathological mechanisms. The aim of this study was to investigate the association between GERD and appendicitis using a large population-based dataset. This study used administrative claims data from the Taiwan Longitudinal Health Insurance Database 2005. We identified 7113 patients with appendicitis as cases, and 28452 matched patients without appendicitis as controls. This study revealed that GERD was found in 359 (5.05%) cases and 728 (2.56%) controls (p < 0.001). Conditional logistic regression shows that the adjusted odds ratio (OR) of GERD for cases was 2.05 (95% confidence interval (CI): 1.08~2.33) compared to controls. The adjusted ORs of prior GERD for patients aged 18~39, 40~59, and ≥60 years with appendicitis were 1.96 (95% CI: 1.56~2.47), 2.36 (95% CI: 1.94~2.88), and 1.71 (95% CI: 1.31~2.22) than controls, respectively. We concluded that patients with appendicitis had higher odds of prior GERD than those without appendicitis regardless of age group. PMID:26932391

  20. Tissue mimicking materials for dental ultrasound.

    PubMed

    Singh, Rahul S; Culjat, Martin O; Grundfest, Warren S; Brown, Elliott R; White, Shane N

    2008-04-01

    While acoustic tissue mimicking materials have been explored for a variety of soft and hard biological tissues, no dental hard tissue mimicking materials have been characterized. Tooth phantoms are necessary to better understand acoustic phenomenology within the tooth environment and to accelerate the advancement of dental ultrasound imaging systems. In this study, soda lime glass and dental composite were explored as surrogates for human enamel and dentin, respectively, in terms of compressional velocity, attenuation, and acoustic impedance. The results suggest that a tooth phantom consisting of glass and composite can effectively mimic the acoustic behavior of a natural human tooth. PMID:18396919

  1. Significance of CD4+ T-cell count in the management of appendicitis in patients with HIV

    PubMed Central

    Kitaoka, Kumiko; Saito, Kazuhiro; Tokuuye, Koichi

    2015-01-01

    Summary Identification of complicated appendicitis (CA) is critical to the management of appendicitis. However, previous studies have not investigated indicators of CA among patients with HIV or whether it is safe to use conservative treatment for appendicitis in these patients. Among 322 patients with appendicitis, we identified 14 who had HIV. Six of them were operated and 8 were treated with antibiotics; CA was diagnosed in 4. Patients with HIV and CA had a significantly lower CD4+ T-cell count than those with uncomplicated appendicitis. A white blood cell count lower than 7.4 × 109/L was observed exclusively in patients with CA. No patient with HIV whose appendicitis was treated conservatively died or experienced a recurrence. We discuss our findings, which suggest the possibility of conservative treatment of appendicitis in patients with HIV and identification of CA by low CD4+ T-cell count. PMID:26424690

  2. Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis.

    PubMed

    Liang, Tsung-Jung; Liu, Shiuh-Inn; Tsai, Chung-Yu; Kang, Chi-Hsiang; Huang, Wei-Chun; Chang, Hong-Tai; Chen, I-Shu

    2016-03-01

    The recurrence rate for acute appendicitis treated nonoperatively varies between studies. Few studies have adequately evaluated the management of these patients when appendicitis recurs. We aimed to explore the recurrence rate and management of patients with acute appendicitis that were first treated nonoperatively.We identified patients in the Taiwan National Health Insurance Research Database who were hospitalized due to acute appendicitis for the first time between 2000 and 2010 and received nonsurgical treatment. The recurrence and its management were recorded. Data were analyzed to access the risk factors for recurrence and factors that influenced the management of recurrent appendicitis.Among the 239,821 patients hospitalized with acute appendicitis for the first time, 12,235 (5.1%) patients were managed nonoperatively. Of these, 864 (7.1%) had a recurrence during a median follow-up of 6.5 years. Appendectomy was performed by an open and laparoscopic approach in 483 (55.9%) and 258 (29.9%) patients, respectively. The remaining 123 (14.2%) patients were again treated nonsurgically. Recurrence was independently associated with young age, male sex, percutaneous abscess drainage, and medical center admission by multivariable analysis. In addition, age <18, a (CCI) <2, medical center admission, and a longer time to recurrence were correlated with using laparoscopy to treat recurrence. Neither type of appendicitis, percutaneous abscess drainage, nor length of first time hospital stay had an influence on the selection of surgical approach.In conclusion, a laparoscopic appendectomy can be performed in recurrent appendicitis cases, and its application may not be related to previous appendicitis severity. PMID:27015200

  3. Gastrointestinal variant of Lemierre's syndrome complicating ruptured appendicitis.

    PubMed

    Akhrass, Fadi Al; Abdallah, Lina; Berger, Steven; Sartawi, Rami

    2015-01-01

    Fusobacterium necrophorum is a non-spore-forming, obligate anaerobic, filamentous, gramnegative bacillus that frequently colonizes the human oral cavity, respiratory tract, and gastrointestinal tract. Fusobacterium species have rarely been implicated in cases of gastrointestinal variant of Lemierre's syndrome. We describe a case of F. necrophorum bacteremia associated with suppurative porto-mesenteric vein thrombosis (PVT) following acute ruptured appendicitis. In addition, we list the documented twelve cases of Fusobacterium pylephlebitis. Recanalization of the porto-mesenteric veins and relief of the extrahepatic portal hypertension were achieved with early empiric antibiotic and local thrombolytic therapy. Our patient's case underscores the importance of recognizing Fusobacterium bacteremia as a possible cause of suppurative PVT after disruption of the gastrointestinal mucosa following an acute intraabdominal infectious process. Early treatment of this condition using anticoagulation and endovascular thrombolysis as adjunctive therapies may prevent PVT complications. PMID:26793462

  4. Gastrointestinal variant of Lemierre's syndrome complicating ruptured appendicitis

    PubMed Central

    Akhrass, Fadi Al; Abdallah, Lina; Berger, Steven; Sartawi, Rami

    2015-01-01

    Fusobacterium necrophorum is a non-spore-forming, obligate anaerobic, filamentous, gramnegative bacillus that frequently colonizes the human oral cavity, respiratory tract, and gastrointestinal tract. Fusobacterium species have rarely been implicated in cases of gastrointestinal variant of Lemierre's syndrome. We describe a case of F. necrophorum bacteremia associated with suppurative porto-mesenteric vein thrombosis (PVT) following acute ruptured appendicitis. In addition, we list the documented twelve cases of Fusobacterium pylephlebitis. Recanalization of the porto-mesenteric veins and relief of the extrahepatic portal hypertension were achieved with early empiric antibiotic and local thrombolytic therapy. Our patient's case underscores the importance of recognizing Fusobacterium bacteremia as a possible cause of suppurative PVT after disruption of the gastrointestinal mucosa following an acute intraabdominal infectious process. Early treatment of this condition using anticoagulation and endovascular thrombolysis as adjunctive therapies may prevent PVT complications. PMID:26793462

  5. Recurrent abdominal pain post appendectomy--a rare case.

    PubMed

    Cama, Jitoko K

    2010-09-01

    Right iliac fossa pain in young adults who have previously had an appendicectomy represents a diagnostic challenge. In such cases it is important to review the histology of the appendix and the previous operation notes. The appendix stump, if left long following an appendectomy, can result in chronic appendicitis of the stump, or it can rarely develop into a mucocele. This case report describes a patient with an appendix stump mucocele who presented with chronic pain under the right iliac fossa incision and was successfully treated by laparoscopic resection. PMID:21714341

  6. Acute appendicitis with intestinal malrotation: the usefulness of coronal computed tomography.

    PubMed

    Sonomura, Tetsuo; Koyama, Takao; Ishii, Seigo; Takeuchi, Taizo; Sanda, Hiroki; Nakata, Kouhei; Nakai, Motoki; Minamiguchi, Hiroki; Kishi, Kazushi; Sato, Morio

    2014-01-01

    We herein present a rare case of acute appendicitis with intestinal malrotation. Coronal images of contrast-enhanced computed tomography (CT) revealed the small intestine on the right side and the large intestine on the left side, thus indicating intestinal malrotation (non-rotation type). In addition, an enhanced, tubular, fluid-filled structure was detected attached to the cecum, which was located superior to the urinary bladder, suggesting acute appendicitis. The present study shows that coronal CT images provide important information for the diagnosis and treatment of acute appendicitis in patients with intestinal malrotation. PMID:25030562

  7. Magnetic resonance imaging in pediatric appendicitis: a systematic review.

    PubMed

    Moore, Michael M; Kulaylat, Afif N; Hollenbeak, Christopher S; Engbrecht, Brett W; Dillman, Jonathan R; Methratta, Sosamma T

    2016-05-01

    Magnetic resonance imaging for the evaluation of appendicitis in children has rapidly increased recently. This change has been primarily driven by the desire to avoid CT radiation dose. This meta-analysis reviews the diagnostic performance of MRI for pediatric appendicitis and discusses current knowledge of cost-effectiveness. We used a conservative Haldane correction statistical method and found pooled diagnostic parameters including a sensitivity of 96.5% (95% confidence interval [CI]: 94.3-97.8%), specificity of 96.1% (95% CI: 93.5-97.7%), positive predictive value of 92.0% (95% CI: 89.3-94.0%) and negative predictive value of 98.3% (95% CI: 97.3-99.0%), based on 11 studies. Assessment of patient outcomes associated with MRI use at two institutions indicates that time to antibiotics was 4.7 h and 8.2 h, time to appendectomy was 9.1 h and 13.9 h, and negative appendectomy rate was 3.1% and 1.4%, respectively. Alternative diagnoses were present in ~20% of cases, most commonly adnexal cysts and enteritis/colitis. Regarding technique, half-acquisition single-shot fast spin-echo (SSFSE) pulse sequences are crucial. While gadolinium-enhanced T1-weighted pulse sequences might be helpful, any benefit beyond non-contrast MRI has not been confirmed. Balanced steady-state free precession (SSFP) sequences are generally noncontributory. Protocols do not need to exceed five sequences; four-sequence protocols are commonly utilized. Sedation generally is not indicated; patients younger than 5 years might be attempted based on the child's ability to cooperate. A comprehensive pediatric cost-effectiveness analysis that includes both direct and indirect costs is needed. PMID:27229509

  8. Retroperitoneal mucinous cystadenoma of the appendix mimicking hydatid cyst: A case report

    PubMed Central

    Sikar, Hasan Ediz; Çetin, Kenan; Gündoğan, Ersin; Gündoğan, Gökçen Alinak; Kaptanoğlu, Levent

    2016-01-01

    Appendiceal mucocele is a cystic dilatation of the appendix due to abnormal appendiceal mucinous secretion. Cystadenoma of the appendix is one of the most common causes and is encountered in 0.6% of all appendectomy specimens. The diagnosis may be difficult due to the asymptomatic nature of the disease; pain in the right lower quadrant may be the only symptom. Complex ovarian cyst, urolithiasis or cystic hydatid disease of the liver have been reported as mimicking appendiceal mucocele in the literature. In this study, we present a case of mucinous cystadenoma of the appendix mimicking retroperitoneal hydatid cyst in a 59-year-old woman. The patient was treated with laparoscopic appendectomy with partial resection of the caecum following laparoscopic exploration.

  9. Seeing past the appendix: the role of ultrasound in right iliac fossa pain

    PubMed Central

    MacDonald, L; Johnson, G; Rudralingham, V

    2013-01-01

    Acute right iliac fossa pain is a common surgical presentation. The presentation is often non-specific and encompasses a wide differential, which creates a diagnostic challenge. Ultrasound is commonly the initial cross-sectional imaging modality and can be used as a tool to triage patients appropriately; assessing for appendicitis and other salient findings, which may indicate an alternative condition. Additionally, the dynamic nature of this imaging modality enables patient interaction. Following a systematic assessment of the abdomen and pelvis, a more focused interrogation of the right iliac fossa is performed. In this pictorial review, we illustrate the sonographic features of appendicitis and other conditions that can mimic appendicitis in its presentation. This highlights that through a systematic approach, it is possible to distinguish between these different pathologies, enabling clinicians to optimally manage the patient.

  10. Rare Mimickers of Exostosis: A Case Series

    PubMed Central

    Perubhotla, Lakshmi Manasa

    2016-01-01

    Exophytic growths from bones are a common entity. Osteochondroma is the most common benign exophytic lesion and we tend to diagnose every benign looking exophytic lesion as osteochondroma. Here we reported two entities of cases, one was Nora’s lesion and another one was supracondylar process of humerus, both of which were mimickers of osteochondroma and their salient and differentiating features from osteochondromas.

  11. Acute pain.

    PubMed

    Good, M

    1999-01-01

    The review of acute pain describes the problem of unresolved pain and its effects on the neural, autonomic, and immune systems. Conceptualizations and mechanisms of pain are reviewed as well as theories of pain management. Descriptive studies of patient and nurse factors that inhibit effective pain management are discussed, followed by studies of pharmacological and nonpharmacological interventions. Critical analysis reveals that most studies were atheoretical, and therefore, this proliferation of information lacked conceptual coherence and organization. Furthermore, the nature and extent of barriers to pain management were described, but few intervention studies have been devised, as yet, to modify the knowledge, beliefs, and attitudes of nurses and patients that are barriers to pain management. Although some of the complementary therapies have sufficient research support to be used in clinical pain management, the physiological mechanisms and outcomes need to be studied. It is critical at this time to design studies of interventions to improve assessment, decision making, attentive care, and patient teaching. PMID:10418655

  12. Pain Management

    MedlinePlus

    ... the brain played a role in producing the perception of pain. In the 19th century, physician-scientists ... they are experiencing. Discoveries of differences in pain perceptions and responses to treatment by gender has have ...

  13. Penis pain

    MedlinePlus

    ... pain. If penis pain is caused by a sexually transmitted disease, it is important for your sexual partner to ... Are you at risk for exposure to any sexually transmitted diseases? What other symptoms do you have? The physical ...

  14. Breast pain

    MedlinePlus

    Pain - breast; Mastalgia; Mastodynia; Breast tenderness ... There are many possible causes for breast pain. For example, hormone level changes from menstruation or pregnancy often cause breast tenderness. Some swelling and tenderness just before your period ...

  15. Shoulder pain

    MedlinePlus

    ... 4 muscles and their tendons, called the rotator cuff, give the shoulder its wide range of motion. Swelling, damage, or bone changes around the rotator cuff can cause shoulder pain. You may have pain ...

  16. Elbow pain

    MedlinePlus

    Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is ... injure the tendons on the outside of the elbow. This condition is commonly called tennis elbow . Golfers ...

  17. Ribcage pain

    MedlinePlus

    ... not cause the pain in someone who has pleurisy (swelling of the lining of the lungs) or ... Inflammation of cartilage near the breastbone ( costochondritis ) Osteoporosis Pleurisy (the pain is worse when breathing deeply)

  18. Abdominal pain

    MedlinePlus

    ... water or other clear fluids. You may have sports drinks in small amounts. People with diabetes must ... pain occur? For example, after meals or during menstruation? What makes the pain worse? For example, eating, ...

  19. Back Pain

    MedlinePlus

    ... Oh, my aching back!", you are not alone. Back pain is one of the most common medical problems, ... 10 people at some point during their lives. Back pain can range from a dull, constant ache to ...

  20. Pain Assessment

    MedlinePlus

    ... as a result of the pain, and the nature of other medical and psychiatric problems, should be ... information helps the health care provider understand the nature of the pain or the potential benefits of ...

  1. Finger pain

    MedlinePlus

    Pain - finger ... Nearly everyone has had finger pain at some time. You may have: Tenderness Burning Stiffness Numbness Tingling Coldness Swelling Change in skin color Redness Many conditions, such ...

  2. Chest pain

    MedlinePlus

    ... of pain, including your heart, lungs, esophagus, muscles, ribs, tendons, or nerves. Pain may also spread to ... often occurs with fast breathing Inflammation where the ribs join the breast bone or sternum ( costochondritis ) Shingles , ...

  3. Patellofemoral Pain.

    PubMed

    Dutton, Rebecca A; Khadavi, Michael J; Fredericson, Michael

    2016-02-01

    Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain. PMID:26616176

  4. Use of Clinical Data to Predict Appendicitis in Patients with Equivocal US Findings.

    PubMed

    Athans, Brett S; Depinet, Holly E; Towbin, Alexander J; Zhang, Yue; Zhang, Bin; Trout, Andrew T

    2016-08-01

    Purpose To determine the incremental value of clinical data in patients with ultrasonographic (US) examinations that were interpreted as being equivocal for acute appendicitis. Materials and Methods Institutional review board approval, with a waiver of informed consent, was obtained for this analysis of clinical and imaging data in patients younger than 18 years old who were evaluated for acute appendicitis. Findings from US examinations were reported in a structured fashion, including two possible equivocal impressions. Clinical data were captured as Pediatric Appendicitis (PAS) or Alvarado scores and considered as categoric (high, intermediate, or low likelihood) and continuous variables to simulate stratification of equivocal US examinations to predict appendicitis. Receiver operating characteristic curves were used to define score cutoffs, and logistic regression was used to assess individual clinical variables as predictors of appendicitis. Results The study population was made up of 776 patients (mean age, 11.7 years ± 3.7), with 429 (55.2%) girls. A total of 203 (26%) patients had appendicitis. US had a negative predictive value of 96.2% and a positive predictive value of 93.3% for depicting appendicitis, with 89 of 782 (11.4%) equivocal examinations. Categoric PAS and Alvarado scores were equivocal for 59.5% (53 of 89) and 50.6% (45 of 89) of equivocal US examinations, respectively. Categoric low- and high-likelihood PAS and Alvarado scores correctly predicted the presence of appendicitis in 61.1% (22 of 36) and 77.3% (34 of 44) of equivocal US examinations, respectively. As continuous variables, a PAS or Alvarado score of 5 or lower could be used to exclude appendicitis, with a 80.8% (21 of 26) and 90% (18 of 20) negative predictive value, respectively. Conclusion The study confirms the excellent performance of US for depicting pediatric appendicitis. In the subset of equivocal US examinations, a low clinical score (≤5) may be used to identify patients

  5. Face pain

    MedlinePlus

    Face pain may be dull and throbbing or an intense, stabbing discomfort in the face or forehead. It can occur in one or ... Pain that starts in the face may be caused by a nerve problem, injury, or infection. Face pain may also begin in other places in the body. ...

  6. A Rare Case of Neonatal Complicated Appendicitis in a Child with Patau's Syndrome

    PubMed Central

    Pastore, Valentina; Bartoli, Fabio

    2014-01-01

    Neonatal appendicitis is a rare condition with high mortality rate. Signs and symptoms are often nonspecific, imaging modalities are not always diagnostic, and preoperative diagnosis is difficult with subsequent delay and complications. Its pathophysiology may be different from appendicitis in older children and comorbidities can be found. We report a case of a female neonate with Patau's syndrome, intestinal malrotation, and Fallot tetralogy in whom perforated appendix, probably occurring during fetal period due to vascular insufficiency, was found at laparotomy. PMID:25276460

  7. [Facial and eye pain - Neurological differential diagnosis].

    PubMed

    Kastrup, O; Diener, H-C; Gaul, C

    2011-12-01

    Head and facial pain are common in neurological practice and the pain often arises in the orbit or is referred into the eye. This is due to the autonomic innervation of the eye and orbit. There are acute and chronic pain syndromes. This review gives an overview of the differential diagnosis and treatment. Idiopathic headache syndromes, such as migraine and cluster headache are the most frequent and are often debilitating conditions. Trigemino-autonomic cephalalgias (SUNCT and SUNA) have to be taken into account, as well as trigeminal neuralgia. Trigemino-autonomic headache after eye operations can be puzzling and often responds well to triptans. Every new facial pain not fitting these categories must be considered symptomatic and a thorough investigation is mandatory including magnetic resonance imaging. Infiltrative and neoplastic conditions frequently lead to orbital pain. As a differential diagnosis Tolosa-Hunt syndrome and Raeder syndrome are inflammatory conditions sometimes mimicking neoplasms. Infections, such as herpes zoster ophthalmicus are extremely painful and require rapid therapy. It is important to consider carotid artery dissection as a cause for acute eye and neck pain in conjunction with Horner's syndrome and bear in mind that vascular oculomotor palsy is often painful. All of the above named conditions should be diagnosed by a neurologist with special experience in pain syndromes and many require an interdisciplinary approach. PMID:22130681

  8. Temporomandibular pain.

    PubMed

    Prasad, S Raghavendra; Kumar, N Ravi; Shruthi, H R; Kalavathi, S D

    2016-01-01

    Temporomandibular joint pain has various medical and dental etiological factors. The etiology of the temporomandibular joint pain is enigmatic, no single etiological factor is regarded as the cause. Its distribution is also not confined to a single area. This article presents the basic etiologic factors, its epidemiology, distribution of pain, classification of patients and the psychosocial behavior of patients suffering with temporomandibular pain. As overwhelming majority of medical and dental conditions/issues related to etiology of temporomandibular pain in patients have traditionally been presented and interpreted from the clinician's point of view. PMID:27601822

  9. Temporomandibular pain

    PubMed Central

    Prasad, S Raghavendra; Kumar, N Ravi; Shruthi, HR; Kalavathi, SD

    2016-01-01

    Temporomandibular joint pain has various medical and dental etiological factors. The etiology of the temporomandibular joint pain is enigmatic, no single etiological factor is regarded as the cause. Its distribution is also not confined to a single area. This article presents the basic etiologic factors, its epidemiology, distribution of pain, classification of patients and the psychosocial behavior of patients suffering with temporomandibular pain. As overwhelming majority of medical and dental conditions/issues related to etiology of temporomandibular pain in patients have traditionally been presented and interpreted from the clinician's point of view. PMID:27601822

  10. Synthesis, computational modeling, and properties of benzo-appended BODIPYs.

    PubMed

    Uppal, Timsy; Hu, Xiaoke; Fronczek, Frank R; Maschek, Stephanie; Bobadova-Parvanova, Petia; Vicente, M Graça H

    2012-03-26

    A series of new functionalized mono- and dibenzo-appended BODIPY dyes were synthesized from a common tetrahydroisoindole precursor following two different synthetic routes. Route A involved the assembly of the BODIPY core prior to aromatization, while in Route B the aromatization step was performed first. In general, Route A gave higher yields of the target dibenzo-BODIPYs, due to the ease of aromatization of the BODIPYs compared with the corresponding dipyrromethenes, probably due to their higher stability under the oxidative conditions (2,3-dichloro-5,6-dicyano-1,4-benzoquinone in refluxing toluene). However, due to the slow oxidation of highly electron-deficient BODIPY 3 c bearing a meso-C(6)F(5) group, dibenzo-BODIPY 4 c was obtained, in 35 % overall from dipyrromethane, only by Route B. Computational calculations performed at the 6-31G(d,p) level are in agreement with the experimental results, showing similar relative energies for all reaction intermediates in both routes. In addition, BODIPY 3 c had the highest molecular electrostatic potential (MEPN), confirming its high electron deficiency and consequent resistance toward oxidation. X-ray analyses of eight BODIPYs and several intermediates show that benzannulation further enhances the planarity of these systems. The π-extended BODIPYs show strong red-shifted absorptions and emissions, about 50-60 nm per benzoannulated ring, at 589-658 and 596-680 nm, respectively. In particular, db-BODIPY 4 c bearing a meso-C(6)F(5) group showed the longest λ(max) of absorption and emission, along with the lowest fluorescence quantum yield (0.31 in CH(2)Cl(2)); on the other hand monobenzo-BODIPY 8 showed the highest quantum yield (0.99) of this series. Cellular investigations using human carcinoma HEp2 cells revealed high plasma membrane permeability for all dibenzo-BODIPYs, low dark- and photo-cytotoxicities and intracellular localization in the cell endoplasmic reticulum, in addition to other

  11. Primary omental gangrene mimicking appendicular perforation peritonitis—A case report

    PubMed Central

    Kumar, A.; Shah, J.; Vaidya, P.

    2016-01-01

    Introduction Primary omental torsion is a rare cause of acute abdomen in adults and presents with variable signs and symptoms. Establishing a preoperative diagnosis may be difficult in the emergency setting. It is rarely diagnosed preoperatively as it mimics common surgical emergencies such as acute appendicitis, appendicular perforation, acute cholecystitis and perforated peptic ulcers and can lead to the clinical deterioration of patient if missed Presentation of case A 47 years old male was taken to the operating room with a diagnosis of appendicular perforation peritonitis and during surgery was found to have a primary omental gangrene with pyoperitoneum, for which omentectomy and peritoneal lavage was performed. Discussion Torsion of the omentum is a condition in which the organ twists on its long axis to such an extent that its vascularity is compromised. Omental torsion can be primary (idiopathic) or secondary, depending on an underlying cause. Primary omental torsion was first described by Eitel in 1899. However, very few cases have been reported. Our case was a rare case presenting with omental gangrene with pyoperitoneum mimicking appendicular perforation peritonitis. Conclusion Primary omental torsion is a rare diagnosis. A high index of clinical suspicion is required for a preoperative diagnosis. In doubtful cases a CT scan may be helpful. Surgical excision of the omentum remains the treatment of choice; however, conservative management may be attempted in an uncomplicated omental torsion. PMID:26945486

  12. Case-based discussion: an unusual manifestation of diaphragmatic hernia mimicking pneumothorax in an adult male.

    PubMed

    Vyas, Pradeep Kumar; Godbole, Chintamani; Bindroo, Susheel Kumar; Mathur, Rajiv S; Akula, Bharathi; Doctor, Nilesh

    2016-12-01

    Diaphragmatic hernia is an important cause of emergency hospital admission associated with significant morbidity. It usually results from congenital defect or rupture in the diaphragm due to trauma. Prompt and appropriate diagnosis is necessary in patients with this condition, as surgical intervention by either abdominal or thoracic approach may be necessary. Here, we report a case of left-sided diaphragmatic hernia presenting with sudden onset of breathlessness, respiratory distress and left-sided chest pain radiating to the abdomen, mimicking pneumothorax, treated successfully with surgical intervention. PMID:26924754

  13. A case of primary pancreatic non-Hodgkin B-cell lymphoma mimicking autoimmune pancreatitis.

    PubMed

    Anderloni, Andrea; Genco, Chiara; Ballarè, Marco; Carmagnola, Stefania; Battista, Serena; Repici, Alessandro

    2015-06-01

    Non Hodgkin lymphoma frequently involves the gastrointestinal tract, in particular the stomach and the small bowel. Rarely, it can also be a cause of pancreatic masses. Clinical presentation is often non-specific and may overlap with other pancreatic conditions such as carcinoma, neuroendocrine tumours and autoimmune pancreatitis. We report a case of primary pancreatic lymphoma in a young woman with jaundice, fever and abdominal pain mimicking autoimmune pancreatitis. Clinical evaluation included the abdominal Computed Tomography scan, Magnetic Resonance Imaging and an upper gastrointestinal endoscopy that revealed a large duodenal mass. Endoscopic biopsies were performed and eventually histological examination was coherent with a diagnosis of primary pancreatic lymphoma. PMID:26114186

  14. Chronic Esophageal Perforation With Periesophageal Abscess Mimicking Malignancy on FDG PET/CT.

    PubMed

    Dong, Aisheng; Zhang, Ling; Wang, Yang; Zuo, Changjing

    2016-06-01

    A 53-year-old man was admitted because of progressive dysphagia and retrosternal pain for 20 days. Esophagogastroduodenoscopy showed an irregular submucosal bulge on the distal esophageal wall. A barium swallow showed a triangular-shaped outpouching of contrast material with minimal contained extravasation into the periesophageal area. Enhanced CT showed thickening of the distal esophagus with an area containing air and septa. FDG PET/CT showed intense FDG uptake of the thickened esophageal wall mimicking malignancy. Endoscopic ultrasonography-guided biopsy of the submucosal mass revealed granulation tissue. The imaging and pathologic findings were consistent with chronic esophageal perforation with periesophageal abscess. PMID:26914572

  15. Chilaiditi Sign on 99mTc-Mebrofenin Hepatobiliary Scan Mimicking Bile Leak in Acute Cholecystitis.

    PubMed

    Pascarella, Suzanne; Dadparvar, Simin

    2016-06-01

    Chilaiditi sign is the incidental radiologic finding of intestinal interposition between the liver and diaphragm, whereas Chilaiditi syndrome describes the presence of accompanying clinical symptoms including abdominal pain, constipation, vomiting, and respiratory distress. We describe a case of radiotracer accumulation over the liver dome on Tc-mebrofenin hepatobiliary scan performed on a 72-year-old man with acute cholecystitis mimicking a bile leak. However, chest radiograph and CT revealed intestinal hepatodiaphragmatic interposition. This case illustrates the importance of being familiar with the scintigraphic appearance of the Chilaiditi sign and correlating abnormal nuclear medicine scan findings with other available radiologic modalities. PMID:26859214

  16. Digital speckle pattern interferometry based anomaly detection in breast mimicking phantoms: a pilot study

    NASA Astrophysics Data System (ADS)

    Udayakumar, K.; Sujatha, N.; Ganesan, A. R.

    2015-03-01

    Early screening of subsurface anomalies in breast can improve the patient survival rate. Clinically approved breast screening modalities may either have body ionizing effect/cause pain to the body parts/ involves body contact/ increased cost. In this paper, a non-invasive, whole field Digital Speckle Pattern Interferometry (DSPI) is used to study normal and abnormal breast mimicking tissue phantoms. While uniform fringes were obtained for a normal phantom in the out of plane speckle pattern interferometry configuration, the non uniformity in the observed fringes clearly showed the anomaly location in the abnormal phantom. The results are compared with deformation profiles using finite element analysis of the sample under similar loading conditions.

  17. Herpetic cranial polyneuritis mimicking brain stem infarction-an atypical presentation of Ramsay Hunt syndrome.

    PubMed

    Bharadwaj, Sneha; Moffat, Andrew Campbell; Wood, Brad; Bharadwaj, Avinash

    2016-01-01

    An elderly man presented with severe right ear pain and discharge, hoarseness and dysphagia causing significant involuntary weight loss. Extensive investigations by varied specialties only highlighted right vocal cord palsy and right parotid lymphadenitis. Reassessment on transfer to a rehabilitation ward noted clinically subtle right Ramsay Hunt syndrome with multiple lower cranial nerve involvement. We illustrate a case of varicella zoster virus cranial polyneuritis with bulbar symptoms mimicking bulbar stroke, requiring percutaneous endoscopic gastrostomy feeds, with significant clinical and radiological recovery over 1 year. PMID:27251418

  18. Diffuse peritoneal deciduosis mimicking metastatic lesions

    PubMed Central

    Baroni Cruz, Dennis; Dhamer, Thricy; da Rocha, Vívian Wünderlich; Dupont, Roberta Finkler

    2014-01-01

    A 32-year-old woman with an uneventful antenatal period underwent a caesarean section for breech presentation. At laparotomy, there were multiple yellowish elastic nodules distributed along the parietal peritoneal surface, totalling over 30 lesions and worrying the surgical team. The conclusive diagnosis of peritoneal deciduosis was supported by pathological analysis (histology and immunohistochemistry). The present case reports an uncommon presentation of diffuse peritoneal deciduosis mimicking metastatic lesions. PMID:24526201

  19. Intracranial capillary hemangioma mimicking a dissociative disorder

    PubMed Central

    John, Santosh G.; Pillai, Unnikrishnan; Lacasse, Alexander

    2012-01-01

    Capillary hemangiomas, hamartomatous proliferation of vascular endothelial cells, are rare in the central nervous system (CNS). Intracranial capillary hemangiomas presenting with reversible behavioral abnormalities and focal neurological deficits have rarely been reported. We report a case of CNS capillary hemangioma presenting with transient focal neurological deficits and behavioral abnormalities mimicking Ganser's syndrome. Patient underwent total excision of the vascular malformation, resulting in complete resolution of his symptoms. PMID:24765434

  20. Foreign Body Mimicking a Dental Implant Radiographically.

    PubMed

    Demirkol, Mehmet

    2015-11-01

    Foreign bodies are often encountered in the maxillofacial region and can present in several ways. They frequently occur as a result of accidents, explosions, and gunshot injuries or because of iatrogenic factors in therapeutic interventions in daily dental practice. This report describes an unusual case of a broken elevator blade mimicking a dental implant embedded in alveolar bone radiographically, within the maxillary palatal mucosa during a traumatic maxillary right first molar extraction. PMID:26594991

  1. An accurate test for acute appendicitis: In-111 WBC imaging

    SciTech Connect

    Navarro, D.A.; Weber, P.M.; Kang, I.Y.; dosRemedios, L.V.; Jasko, I.A.

    1985-05-01

    The decision to operate when acute appendicitis (APPY) is suspected is often difficult. Surgeons accept up to a 20% false positive rate to avoid any delay that may result in appendiceal rupture and peritonitis. The authors have successfully improved early diagnostic accuracy by using abdominal imaging beginning 2 hours after injecting In-111 labeled WBC. Patients with clear-cut (APPY) had laparotomy and were not studied. Those who were to be observed in the ER for possible (APPY) had their leukocytes harvested, labeled with In-111 oxine, and reinjected. Abnormal localized activity in the right lower quadrant (RLQ) imaged at 2 hours was graded relative to bone marrow activity (8M): 0, 1+BM. When available the surgical specimen was imaged for In-111 activity. Of 31 patients studied there were 13 with positive scans for (APPY) all surgically confirmed. There were 4 additional abnormal studies all demonstrating known diagnostic patterns, 2 of pertonitis and 2 of colitis. There were 14 negative studies in 8 of whom the clinical course was benign; the remaining 6 had laparotomy with 3 having (APPY) and 3 not. Thus there were no false positives and 3 false negatives. One case negative at 2 hours had appendiceal activity later. The 3 cases with 3+ activity all had apendiceal abscesses. This new application of In-111 oxine WBC imaging is safe, simple, sensitive and specific. It shortens the time to surgical intervention and should reduce the surgical false positive rate.

  2. Analytic investigation of helicopter rotor blade appended aeroelastic devices

    NASA Technical Reports Server (NTRS)

    Bielawa, Richard L.

    1984-01-01

    Analytic evaluations of four different passive aeroelastic devices appended to helicopter rotor blades are presented. The devices consist of a passive tuned tab, a control coupled tab, an all-flying tip and a harmonic dilational airfoil tip. Each device was conceived for improving either aerodynamic performance or reducing vibratory control loads or hub shears. The evaluation was performed using a comprehensive rotor aeroelastic analysis (the G400PA code with appropriate modifications), together with data for a realistic helicopter rotor blade (the UH-60A Blackhawk), in high speed flight (90 m/s, 175 kts). The results of this study show that significant performance (L/(D sub e)) gains can be achieved with the all-flying free tip. Results from the harmonic dilational airfoil tip show the potential for moderate improvements in L/(D sub e). Finally, the results for the passive tuned tab and the control coupled tab, as configured for this study, show these devices to be impractical. Sections are included which describe the operation of each device, the required G400PA modifications, and the detailed results obtained for each device.

  3. Common Questions About the Evaluation of Acute Pelvic Pain.

    PubMed

    Bhavsar, Amit K; Gelner, Elizabeth J; Shorma, Toni

    2016-01-01

    Acute pelvic pain is defined as lower abdominal or pelvic pain of less than three months' duration. It is a common presentation in primary care. Evaluation can be challenging because of a broad differential diagnosis and because many associated signs and symptoms are nonspecific. The most common diagnoses in reproductive-aged women with acute pelvic pain are idiopathic pelvic pain, pelvic inflammatory disease, acute appendicitis, ovarian cysts, ectopic pregnancy, and endometriosis. Among postmenopausal women, cancer must be considered. Findings from the history and physical examination can point to likely diagnoses, and laboratory testing and imaging can help confirm. Women of reproductive age should take a pregnancy test. In early pregnancy, transvaginal ultrasonography and beta human chorionic gonadotropin levels can help identify ectopic pregnancy and spontaneous abortion. For nonpregnant women, ultrasonography or computed tomography is indicated, depending on the possible diagnosis (e.g., ultrasonography is preferred when ovarian pathology is suspected). If ultrasonography results are nondiagnostic, magnetic resonance imaging can be helpful in pregnant women when acute appendicitis is suspected. If magnetic resonance imaging is unavailable, computed tomography may be indicated. PMID:26760839

  4. Fighting Chronic Pain

    MedlinePlus

    ... pain, bone pain from spread of cancer, fibromyalgia, chronic fatigue syndrome Neurologic: "Phantom limb" pain after amputation, nerve pain from diabetes Read More "Chronic Pain" Articles Easing Chronic Pain: Better Treatments and ...

  5. Low back pain - chronic

    MedlinePlus

    Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause ...

  6. Autoantibody pain.

    PubMed

    Goebel, Andreas

    2016-06-01

    As autoantibodies bind to target tissues, Fc-region dependent inflammation can induce pain via mediators exciting nociceptors. But recently another possibility has emerged, where autoantibody binding to nociceptors can directly cause pain, without inflammation. This is thought to occur as a result of Fab-region mediated modification of nerve transduction, transmission, or neuropeptide release. In three conditions, complex regional pain syndrome, anti-voltage gated potassium channel complex autoimmunity, and chronic fatigue syndrome, all associated with no or only little inflammation, initial laboratory-, and clinical trial-results have suggested a potential role for autoantibody-mediated mechanisms. More research assessing the pathogenic roles of autoantibodies in these and other chronic pain conditions is required. The concept of autoantibody-mediated pain offers hope for the development of novel therapies for currently intractable pains. PMID:26883460

  7. Neuropathic Pain

    PubMed Central

    Costigan, Michael; Scholz, Joachim; Woolf, Clifford J.

    2009-01-01

    Neuropathic pain is triggered by lesions to the somatosensory nervous system that alter its structure and function so that pain occurs spontaneously and responses to noxious and innocuous stimuli are pathologically amplified. The pain is an expression of maladaptive plasticity within the nociceptive system, a series of changes that constitute a neural disease state. Multiple alterations distributed widely across the nervous system contribute to complex pain phenotypes. These alterations include ectopic generation of action potentials, facilitation and disinhibition of synaptic transmission, loss of synaptic connectivity and formation of new synaptic circuits, and neuroimmune interactions. Although neural lesions are necessary, they are not sufficient to generate neuropathic pain; genetic polymorphisms, gender, and age all influence the risk of developing persistent pain. Treatment needs to move from merely suppressing symptoms to a disease-modifying strategy aimed at both preventing maladaptive plasticity and reducing intrinsic risk. PMID:19400724

  8. The Diagnostic Value of Surface Markers in Acute Appendicitis; A Diagnostic Accuracy Study

    PubMed Central

    Gholi Mezerji, Naser Mohammad; Rafeie, Mohammad; Shayan, Zahra; Mosayebi, Ghasem

    2015-01-01

    Objective: To determine the diagnostic value of blood cells surface markers in patients with acute appendicitis. Methods: In this cross-sectional study, 71 patients who underwent appendectomy following a diagnosis of appendicitis were recruited during a one-year period. The patients were divided into two groups: patients with histopathologically confirmed acute appendicitis and subjects with normal appendix. Blood cell surface markers of all patients were measured. Univariate and multivariate analytical methods were applied to identify the most useful markers. Receiver operating characteristics (ROC) curves were also used to find the best cut-off point, sensitivity, and specificity. Results: Overall we included 71 patients with mean age of 22.6±10.7 years. Of the 71 cases, 45 (63.4%) had acute appendicitis while 26 (36.6%) were normal. There was no significant difference between two study groups regarding the age (p=0.151) and sex (p=0.142). The initial WBC count was significantly higher in those with acute appendicitis (p=0.033). Maximum and minimum area under the ROC curve in univariate analysis was reported for CD3/RA (0.71) and CD38 (0.533), respectively. Multivariate regression models revealed the percentage of accurate diagnoses based on the combination of γ/δ TCR, CD3/RO, and CD3/RA markers to be 74.65%. Maximum area under the ROC curve (0.79) was also obtained for the same combination. Conclusion: the best blood cell surface markers in the prediction of acute appendicitis were HLA-DR+CD19, a/β TCR, and CD3/RA. The simultaneous use of γ/δ TCR, CD3/RA, and CD3/RO showed the highest diagnostic value in acute appendicitis. PMID:27162905

  9. The Use of Delta Neutrophil Index and Myeloperoxidase Index for Predicting Acute Complicated Appendicitis in Children

    PubMed Central

    Kim, Oh Hyun; Cha, Yong Sung; Hwang, Sung Oh; Jang, Ji Young; Choi, Eun Hee; Kim, Hyung Il; Cha, KyoungChul; Kim, Hyun; Lee, Kang Hyun

    2016-01-01

    Background In children with acute appendicitis, 30% to 75% present with a complication, such as perforation, and the early diagnosis of complications is known to improve outcomes. Serum delta neutrophil index (DNI) and myeloperoxidase index (MPXI) are new inflammatory markers, and thus, in the present study, the authors evaluated the predictive values of these two markers for the presence of a complication in children with acute appendicitis. Methods This retrospective observational study was conducted on 105 consecutive children (<12 years old) with acute appendicitis treated over a 31-month period. DNI, MPXI, C-reactive protein (CRP), and white blood cells (WBCs) were measured in an emergency department and investigated with respect to their abilities to predict the presence of acute complicated appendicitis. Results Twenty-nine of the 105 patients (median age, 9 years) were allocated to the complicated group (27.6%) and 76 to the non-complicated group (72.4%). Median serum DNI and CRP were significantly higher in the complicated group [0% vs. 2.2%, p<0.001 and 0.65 mg/dL vs. 8.0 mg/dL, p<0.001], but median MPXI was not (p = 0.316). Area under curve (AUC) for the ability of serum DNI and CRP to predict the presence of acute complicated appendicitis were 0.738 and 0.840, respectively. Multiple logistic regression analyses showed initial CRP [odds ratio 1.301, 95% confidence interval (1.092–1.549), p = 0.003] significantly predicted the presence of a complication. The optimal cutoff for serum CRP was 4.0 mg/dL (sensitivity 69%, specificity 83%, AUC 0.840). Conclusions Although serum DNI values were significantly higher in children with acute complicated appendicitis, no evidence was obtained to support the notion that serum DNI or serum MPXI aid the differentiation of acute complicated and non-complicated appendicitis in the ED setting. PMID:26859663

  10. Facial pain.

    PubMed

    Graff-Radford, Steven B

    2009-07-01

    Facial pain is a debilitating disorder if left untreated. Too often, patients are labeled as having psychopathology when face pain etiology is unclear. These patients are categorized as "atypical," "idiopathic," or "psychogenic." Cases of facial pain involving neuropathic, neurovascular, musculoskeletal, as well as intracranial and extracranial systems will be reviewed. Peripheral and central mechanisms associated with these disorders are used to provide an update of these frequently seen clinical issues. PMID:19590376

  11. Imaging Pain.

    PubMed

    Martucci, Katherine T; Mackey, Sean C

    2016-06-01

    The challenges and understanding of acute and chronic pain have been illuminated through the advancement of central neuroimaging. Through neuroimaging research, new technology and findings have allowed us to identify and understand the neural mechanisms contributing to chronic pain. Several regions of the brain are known to be of particular importance for the maintenance and amplification of chronic pain, and this knowledge provides novel targets for future research and treatment. This article reviews neuroimaging for the study of chronic pain, and in particular, the rapidly advancing and popular research tools of structural and functional MRI. PMID:27208709

  12. An unusual case of vascular abnormality mimicking a lateral meniscal cyst.

    PubMed

    Vergis, A; Maletius, W; Messner, K

    1995-10-01

    An unusual case of a vascular abnormality mimicking a lateral meniscal cyst is reported. The patient was a 31-year-old active sportsman who presented with intermittent pain over the lateral aspect of the left knee joint line, occurring only during activities involving twisting motions such as playing soccer. He did not experience local tenderness or swelling, clicking, locking, or giving way. The magnetic resonance imaging, which was done after a diagnostic arthroscopy with normal intra-articular findings, showed a cyst formation of approximately 4-mm diameter adjacent to the lateral meniscus periphery, but no meniscal tissue degeneration. Exactly at the preoperatively marked site of most intensive pain sensation during twisting motions, surgical exposure showed a venous-aneurysm-like tumor, which was removed. The operation resulted in complete relief of symptoms and undisturbed sporting activities including soccer. PMID:8534307

  13. Acute Appendicitis Is Associated with Peptic Ulcers: A Population-based Study

    PubMed Central

    Tsai, Ming-Chieh; Kao, Li-Ting; Lin, Herng-Ching; Chung, Shiu-Dong; Lee, Cha-Ze

    2015-01-01

    Despite some studies having indicated a possible association between appendicitis and duodenal ulcers, this association was mainly based on regional samples or limited clinician experiences, and as such, did not permit unequivocal conclusions. In this case-control study, we examined the association of acute appendicitis with peptic ulcers using a population-based database. We included 3574 patients with acute appendicitis as cases and 3574 sex- and age-matched controls. A Chi-squared test showed that there was a significant difference in the prevalences of prior peptic ulcers between cases and controls (21.7% vs. 16.8%, p < 0.001). The adjusted odds ratio (OR) of prior peptic ulcers for cases was 1.40 (95% confidence interval [CI]: 1.24~1.54, p < 0.001) compared to controls. The results further revealed that younger groups demonstrated higher ORs for prior peptic ulcers among cases than controls. In particular, the adjusted OR for cases < 30 years old was as high as 1.65 (95% CI = 1.25~2.19; p < 0.001) compared to controls. However, we failed to observe an association of acute appendicitis with peptic ulcers in the ≥ 60-year age group (OR = 1.19, 95% CI = 0.93~1.52). We concluded that there is an association between acute appendicitis and a previous diagnosis of peptic ulcers. PMID:26643405

  14. Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature

    PubMed Central

    2013-01-01

    Background Ultrasound is a widely used technique in the diagnosis of acute appendicitis; nevertheless, its utilization still remains controversial. Methods The accuracy of the Ultrasound technique in the diagnosis of acute appendicitis in the adult patient, as shown in the literature, was searched for. Results The gold standard for the diagnosis of appendicitis still remains pathologic confirmation after appendectomy. In the published literature, graded-compression Ultrasound has shown an extremely variable diagnostic accuracy in the diagnosis of acute appendicitis (sensitivity range from 44% to 100%; specificity range from 47% to 99% ). This is due to many reasons, including lack of operator skill, increased bowel gas content, obesity, anatomic variants, and limitations to explore patients with previuos laparotomies. Conclusions Graded-compression Ultrasound still remains our first-line method in patients referred with clinically suspected acute appendicitis: nevertheless, due to variable diagnostic accuracy, individual skill is requested not only to perform a successful exam, but also in order to triage those equivocal cases that, subsequently, will have to undergo assessment by means of Computed Tomography. PMID:23902717

  15. An Imaging Diagnostic Protocol in Children with Clinically Suspected Acute Appendicitis.

    PubMed

    Epifanio, Matias; Antonio de Medeiros Lima, Marco; Corrêa, Patricia; Baldisserotto, Matteo

    2016-05-01

    The objective of the present study is to evaluate a new diagnostic strategy using clinical findings followed by ultrasound (US) and, in selected cases, MRI. This study included 166 children presenting signs and symptoms suggesting acute appendicitis. Cases classified as suggesting appendicitis according to clinical exams had to be referred to surgery, whereas the other cases were discharged. Unclear cases were evaluated using US. If the US results were considered inconclusive, patients underwent MRI. Of the 166 patients, 78 (47%) had acute appendicitis and 88 (53%) had other diseases. The strategy under study had a sensitivity of 96 per cent, specificity of 100 per cent, positive predictive value of 100 per cent, negative predictive value of 97 per cent, and accuracy of 98 per cent. Eight patients remained undiagnosed and underwent MRI. After MRI two girls presented normal appendixes and were discharged. One girl had an enlarged appendix on MRI and appendicitis could have been confirmed by surgery. In the other five patients, no other sign of the disease was detected by MRI such as an inflammatory mass, free fluid or an abscess in the right iliac fossa. All of them were discharged after clinical observation. In the vast majority of cases the correct diagnosis was reached by clinical and US examinations. When clinical assessment and US findings were inconclusive, MRI was useful to detect normal and abnormal appendixes and valuable to rule out other abdominal pathologies that mimic appendicitis. PMID:27215717

  16. [The role and place of helical ct for preporative diagnosis of acute appendicitis].

    PubMed

    Nemsadze, G Sh; Urushadze, O P; Tokhadze, L T; Lomidze, M N; Kipshidze, N N

    2009-09-01

    The goal of our study was to ascertain the role and place of helical CT for preoperative diagnosis of acute appendicitis. Our study relied upon the results of helical CT scans of 60 patients, which were diagnosed probable acute appendicitis based upon clinical signs. Of these 60 patients 49 (81,6%) were female, 11 (18,4%) male. For all patients laboratory studies of blood were made, 31 patients were examined by ultrasonography. Among this group the diagnosis of acute appendicitis was verified by CT scan in 41 patients. In the case of 5 patients the scan was equivocal because of smaller amount of omentum; in this subgroup of 5 patients (5% overall) three were given radiocontrast dye, and two (3,3% overall) were not. In 11 (18,3%) cases the diagnosis of acute appendicitis was not verified, and in three cases the diagnosis was incorrect. According to data of our study and intraoperative data analysis, sensitivity of this method approaches 93% and the specificity - 92%, and overall diagnostic accuracy 93%. Helical CT may be stated as diagnostic method of choice in the diagnosis of acute appendicitis. It is helpful in clinical decision making, and reducing the amount of false appendectomies. PMID:19801721

  17. Evaluation of Tc-99m leukocyte scan in the diagnosis of acute appendicitis

    SciTech Connect

    Butler, J.A.; Marcus, C.S.; Henneman, P.L.; Inkelis, S.H.; Wilson, S.E.

    1987-05-01

    A new /sup 99m/Tc Microlite leukocyte scan was performed in 38 patients to assess its value in the diagnosis of acute appendicitis. Autologous leukocytes are labeled with /sup 99m/Tc by inducing phagocytosis of /sup 99m/Tc albumin microcolloid particles. The advantages of this test over the standard indium-111 scan include superior imaging capability, a marked reduction (greater than 75%) in the radiation dose, and performance of the test including labeling, in less than 3 hr. Imaging is performed at 5-90 min postinjection of labeled cells. There were 19 male and 19 female patients with ages ranging from 10 to 80 years, in whom the diagnosis of appendicitis was indeterminate on clinical examination. Of the 13 of the 38 patients (34%) who came to surgery 12 had acute appendicitis. The WBC scan correctly identified 10 of the 12 cases of appendicitis. There were two false-negative studies. In the nonoperative group of 25 patients admitted for observation, 21 studies were reported as negative and four identified other sites of inflammation. All patients with a negative study have remained asymptomatic on follow-up. With a sensitivity of 83% (10/12) and a specificity of 100% (26/26) the /sup 99m/Tc leukocyte scan provides a rapid and highly accurate method for diagnosis of appendicitis in this preliminary study of patients with equivocal clinical exams.

  18. Pain channelopathies

    PubMed Central

    Cregg, Roman; Momin, Aliakmal; Rugiero, Francois; Wood, John N; Zhao, Jing

    2010-01-01

    Pain remains a major clinical challenge, severely afflicting around 6% of the population at any one time. Channelopathies that underlie monogenic human pain syndromes are of great clinical relevance, as cell surface ion channels are tractable drug targets. The recent discovery that loss-of-function mutations in the sodium channel Nav1.7 underlie a recessive pain-free state in otherwise normal people is particularly significant. Deletion of channel-encoding genes in mice has also provided insights into mammalian pain mechanisms. Ion channels expressed by immune system cells (e.g. P2X7) have been shown to play a pivotal role in changing pain thresholds, whilst channels involved in sensory transduction (e.g. TRPV1), the regulation of neuronal excitability (potassium channels), action potential propagation (sodium channels) and neurotransmitter release (calcium channels) have all been shown to be potentially selective analgesic drug targets in some animal pain models. Migraine and visceral pain have also been associated with voltage-gated ion channel mutations. Insights into such channelopathies thus provide us with a number of potential targets to control pain. PMID:20142270

  19. [Chest pain].

    PubMed

    Horn, Benedikt

    2015-01-01

    Chest pain in ambulatory setting is predominantly not heart-associated. Most patients suffer from muskuloskeletal or functional (psychogenic) chest pain. Differential diagnosis covers aortic dissection, rib-fracture, shingles, GERD, Tietze-Syndrome, pulmonary embolism, pleuritis, pneumothorax, pleurodynia and metastatic disease. In most cases history, symptoms and signs allow a clinical diagnosis of high pretest-probability. PMID:25533261

  20. Neck Pain

    MedlinePlus

    ... get better. No 7. Did you have a whiplash-type injury in the past, or do you have pain and/or stiffness every day in your neck, hands, knees, hips or other joints? Yes Your pain may be from DEGENERATIVE CERVICAL ARTHRITIS, a disorder that affects the bones and ...

  1. Pain frequency moderates the relationship between pain catastrophizing and pain

    PubMed Central

    Kjøgx, Heidi; Zachariae, Robert; Pfeiffer-Jensen, Mogens; Kasch, Helge; Svensson, Peter; Jensen, Troels S.; Vase, Lene

    2014-01-01

    Background: Pain frequency has been shown to influence sensitization, psychological distress, and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method: A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale (PCS), Beck Depression Inventory, and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency. Results: In both samples, high pain frequency was found to moderate the association between pain catastrophizing and pain intensity, whereas low pain frequency did not. The psychometric properties and the factor structure of the Danish version of the PCS were confirmed. Conclusions: This is the first study to validate the Danish version of the PCS and to show that pain frequency moderates the relationship between pain catastrophizing and reported pain in both non-clinical and clinical populations. PMID:25646089

  2. A preliminary study on how hypohydration affects pain perception.

    PubMed

    Bear, Tracey; Philipp, Michael; Hill, Stephen; Mündel, Toby

    2016-05-01

    Chronic pain is a prevalent health issue with one in five people suffering from some form of chronic pain, with loss of productivity and medical costs of chronic pain considerable. However, the treatment of pain can be difficult, as pain perception is complex and can be affected by factors other than tissue damage. This study investigated the effect of hypohydration (mild, voluntary dehydration from ∼24 h of limiting fluid intake, mimicking someone drinking less than usual) on a person's pain perception. Seventeen healthy males (age 27 ± 5 years) visited the laboratory on three occasions, once as a familiarization and then twice again while either euhydrated (urine specific gravity: 1.008 ± 0.005) or hypohydrated (urine specific gravity: 1.024 ± 0.003, and -1.4 ± 0.9% body mass). Each visit, they performed a cold pressor test, where their feet were placed in cold water (0-3°C) for a maximum of 4 min. Measures of hydration status, pain sensitivity, pain threshold, and catastrophization were taken. We found that hypohydration predicted increased pain sensitivity (β = 0.43), trait pain catastrophizing, and baseline pain sensitivity (β = 0.37 and 0.47, respectively). These results are consistent with previous research, and suggest that a person's hydration status may be an important factor in their perception of acute pain. PMID:26785699

  3. Nontuberculous mycobacterial pulmonary disease mimicking lung cancer

    PubMed Central

    Hong, Su Jin; Kim, Tae Jung; Lee, Jae-Ho; Park, Jeong-Soo

    2016-01-01

    Abstract To describe the features and clinical implications of computed tomography (CT), positron emission tomography (PET), and percutaneous needle aspiration biopsy (PCNB) in pulmonary nontuberculous mycobacterial (NTM) disease manifesting as a solitary nodule, mass, or mass-like consolidation mimicking malignancy. Among a cohort of 388 patients with NTM pulmonary disease, 14 patients with clinically and radiologically suspected lung cancer were included in our study. Two chest radiologists evaluated CT features, including lesion type (nodule, mass, or mass-like consolidation), morphologic features (margin, degree of enhancement, calcification), and presence of accompanying findings suggestive of NTM pulmonary disease (bronchiectasis with clustered centrilobular nodules or upper-lobe cavitary lesions) by consensus. Diagnostic procedures for microbiologic diagnosis of NTM disease and clinical outcome were reviewed. Incidence of NTM pulmonary disease presenting as solitary nodule/mass (n = 8) or mass-like consolidation (n = 6) was 3.6% (14 of 388). Most lesions were detected incidentally during routine health check-up or evaluation of other disease (11 of 14, 79%). Lesions typically showed poor contrast-enhancement (9 of 12) and internal calcification (6 of 14). No lesions had CT features suggestive of NTM pulmonary disease. All 4 lesions for which PET/CT imaging was performed showed strong fluorodeoxyglucose uptake simulating malignant lesions (mean, 4.9; range, 3.6–7.8). PCNB revealed mycobacterial histology in 6 of 11 specimens and positive culture results were obtained for 7 of 7 specimens. NTM pulmonary disease may present as a solitary nodule, mass, or mass-like consolidation mimicking malignancy. CT features and PCNB are important to diagnose NTM disease mimicking lung cancer to avoid unnecessary surgery. PMID:27367996

  4. Primary cardiac lymphoma mimicking infiltrative cardiomyopathy.

    PubMed

    Lee, Ga Yeon; Kim, Won Seog; Ko, Young-Hyeh; Choi, Jin-Oh; Jeon, Eun-Seok

    2013-05-01

    Primary cardiac lymphoma is a rare malignancy which has been described as thickened myocardium due to the infiltration of atypical lymphocytes and accompanying intracardiac masses. Here, we report a case of a primary cardiac lymphoma without demonstrable intracardiac masses, mimicking infiltrative cardiomyopathy. A 40-year-old male presented with exertional dyspnoea and was diagnosed as having restrictive cardiomyopathy with severely decreased LV systolic function. Endomyocardial biopsy was performed and the diagnosis of primary cardiac lymphoma was confirmed. After appropriate chemotherapy, he recovered his systolic function fully. PMID:23248217

  5. Neglected foreign body aspiration mimicking bronchial carcinoma.

    PubMed

    Afghani, Reza; Khandashpour Ghomi, Mahmoud; Khandoozi, Seyed Reza; Yari, Behrouz

    2016-07-01

    Foreign body aspiration can occur in any age group, but it is more commonly seen in children. In adults, there is usually a predisposing condition that poses a risk of aspiration. If aspiration occurs, prompt diagnosis and extraction of the foreign body is needed to prevent early and late complications. We report a rare case of neglected foreign body aspiration in a 45-year-old schizophrenic opium addicted patient, which resulted in an occlusive lesion in the bronchus, mimicking bronchial carcinoma. PMID:27273232

  6. Metastatic gastric signet-ring cell carcinoma: A rare cause of acute appendicitis

    PubMed Central

    Erçetin, Candaş; Dural, Ahmet Cem; Özdenkaya, Yaşar; Dural, Özlem; Dada, Huriye Gözde Muhafız; Yeğen, Gülçin; Kapran, Yersu; Erbil, Yeşim

    2016-01-01

    We report a 32-year-old patient who underwent laparoscopy with classical symptoms and signs of acute appendicitis. An inflamed, edematous and non-perforated appendix, also a large amount gelatinous ascites, omental and peritoneal implants were seen. Appendectomy was performed and multiple biopsies were taken from omentum and peritoneum for definitive diagnosis. Histopathologic diagnosis was a metastatic gastric signet-ring cell carcinoma (GSRCC) involving appendix and other specimens. A flat lesion involving corpus to antrum was diagnosed by gastroscopy and GSRCC was verified histopathologically in a tertiary centre and the case evaluated as stage IV gastric carcinoma. This case with no sign of gastric cancer was presented as an acute appendicitis. Metastatic carcinoma to the appendix, causing acute appendicitis is extremely rare in clinical practice and usually associated with high morbidity and mortality.

  7. Conventional single-port laparoscopic appendectomy for complicated appendicitis in children: Efficient and cost-effective

    PubMed Central

    Karakuş, Osman Zeki; Ulusoy, Oktay; Ateş, Oğuz; Hakgüder, Gülce; Olguner, Mustafa; Akgür, Feza Miraç

    2016-01-01

    BACKGROUND: Laparoscopic appendectomy (LA) is gradually gaining popularity among paediatric surgeons for complicated appendicitis. A retrospective study was conducted to compare conventional single port LA, multiport LA and open appendectomy (OA) for complicated appendicitis in children. PATIENTS AND METHODS: From January 1995 from December 2014, 1,408 patients (604 girls, 804 boys) underwent surgery for uncomplicated and complicated appendicitis. The patient characteristics, operation times, duration of hospitalization, operative costs, and postoperative complications were recorded. A 10-mm 0° scope with a parallel eye piece and an integrated 6 mm working channel were inserted through an 11-mm “conventional umbilical port” for single port LA. RESULTS: A total of 314 patients with complicated appendicitis (128 girls, 186 boys) underwent appendectomy. Among these, 102 patients (32.4%) underwent single port LA, 17 patients (5.4%) underwent multiport LA and 195 patients (62.1%) underwent OA. The hospital stay of the single port LA group was significantly less (3.88 ± 1.1) compared with multiport LA (5.41 ± 1.2) and OA groups (6.14 ± 1.1) (P < 0.001). Drain usage, wound infection and adhesive intestinal obstruction rates were significantly high in the OA group. There was no significant difference between the groups in postoperative intraabdominal abscess formation. Single-port LA performed for complicated appendicitis was cheaper compared with the other groups. CONCLUSIONS: The present study has shown that single-port LA for complicated appendicitis can be conducted in a reasonable operative time; it shortens the hospitalization period, markedly reduces postoperative wound infection and adhesive intestinal obstruction rates and does not increase the operative cost. PMID:26917914

  8. Transumbilical Laparoscopic-Assisted Appendectomy in the Treatment of Acute Uncomplicated Appendicitis in Children

    PubMed Central

    Noviello, Carmine; Romano, Mercedes; Martino, Ascanio; Cobellis, Giovanni

    2015-01-01

    Transumbilical laparoscopic-assisted appendectomy (TULAA) is increasingly being performed worldwide. The authors report their experience in the treatment of acute uncomplicated appendicitis in children with TULAA. From January 2008 to December 2012 all types of acute appendicitis were divided, according to the clinical and ultrasonographic findings, into complicated (appendiceal mass/abscess, diffuse peritonitis) and uncomplicated. Complicated appendicitis was treated by open appendectomy (OA). All patients with the suspicion of uncomplicated appendicitis were offered TULAA by all surgeons of the team. Conversion to open or laparoscopic appendectomy (LA) was performed in case of impossibility to complete TULAA, depending on the choice of surgeon. The histopathologic examination of appendix was always performed. 444 children (252 males) with acute appendicitis were treated. The mean age was 9.2 years (range, 2 to 14 years). Primary OA was performed in 144 cases. In 300 patients a transumbilical laparoscopic-assisted approach was performed. TULAA was completed in 252 patients. Conversion to OA was performed in 45 patients and to LA in 3. Conversion was related to the impossibility to adequately expose the appendix in 47 patients and bleeding in 1. The mean operative time for TULAA was 42 minutes. Histopathologic examination of the appendix removed by TULAA showed a phlegmonous/gangrenous type in 92.8% of cases. Among the 252 TULAA there were 11 cases of umbilical wound infection. TULAA is a feasible and effective procedure for uncomplicated appendicitis in children. It combines the advantages of open and laparoscopic technique (low operative time, low complications rate, and excellent cosmetic results). PMID:26491433

  9. Optimised z-axis coverage at multidetector-row CT in adults suspected of acute appendicitis

    PubMed Central

    Brassart, N; Winant, C; Tack, D; Gevenois, P A; De Maertelaer, V

    2013-01-01

    Objective: To compare diagnostic performances of two reduced z-axis coverages to full coverage of the abdomen and pelvis for the diagnosis of acute appendicitis and alternative diseases at unenhanced CT. Methods: This study included 152 adults suspected of appendicitis who were enrolled in two ethical committee-approved previous prospective trials. Based on scans covering the entire abdomen and pelvis (set L), two additional sets of images were generated, each with reduced z-axis coverages: (1) from the top of the iliac crests to the pubis (set S) and (2) from the diaphragmatic crus to the pubis (set M). Two readers independently coded the visualisation of the appendix, measured its diameter and proposed a diagnosis (appendicitis or alternative). Final diagnosis was based on surgical findings or clinical follow-up. Fisher exact and McNemar tests and logistic regression were used. Results: 46 patients had a definite diagnosis of appendicitis and 53 of alternative diseases. The frequency of appendix visualisation was lower for set S than set L for both readers (89% and 84% vs 95% and 91% by Readers A and B, respectively; p=0.021 and 0.022). The probability of giving a correct diagnosis was lower for set S (68%) than set L (78%; odds ratio, 0.611; p=0.008) for both readers, without significant difference between sets L and M (77%, p=0.771); z-axis coverage being reduced by 25% for set M. Conclusion: Coverage from diaphragmatic crus to pubis, but not focused on pelvis only, can be recommended in adults suspected of appendicitis. Advances in knowledge: In suspected appendicitis, CT-coverage can be reduced from diaphragmatic crus to pubis. PMID:23690436

  10. Diagnosing appendicitis: What works, what does not and where to go from here?

    PubMed

    Craig, Simon; Dalton, Sarah

    2016-02-01

    Although acute appendicitis is the most common reason for emergency abdominal surgery in children, diagnosis is far from straightforward. Delays in diagnosis can result in significant complications, whereas over-diagnosis can result in costly inter-hospital transfers and unnecessary surgery. This article aims to describe current evidence-based assessment of children with possible appendicitis presenting to the emergency department. We provide an overview of the literature relating to the various available diagnostic approaches, including the application of history, examination, pathology tests, imaging, and clinical decision rules. PMID:26437742

  11. Culture-Independent Evaluation of the Appendix and Rectum Microbiomes in Children with and without Appendicitis

    PubMed Central

    Davenport, Katherine P.; Fraser, Claire M.; Sandler, Anthony D.; Zeichner, Steven L.

    2014-01-01

    Purpose The function of the appendix is largely unknown, but its microbiota likely contributes to function. Alterations in microbiota may contribute to appendicitis, but conventional culture studies have not yielded conclusive information. We conducted a pilot, culture-independent 16S rRNA-based microbiota study of paired appendix and rectal samples. Methods We collected appendix and rectal swabs from 21 children undergoing appendectomy, six with normal appendices and fifteen with appendicitis (nine perforated). After DNA extraction, we amplified and sequenced 16S rRNA genes and analyzed sequences using CLoVR. We identified organisms differing in relative abundance using ANOVA (p<0.05) by location (appendix vs. rectum), disease (appendicitis vs. normal), and disease severity (perforated vs. non-perforated). Results We identified 290 taxa in the study's samples. Three taxa were significantly increased in normal appendices vs. normal rectal samples: Fusibacter (p = 0.009), Selenomonas (p = 0.026), and Peptostreptococcus (p = 0.049). Five taxa were increased in abundance in normal vs. diseased appendices: Paenibacillaceae (p = 0.005), Acidobacteriaceae GP4 (p = 0.019), Pseudonocardinae (p = 0.019), Bergeyella (p = 0.019) and Rhizobium (p = 0.045). Twelve taxa were increased in the appendices of appendicitis patients vs. normal appendix: Peptostreptococcus (p = 0.0003), Bilophila (p = 0.0004), Bulleidia (p = 0.012), Fusobacterium (p = 0.018), Parvimonas (p = 0.003), Mogibacterium (p = 0.012), Aminobacterium (p = 0.019), Proteus (p = 0.028), Actinomycineae (p = 0.028), Anaerovorax (p = 0.041), Anaerofilum (p = 0.045), Porphyromonas (p = 0.010). Five taxa were increased in appendices in patients with perforated vs. nonperforated appendicitis: Bulleidia (p = 0.004), Fusibacter (p = 0.005), Prevotella (p = 0.021), Porphyromonas (p = 0.030), Dialister (p = 0.035). Three taxa

  12. [Spiritual pain].

    PubMed

    Sato, Satoru

    2011-09-01

    We defined a spiritual pain as feelings of failure and regret at end-of-life, followed by hopelessness and worthlessness in patient's own life. In Japanese, spiritual pain should be assessed in patient's dignity, psycho-social factor, and prognostic stage, not only in religious context. And patient's spirituality should be supported with providing pain and symptom relief based on human relationships. "Sterbebegleitung" is a German proverb, introduced by Alfons Deeken, and seemed to be a suggestive word for such hope-recovering relationships. PMID:21950035

  13. What a Pain! Kids and Growing Pains

    MedlinePlus

    ... Here's Help White House Lunch Recipes What a Pain! Kids and Growing Pains KidsHealth > For Kids > What a Pain! Kids and ... something doctors call growing pains . What Are Growing Pains? Growing pains aren't a disease. You probably ...

  14. Imaging findings of mimickers of hepatocellular carcinoma

    PubMed Central

    Lee, Eunchae; Jang, Hyun-Jung

    2015-01-01

    Radiological imaging plays a crucial role in the diagnosis of hepatocellular carcinoma (HCC) as the noninvasive diagnosis of HCC in high-risk patients by typical imaging findings alone is widely adopted in major practice guidelines for HCC. While imaging techniques have markedly improved in detecting small liver lesions, they often detect incidental benign liver lesions and non-hepatocellular malignancy that can be misdiagnosed as HCC. The most common mimicker of HCC in cirrhotic liver is nontumorous arterioportal shunts that are seen as focal hypervascular liver lesions on dynamic contrast-enhanced cross-sectional imaging. Rapidly enhancing hemangiomas can be easily misdiagnosed as HCC especially on MR imaging with liver-specific contrast agent. Focal inflammatory liver lesions mimic HCC by demonstrating arterial-phase hypervascularity and subsequent washout on dynamic contrast-enhanced imaging. It is important to recognize the suggestive imaging findings for intrahepatic cholangiocarcinoma (CC) as the management of CC is largely different from that of HCC. There are other benign mimickers of HCC such as angiomyolipomas and focal nodular hyperplasia-like nodules. Recognition of their typical imaging findings can reduce false-positive HCC diagnosis. PMID:26770920

  15. Ileal duplication mimicking intestinal intussusception: a congenital condition rarely reported in adult.

    PubMed

    Li, Bing-Lu; Huang, Xin; Zheng, Chao-Ji; Zhou, Jiao-Lin; Zhao, Yu-Pei

    2013-10-14

    Intestinal duplication is an uncommon congenital condition in young adults. A 25-year-old man complained of chronic, intermittent abdominal pain for 3 years following previous appendectomy for the treatment of suspected appendicitis. Abdominal discomfort and pain, suggestive of intestinal obstruction, recurred after operation. A tubular mass was palpable in the right lower quadrant. Computed tomography enterography scan identified suspicious intestinal intussusception, while Tc-99m pertechnetate scintigraphy revealed a cluster of strip-like abnormal radioactivity in the right lower quadrant. On exploratory laparotomy, a tubular-shaped ileal duplication cyst was found arising from the mesenteric margin of the native ileal segment located 15 cm proximal to the ileocecal valve. Ileectomy was performed along with the removal of the duplication disease, and the end-to-end anastomosis was done to restore the gastrointestinal tract continuity. Pathological examination showed ileal duplication with ectopic gastric mucosa. The patient experienced an eventless postoperative recovery and remained asymptomatic within 2 years of postoperative follow-up. PMID:24151372

  16. Epiploic Appendagitis: A Rare Cause of Acute Abdominal Pain in Children. Report of a Case and Review of the Pediatric Literature.

    PubMed

    Redmond, Paul; Sawaya, David E; Miller, Kristen H; Nowicki, Michael J

    2015-10-01

    A 9-year-old boy presented with acute onset of abdominal pain and vomiting. History, physical examination, and initial laboratory testing failed to provide a diagnosis. A computed tomography scan revealed the rare finding of epiploic appendagitis. We review the literature of this rare, but increasingly recognized, condition that mimics appendicitis and needs to be considered in the child with acute abdominal pain. PMID:26427946

  17. Faecal retention: a common cause in functional bowel disorders, appendicitis and haemorrhoids--with medical and surgical therapy.

    PubMed

    Raahave, Dennis

    2015-03-01

    The present studies explored whether faecal retention in the colon is a causative factor in functional bowel disease, appendicitis, and haemorrhoids. Faecal retention was characterized by colon transit time (CTT) after radio-opaque marker ingestion and estimation of faecal loading on abdominal radiographs at 48 h and 96 h. Specific hypotheses were tested in patients (n = 251 plus 281) and in healthy random controls (n = 44). A questionnaire was completed for each patient, covering abdominal and anorectal symptoms and without a priori grouping. Patients with functional bowel disorders, predominantly women, had a significantly increased CTT and faecal load compared to controls. The CTT was significantly and positively correlated with segmental and total faecal loading. The faecal load was equal at 48 h and 96 h, mirroring the presence of permanent faecal reservoirs. In these first clinical studies to correlate bowel symptoms with CTT and colon faecal loading, abdominal bloating was significantly correlated with faecal loading in the right colon, total faecal load, and CTT. Abdominal pain was significantly and positively correlated to distal faecal loading and significantly associated with bloating. A new phenomenon with a high faecal load and a normal CTT was observed in a subset of patients (n = 90), proving faecal retention as hidden constipation. The CTT and faecal load were significantly higher in the right-side compared to the left and distal segments. Within the control group of healthy persons, the right-sided faecal load was significantly greater than the left and distal load. The CTT and faecal load significantly positively correlated with a palpable mass in the left iliac fossa and meteorism. Cluster analysis revealed that CTT and faecal load positively correlated with a symptom factor consisting of bloating, proctalgia and infrequent defecation of solid faeces. On the other hand, CTT and faecal load negatively correlated with a symptom factor comprising

  18. Missed acute appendicitis presenting as necrotising fasciitis of the thigh

    PubMed Central

    Taif, Sawsan; Alrawi, Asif

    2014-01-01

    Necrotising fasciitis is a rapidly progressive soft tissue infection that leads to diffuse tissue necrosis. It is associated with systemic toxicity and rapid deterioration resulting in high mortality. Rapid diagnosis and prompt treatment are essential to improve the outcome. We report the case of a 26-year-old woman who presented with severe thigh pain and swelling associated with irritability of a few hours’ duration following 2 days history of right abdominal pain. Urgent MRI and CT scan showed features of necrotising fasciitis in the thigh spreading from an inflamed appendix. Emergency surgery was performed which revealed perforated appendix with disseminated infection in the intraperitoneal and retroperitoneal spaces as well as the right thigh. The patient rapidly deteriorated with evidence of sepsis, shock and renal impairment. In spite of surgery and all supportive measures, she succumbed shortly postoperatively. Blood culture revealed Staphylococcus aureus and Streptococci, while tissue culture showed growth of Escherichia coli and proteus. PMID:24792028

  19. Missed acute appendicitis presenting as necrotising fasciitis of the thigh.

    PubMed

    Taif, Sawsan; Alrawi, Asif

    2014-01-01

    Necrotising fasciitis is a rapidly progressive soft tissue infection that leads to diffuse tissue necrosis. It is associated with systemic toxicity and rapid deterioration resulting in high mortality. Rapid diagnosis and prompt treatment are essential to improve the outcome. We report the case of a 26-year-old woman who presented with severe thigh pain and swelling associated with irritability of a few hours' duration following 2 days history of right abdominal pain. Urgent MRI and CT scan showed features of necrotising fasciitis in the thigh spreading from an inflamed appendix. Emergency surgery was performed which revealed perforated appendix with disseminated infection in the intraperitoneal and retroperitoneal spaces as well as the right thigh. The patient rapidly deteriorated with evidence of sepsis, shock and renal impairment. In spite of surgery and all supportive measures, she succumbed shortly postoperatively. Blood culture revealed Staphylococcus aureus and Streptococci, while tissue culture showed growth of Escherichia coli and proteus. PMID:24792028

  20. Prevent Back Pain

    MedlinePlus

    ... Back Pain Print This Topic En español Prevent Back Pain Browse Sections The Basics Overview Am I at ... Health: Back Pain . There are different types of back pain. Back pain can be acute or chronic. It ...

  1. Chronic pain - resources

    MedlinePlus

    Pain - resources; Resources - chronic pain ... The following organizations are good resources for information on chronic pain: American Chronic Pain Association -- www.theacpa.org National Fibromyalgia and Chronic Pain Association -- www.fmcpaware.org ...

  2. Pain Control

    MedlinePlus

    ... have tried to find relief from cancer pain. ■■ Physical Therapy. Exercises or methods used to help restore strength, ... that you see a licensed expert when trying physical therapy, massage, hypnosis, or acupuncture. 25 To learn more ...

  3. Orofacial Pain

    MedlinePlus

    ... time. Signs that may indicate a headache of dental origin include: ; Pain behind the eyes Sore jaw muscles or "tired" ... t Sleep? Check Your Bite What Causes a Toothache? Your Posture May Be the Cause of Jaw ...

  4. Penis pain

    MedlinePlus

    Pain - penis ... Bites, either human or insect Cancer of the penis Erection that does not go away (priapism) Genital herpes Infected hair follicles Infected prosthesis of the penis Infection under the foreskin of uncircumcised men ( balanitis ) ...

  5. Feeling pain

    MedlinePlus Videos and Cool Tools

    ... protective mechanism, alerting it to potential or actual damage to the body’s tissues. In the example of ... the pain receptors in the skin detect tissue damage from the bee sting. Then, the peripheral nerves ...

  6. Knee pain

    MedlinePlus

    ... the front of your knee around the kneecap Torn ligament. An anterior cruciate ligament (ACL) injury, or ... into your knee, swelling, or an unstable knee. Torn cartilage (a meniscus tear ). Pain felt on the ...

  7. Testicle pain

    MedlinePlus

    ... be caused by a hernia or kidney stone. Testicular cancer is almost always painless. But any testicle lump ... Read More Abdominal pain Scrotum Testes Testicle lump Testicular cancer Testicular torsion Update Date 8/31/2015 Updated ...

  8. Hip pain

    MedlinePlus

    ... the bones or cartilage of your hip, including: Hip fractures – can cause sudden hip pain. These injuries can be serious and lead to major problems. Hip fractures are more common as people get older because ...

  9. Wrist pain

    MedlinePlus

    ... wrist; Pain - carpal tunnel; Injury - wrist; Arthritis - wrist; Gout - wrist; Pseudogout - wrist ... 37.7°C), and recent illness. Other Causes Gout : This occurs when your body produces too much ...

  10. Shoulder pain

    MedlinePlus

    Pain - shoulder ... The shoulder is the most movable joint in the human body. A group of 4 muscles and their tendons, called the rotator cuff, give the shoulder its wide range of motion. Swelling, damage, or ...

  11. Joint pain

    MedlinePlus

    ... or conditions. It may be linked to arthritis , bursitis , and muscle pain . No matter what causes it, ... Autoimmune diseases such as rheumatoid arthritis and lupus Bursitis Chondromalacia patellae Crystals in the joint: gout (especially ...

  12. Abdominal Pain

    MedlinePlus

    ... can help the overall situation for the child. Teaching kids self-hypnosis [8] or guided imagery [8a] ... related topics? Functional Abdominal Pain (English, French or Spanish)—from The North American Society for Pediatric Gastroenterology, ...

  13. Face pain

    MedlinePlus

    ... gets worse when you bend forward) Tic douloureux Temporomandibular joint dysfunction syndrome Sometimes the reason for the face pain ... is persistent, unexplained, or accompanied by other unexplained symptoms. Call your primary provider. What to Expect at ...

  14. Neonatal pain

    PubMed Central

    Walker, Suellen M

    2014-01-01

    Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback. PMID:24330444

  15. Comparison of Alvarado Score Evaluation and Clinical Judgment in Acute Appendicitis

    PubMed Central

    Merhi, Bassem Abou; Khalil, Mahmoud; Daoud, Nabil

    2014-01-01

    ABSTRACT Background: Acute appendicitis is the most common surgical emergency in children, but its diagnosis is sometimes difficult. The aim: of this study is to evaluate retrospectively the Alvarado score in relation to the surgical management based on clinical judgment. Methods: Medical files of 232 children who underwent appendectomy at Makassed General Hospital from January 1997 till December 2006 were reviewed. Demographic characteristics, symptoms and signs, laboratory results and imaging findings for all children were recorded. Results: The positive predictive value of our clinical judgment was 86.4% and the negative appendectomy rate was 13.6% based on the pathology results. The reliability of Alvarado score in our population found a PPV of 80.7% and a negative appendectomy rate of 11.3%. A multivariate analysis revealed that anorexia, neutrophils left shift and rebound tenderness are significantly correlated with a correct diagnosis of appendicitis (p = 0.012, 0.023 and 0.046 respectively). Conclusion: Although, Alvarado score provides measurably useful diagnostic information in evaluating children with suspected appendicitis, we found that good clinical judgment remain the main stay of correct diagnosis of appendicitis. PMID:24783903

  16. Unusual presentation of left sided acute appendicitis in elderly male with asymptomatic midgut malrotation

    PubMed Central

    Singla, Animesh A.; Rajaratnam, Joshua; Singla, Apresh A.; Wiltshire, Stephanie; Kwik, Charlotte; Smigelski, Michelle; Morgan, Mathew J.

    2015-01-01

    Introduction Acute appendicitis in the setting of midgut malrotation is uncommon. Midgut malrotation commonly presents within the first month of life. A minority remain asymptomatic and may present with concomitant abdominal pathology making diagnosis difficult. Presentation of case This paper reports a rare case of a 73-year-old male diagnosed with acute appendicitis and asymptomatic MM .The patient underwent a laparoscopic appendectomy, but had an unplanned return to theatre for washout of post-operative intra-abdominal haematoma. Discussion Midgut malrotation is commonly described by the stringer classification and type 1a is the most common in adults. There have only been a handful of documented cases of acute appendicitis with midgut malrotation occurring in the adult population. Previous delay in diagnosis has led to a delay in definitive management. Both laparoscopic and open surgery has been used in the past. Conclusion Acute appendicitis with malrotation should be considered in elderly patients presenting with atypical signs and symptoms. Imaging offers significant advantage for timely and definitive management. PMID:26520036

  17. Schistosomiasis Presenting as a Case of Acute Appendicitis with Chronic Mesenteric Thrombosis.

    PubMed

    Mosli, Mohammed H; Chan, Wilson W; Morava-Protzner, Izabella; Kuhn, Susan M

    2016-01-01

    The manifestations of schistosomiasis typically result from the host inflammatory response to parasitic eggs that are deposited in the mucosa of either the gastrointestinal tract or bladder. We present here a case of a 50-year-old gentleman with a rare gastrointestinal presentation of both schistosomal appendicitis and mesenteric thrombosis. PMID:27366174

  18. Acute Appendicitis as Complication of Colon Transit Time Study; A Case Report

    PubMed Central

    Ghahramani, Leila; Roshanravan, Reza; Khodaei, Shahin; Rahimi Kazerooni, Salar; Moslemi, Sam

    2015-01-01

    Colon transit time study with radio opaque markers is a simple method for assessment of colon motility disorder in patients with chronic idiopathic constipation. We report a case of acute appendicitis that was induced by impaction of radio opaque markers after colon transit time study. We think that this case report is first significant complication of colon transit time study until now PMID:26396723

  19. Schistosomiasis Presenting as a Case of Acute Appendicitis with Chronic Mesenteric Thrombosis

    PubMed Central

    Chan, Wilson W.; Morava-Protzner, Izabella; Kuhn, Susan M.

    2016-01-01

    The manifestations of schistosomiasis typically result from the host inflammatory response to parasitic eggs that are deposited in the mucosa of either the gastrointestinal tract or bladder. We present here a case of a 50-year-old gentleman with a rare gastrointestinal presentation of both schistosomal appendicitis and mesenteric thrombosis. PMID:27366174

  20. Acute appendicitis due to Cytomegalovirus in an apparently immunocompetent patient: a case report

    PubMed Central

    2014-01-01

    Introduction In healthy subjects, Cytomegalovirus infection can be asymptomatic or manifest as mononucleosis syndrome, but organ disease has also been reported. However, in immunocompromised patients this infection can lead to its most significant and severe disease and even mortality. When Cytomegalovirus causes a gastrointestinal tract infection, it more commonly manifests with luminal tract disease and is usually characterized by ulcerative lesions. Appendicitis is a rare manifestation, and has been reported mainly in human immunodeficiency virus-infected patients or patients with other causes of immunocompromise. Case presentation The authors report on a case of acute primary Cytomegalovirus infection complicated with acute appendicitis due to Cytomegalovirus in an apparently immunocompetent 24-year-old Caucasian man also suffering from primary sclerosing cholangitis and ulcerative colitis. Diagnosis was based on clinical manifestations, serology results, as well as microbiological and histological findings. Treatment consisted of surgery and anti-Cytomegalovirus therapy. Conclusions Cytomegalovirus should be included among the etiologic agents of acute appendicitis in patients with primary sclerosing cholangitis and ulcerative colitis. Currently, there are no definitive data regarding the frequency of Cytomegalovirus appendicitis and the role of anti-Cytomegalovirus treatment in human immunodeficiency virus-negative and apparently immunocompetent subjects. PMID:24612821

  1. Water templated hydrogen-bonded network of pyridine amide appended carbamate in solid state

    NASA Astrophysics Data System (ADS)

    Ghosh, Kumaresh; Adhikari, Suman; Fröhlich, Roland

    2006-03-01

    The pyridine amide appended carbamates 1 and 2 have been synthesized and their hydrogen-bonded self-assemblies in solid state have been described. The self-association pattern is dependent on the nature the anchored group of the carbamate moiety and influenced by water inclusion. Inclusion of water molecule gives a ladder type hydrogen bonded assemblies with cavities.

  2. High-altitude cerebral oedema mimicking stroke.

    PubMed

    Yanamandra, Uday; Gupta, Amul; Patyal, Sagarika; Varma, Prem Prakash

    2014-01-01

    High-altitude cerebral oedema (HACO) is the most fatal high-altitude illness seen by rural physicians practising in high-altitude areas. HACO presents clinically with cerebellar ataxia, features of raised intracranial pressure (ICP) and coma. Early identification is important as delay in diagnosis can be fatal. We present two cases of HACO presenting with focal deficits mimicking stroke. The first patient presented with left-sided hemiplegia associated with the rapid deterioration in the sensorium. Neuroimaging revealed features suggestive of vasogenic oedema. The second patient presented with monoplegia of the lower limb. Neuroimaging revealed perfusion deficit in anterior cerebral artery territory. Both patients were managed with dexamethasone and they improved dramatically. Clinical picture and neuroimaging closely resembled acute ischaemic stroke in both cases. Thrombolysis in these patients would have been disastrous. Recent travel to high altitude, young age, absence of atherosclerotic risk factors and features of raised ICP concomitantly directed the diagnosis to HACO. PMID:24671373

  3. Orthokeratinised odontogenic cyst mimicking periapical cyst

    PubMed Central

    Rajalakshmi, R; Sreeja, C; Vijayalakshmi, D; Leelarani, V

    2013-01-01

    Orthokeratinised odontogenic cyst (OOC) denotes the odontogenic cyst that microscopically has an orthokeratinised epithelial lining. OOC is characterised by a less-aggressive behaviour and a low rate of recurrence. This report describes a case of OOC involving posterior part of the mandible that mimicked periapical cyst in a 14-year-old boy. The initial clinical diagnosis was given as periapical cyst based on the clinical and radiographical features. Enucleation of the cyst was performed and the specimen was sent for histopathological examination. A definite diagnosis of OOC was made by histopathological examination of the biopsy specimen. This case emphases on including OOC in the differential diagnosis of radiolucencies occurring in the periapical region of non-vital tooth. PMID:24099763

  4. Pulmonary Vein Stenosis Mimicking Nonspecific Interstitial Pneumonia

    PubMed Central

    Linga, Karthika R.; Khoor, Andras; Phelan, Jonathan A.; Mira-Avendano, Isabel

    2015-01-01

    Pulmonary vein stenosis (PVS) is a known complication after catheter ablation of arrhythmias. Surprisingly, little information is available on its manifestations in the lung. We describe the case of a 39-year-old woman who presented from an outside hospital with worsening shortness of breath after catheter ablation of pulmonary veins for atrial fibrillation. After an initial diagnosis of pneumonia and its nonimprovement with antibiotics, a surgical lung biopsy was done and interpreted as nonspecific interstitial pneumonia (NSIP) with vascular changes consistent with pulmonary arterial hypertension. Later, she was admitted to our institution where a transthoracic echocardiogram (TTE) and subsequent computed tomography (CT) angiogram of the heart showed severe stenosis of all four pulmonary veins. The previous lung biopsy was rereviewed and reinterpreted as severe parenchymal congestion mimicking NSIP. Our case demonstrates that PVS is an underrecognized complication of catheter ablation, and increased awareness among both clinicians and pathologists is necessary to avoid misdiagnosis. PMID:26779359

  5. Interleukin 6 and lipopolysaccharide binding protein - markers of inflammation in acute appendicitis.

    PubMed

    Brănescu, C; Serban, D; Dascălu, A M; Oprescu, S M; Savlovschi, C

    2013-01-01

    The rate of incidence of acute appendicitis is 12% in the case of male patients and 25% in case of women, which represents about 7% of the world population. The appendectomy rate has remained constant (i.e. 10 out of 10,000 patients per year). Appendicitis most often occurs in patients aged between 11-40 years, on the threshold between the third and fourth decades, the average age being 31.3 years. Since the first appendectomy performed by Claudius Amyand (1681/6 -1740), on December, 6th, 1735 to our days, i.e., 270 years later, time has confirmed the efficiency of both the therapy method and the surgical solution. The surgical cure in case of acute appendicitis has proved to be acceptable within the most widely practised techniques in general surgery. The variety of clinical forms has reached all age ranges, which in its turn has resulted in a large number of semiotic signs. In the case of acute appendicitis, interdisciplinarity has allowed the transfer of concept and methodology transfer among many areas of expertise, aimed at a better, minute understanding of the inflammatory event itself. Acute appendicitis illustrates inflammation development at digestive level and provides for a diagnostic and paraclinical exploration which continually upgrades. The recent inclusion in the studies of the Lipopolysaccharide binding protein (LBP)- type inflammation markers has laid the foundation of the latter's documented presence in the case of acute appendicitis-related inflammation. Proof of the correlation between the histopathological, clinical and evolutive forms can be found by identifying and quantifying these inflammation markers. The importance of studying inflammation markers allows us to conduct studies going beyond the prognosis of the various stages in which these markers were identified. The present article shows the results of a 1-year monitoring of the inflammation markers' values for Interleukin-6 and Lipopolysaccharide binding protein (LBP)-types, both pre

  6. Role of drains in laparoscopic appendectomy for complicated appendicitis at a busy county hospital.

    PubMed

    Pakula, Andrea M; Skinner, Ruby; Jones, Amber; Chung, Ray; Martin, Maureen

    2014-10-01

    Laparoscopic appendectomy (LA) has become the treatment of choice for acute appendicitis with equal or better outcomes than traditional open appendectomy (OA). LA in patients with a gangrenous or perforated appendicitis carries increased rate of pelvic abscess formation when compared with OA. We hypothesized routine placement of pelvic drains in gangrenous or perforated appendicitis decreases pelvic abscess formation after LA. Three hundred thirty-one patients undergoing LA between January 2007 and June 2011 were reviewed. Patients with perforated or gangrenous appendicitis were included. Group I had a Jackson-Pratt (JP) drain(s) placed and Group II had no JP drain. Data included patient demographics, emergency department laboratory values and vital signs, and computed axial tomography scan findings, intra-abdominal or pelvic abscess postoperatively, interventional radiology drainage, and length of stay. Clinic follow-up notes were reviewed. One hundred forty-eight patients were identified. Forty-three patients had placement of JP drains (Group I) and 105 patients had no JP drain (Group II). Three patients (three of 43 [6%]) in Group I developed pelvic abscess and 21 of 105 (20%) patients in Group II developed pelvic abscesses requiring subsequent drainage. This was statistically significant. Patient demographics, temperature, and mean white blood count before surgery were similar. Presurgery computed tomography (CT) with appendicolith and CT with abscess were more prevalent in Group I. The use of JP drainage in patients with perforated or gangrenous appendicitis during LA has decreased rates of pelvic abscess. This was demonstrated despite the drain group having appendicolith or abscess on preoperative CT. PMID:25264664

  7. Diagnostic Value of White Blood Cell and C-Reactive Protein in Pediatric Appendicitis

    PubMed Central

    Buyukbese Sarsu, Sevgi; Sarac, Fatma

    2016-01-01

    Background. Acute appendicitis (AA) associated with acute phase reaction is the most prevalent disease which requires emergency surgery. Its delayed diagnosis and unnecessarily performed appendectomies lead to numerous complications. In our study, we aimed to detect the role of WBC and CRP in the exclusion of acute and complicated appendicitis and diagnostic accuracy in pediatric age group. Methods. Appendectomized patient groups were constructed based on the results of histological evaluation. The area under a receiver operating characteristic (ROC) curve (AUC) was performed to examine diagnostic accuracy. Results. When WBC and CRP were used in combination, based on cut-off values of ≥13.1 × 103/μL for WBC counts and ≥1.17 mg/dL for CRP level, diagnostic parameters were as follows: sensitivity, 98.7%; specificity, 71.3%; PPV, 50.6%; NPV, 99.5%; diagnostic accuracy, 77.6%; LR(+), 3.44; LR(−), 0.017. AUC values were 0.845 (95% CI 0.800–0.891) for WBC and 0.887 (95% CI 0.841–0.932) for CRP. Conclusions. For complicated appendicitis, CRP has the highest degree of diagnostic accuracy. The diagnosis of appendicitis should be made primarily based on clinical examination, and obviously more specific and systemic inflammatory markers are needed. Combined use of cut-off values of WBC (≥13100/μL) and CRP (≥1.17 mg/L) yields a higher sensitivity and NPV for the diagnosis of complicated appendicitis. PMID:27274988

  8. Appendiceal stump closure by metal endoclip in the management of complicated acute appendicitis

    PubMed Central

    2013-01-01

    Background Closure of appendicular stump has been performed in different ways; however, the use of the metal endoclip in complicated grades of acute appendicitis, has not been evaluated yet in a prospective way. Objective To establish the effectiveness of appendiceal stump closure by metal endoclip for complicated appendicitis. Method From January 2009 to January 2011 were evaluated 131 consecutive patients who underwent a laparoscopic appendectomy for complicated acute appendicitis. From those, 118 underwent appendiceal stump closure by metal endoclip. The patient’s age ranged from 12 to 75 years old (31.7 ± 13.3) and 52.7% were male. Complicated appendicitis refers to gangrenous and/or perforated appendix, which may lead to abscess formation and degrees of peritonitis. The outcomes viability, operative time, infection complication, operative complications, and conversion rate were chosen to evaluate the procedure. Results The appendiceal stump closure by metal endoclip was used in 90% of cases. The presence of appendix base necrosis was the most important factor involved in failure of the procedure. Laparoscopic knot (1.5%), laparoscopic endo-suture (3.8%) and video assisted laparotomy (4.7%) were the alternatives used in difficult cases. The mean operative time was (67.54 ± 28.13 minutes). The wound and intra-abdominal infection rates were 2.54% and 5.08%, respectively. There were no operative complications and the conversion rate was 0.85%. Conclusion The appendiceal stump closure by metal endoclip, in complicated grades of acute appendicitis, is a safe and effective procedure. In patients with appendix base necrosis it should be avoided in favor of other alternatives. PMID:24047531

  9. Pediatric appendicitis rupture rate: a national indicator of disparities in healthcare access.

    PubMed

    Jablonski, Kathleen A; Guagliardo, Mark F

    2005-05-01

    BACKGROUND: The U.S. National Healthcare Disparities Report is a recent effort to measure and monitor racial and ethnic disparities in health and healthcare. The Report is a work in progress and includes few indicators specific to children. An indicator worthy of consideration is racial/ethnic differences in the rate of bad outcomes for pediatric acute appendicitis. Bad outcomes for this condition are indicative of poor access to healthcare, which is amenable to social and healthcare policy changes. METHODS: We analyzed the KID Inpatient Database, a nationally representative sample of pediatric hospitalization, to compare rates of appendicitis rupture between white, African American, Hispanic and Asian children. We ran weighted logistic regression models to obtain national estimates of relative odds of rupture rate for the four groups, adjusted for developmental, biological, socioeconomic, health services and hospital factors that might influence disease outcome. RESULTS: Rupture was a much more burdensome outcome than timely surgery and rupture avoidance. Rupture cases had 97% higher hospital charges and 175% longer hospital stays than non-rupture cases on average. These burdens disproportionately affected minority children, who had 24% - 38% higher odds of appendicitis rupture than white children, adjusting for age and gender. These differences were reduced, but remained significant after adjusting for other factors. CONCLUSION: The racial/ethnic disparities in pediatric appendicitis outcome are large and are preventable with timely diagnosis and surgery for all children. Furthermore, estimating this disparity using the KID survey is a relatively straightforward process. Therefore pediatric appendicitis rupture rate is a good candidate for inclusion in the National Healthcare Disparities Report. As with most other health and healthcare disparities, efforts to reduce disparities in income, wealth and access to care will most likely improve the odds of favorable

  10. Diagnostic Value of White Blood Cell and C-Reactive Protein in Pediatric Appendicitis.

    PubMed

    Buyukbese Sarsu, Sevgi; Sarac, Fatma

    2016-01-01

    Background. Acute appendicitis (AA) associated with acute phase reaction is the most prevalent disease which requires emergency surgery. Its delayed diagnosis and unnecessarily performed appendectomies lead to numerous complications. In our study, we aimed to detect the role of WBC and CRP in the exclusion of acute and complicated appendicitis and diagnostic accuracy in pediatric age group. Methods. Appendectomized patient groups were constructed based on the results of histological evaluation. The area under a receiver operating characteristic (ROC) curve (AUC) was performed to examine diagnostic accuracy. Results. When WBC and CRP were used in combination, based on cut-off values of ≥13.1 × 10(3)/μL for WBC counts and ≥1.17 mg/dL for CRP level, diagnostic parameters were as follows: sensitivity, 98.7%; specificity, 71.3%; PPV, 50.6%; NPV, 99.5%; diagnostic accuracy, 77.6%; LR(+), 3.44; LR(-), 0.017. AUC values were 0.845 (95% CI 0.800-0.891) for WBC and 0.887 (95% CI 0.841-0.932) for CRP. Conclusions. For complicated appendicitis, CRP has the highest degree of diagnostic accuracy. The diagnosis of appendicitis should be made primarily based on clinical examination, and obviously more specific and systemic inflammatory markers are needed. Combined use of cut-off values of WBC (≥13100/μL) and CRP (≥1.17 mg/L) yields a higher sensitivity and NPV for the diagnosis of complicated appendicitis. PMID:27274988

  11. Feasibility of a Nonoperative Management Strategy for Uncomplicated Acute Appendicitis in Children

    PubMed Central

    Minneci, Peter C; Sulkowski, Jason P; Nacion, Kristine M; Mahida, Justin B; Cooper, Jennifer N; Moss, R. Lawrence; Deans, Katherine J

    2014-01-01

    Background Urgent operation has been considered the only appropriate management of acute appendicitis in children for decades. The purpose of this study was to investigate the feasibility of non-operative management of uncomplicated acute appendicitis in children. Study Design A prospective non-randomized clinical trial of children with uncomplicated acute appendicitis comparing non-operative management to urgent appendectomy was performed. The primary outcome is the 30-day success rate of non-operative management. Secondary outcomes include comparisons of disability days, missed school days, hospital length of stay (LOS), and measures of quality of life and healthcare satisfaction. Results Seventy-seven patients were enrolled during October 2012–October 2013; 30 chose non-operative management and 47 chose surgery. There were no significant differences in demographic or clinical characteristics. The immediate and 30-day success rates of non-operative management were 93% (n=28/30) and 90% (n=27/30). There was no evidence of progression of appendicitis to rupture at the time of surgery in the three patients that failed non-operative management. Compared to the surgery group, the non-operative group had fewer disability days (3 vs. 17 days, p<0.0001), returned to school more quickly (3 vs. 5 days, p=0.008), and exhibited higher quality of life scores in both the child (93 vs. 88, p=0.01) and the parent (96 vs. 90, p=0.03), but incurred a longer LOS (38 vs. 20 hours, p<0.0001). Conclusions Non-operative management of uncomplicated acute appendicitis in children is feasible with a high 30-day success rate and short-term benefits including a quicker recovery and improved quality of life scores. Additional follow-up will allow for determination of a longer-term success rate, safety, and cost-effectiveness. PMID:24951281

  12. Chronic Pain Medicines

    MedlinePlus

    ... Treatment of chronic pain usually involves medicines and therapy. Medicines used for chronic pain include pain relievers, antidepressants and anticonvulsants. Different types of medicines help ...

  13. Imaging the pregnant patient with abdominal pain.

    PubMed

    Wallace, Graham W; Davis, Melissa A; Semelka, Richard C; Fielding, Julia R

    2012-10-01

    Imaging of pregnant patients with non-obstetric abdominal pain is reviewed, with an accompanying pictorial essay of cases with concentration on magnetic resonance imaging. Non-obstetric causes of abdominal pain during pregnancy are similar to those of non-pregnant patients. The most common causes are appendicitis and cholecystitis. Other causes are myriad and include biliary, gastrointestinal, infectious, inflammatory, and malignant etiologies, among others. The approach to imaging in pregnant patient is unique, as it is imperative to minimize potentially harmful radiation exposures to the fetus. Ultrasound and MRI are the primary modalities for evaluation of the pregnant patient with abdominal pain. The use of intravenous contrast is discouraged, except in highly-selected patients where there is no other way to obtain vital diagnostic information. CT is still used as the mainstay of evaluation of blunt abdominal trauma and is commonly used for diagnosis of small bowel obstruction, stone disease, and work-up of malignancy during pregnancy. A discussion of test selection and underlying rationale is presented. PMID:22160283

  14. An Abdominal Wall Desmoid Tumour Mimicking Cesarean Scar Endometriomas: A Case Report and Review of the Literature

    PubMed Central

    Vural, Fisun; Müezzinoglu, Bahar

    2015-01-01

    Abdominal wall desmoid tumours (DT) are rare, slow-growing benign muscular-aponeurotic fibrous tumours with the tendency to locally invade and recur. They constitute 0.03% of all neoplasms and high infiltration and recurrence rate, but there is no metastatic potential. Although surgery is the primary treatment modality, the optimal treatment remains unclear. Abdominal wall endometriosis is also an unusual disease, and preoperative clinical diagnosis is not always easy. The preoperative radiologic imaging modalities may not aid all the time. Herein, we report an abdominal mass presenting as cyclic pain. Forty-two years old woman who gave birth by cesarean section admitted the complaints of painful abdominal mass (78x45 mm in size) under her cesarean incision scar. She had severe pain, particularly during menstruation. The clinical and radiological imaging findings mimicking endometrioma. We performed wide surgical excision of mass with a 1 cm tumor-free margin with the diagnosis of a benign mesenchymal tumor in the frozen section. The postoperative course was uneventful and recovered without any complication and recurrence three years after surgery. This report presents a case of abdominal wall desmoid tumor mimicking endometrioma. In this paper, shortcomings in diagnosis, abdominal wall endometriomas, and DTs were discussed in the view of literature. PMID:26500967

  15. Facts and Figures on Pain

    MedlinePlus

    ... adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting ... Institute of Health Statistics survey indicated that low back pain was the most common (27%), followed by severe ...

  16. Chest Pain

    MedlinePlus

    Having a pain in your chest can be scary. It does not always mean that you are having a heart attack. There can be many other causes, ... embolism Costochondritis - an inflammation of joints in your chest Some of these problems can be serious. Get ...

  17. Achilles Pain.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

    Five ailments which can cause pain in the achilles tendon area are: (1) muscular strain, involving the stretching or tearing of muscle or tendon fibers; (2) a contusion, inflammation or infection called tenosynovitis; (3) tendonitis, the inflammation of the tendon; (4) calcaneal bursitis, the inflammation of the bursa between the achilles tendon…

  18. Abdominal Pain

    MedlinePlus

    ... that is sudden and sharp You also have pain in your chest, neck or shoulder You're vomiting blood or have blood in your stool Your abdomen is stiff, hard and tender to touch You can't move your bowels, especially if you're also vomiting

  19. Painful menstrual periods

    MedlinePlus

    ... related activities for a few days during each menstrual cycle. Painful menstruation is the leading cause of lost ... when did the pain begin? When in your menstrual cycle do you experience the pain? Is the pain ...

  20. Back Pain During Pregnancy

    MedlinePlus

    ... Management Education & Events Advocacy For Patients About ACOG Back Pain During Pregnancy Home For Patients Search FAQs Back ... Pain During Pregnancy FAQ115, January 2016 PDF Format Back Pain During Pregnancy Pregnancy What causes back pain during ...

  1. When Sex Is Painful

    MedlinePlus

    ... AQ FREQUENTLY ASKED QUESTIONS GYNECOLOGIC PROBLEMS FAQ020 When Sex Is Painful • How common is painful sex? • What causes pain during sex? • Where is pain during sex felt? • When should ...

  2. American Pain Society

    MedlinePlus

    ... Management Award Recipients Strong Evidence Still Lacking on Medical Marijuana for Pain Fibromyalgia Has Central Nervous System Origins ... Mayday Fund American Pain Society Offers Guidance on Medical Marijuana for Pain Study Shows Pain Often Improves in ...

  3. What Is Chronic Pain?

    MedlinePlus Videos and Cool Tools

    ... Contact Us Shop FAQs The Art of Pain Management Resources Going to the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs Resource Guide to Chronic Pain Treatments Pain ...

  4. Alternative medicine - pain relief

    MedlinePlus

    Acupuncture - pain relief; Hypnosis - pain relief; Guided imagery - pain relief ... you repeat a positive statement over and over. Hypnosis may help relieve pain for: After surgery or labor Arthritis Cancer Fibromyalgia ...

  5. American Chronic Pain Association

    MedlinePlus

    ... ACPA Contact Us Shop FAQs The Art of Pain Management Resources Going to the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs Resource Guide to Chronic Pain Treatments Pain ...

  6. Complex Regional Pain Syndrome

    MedlinePlus

    Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes intense pain, usually in the arms, hands, legs, or feet. ... in skin temperature, color, or texture Intense burning pain Extreme skin sensitivity Swelling and stiffness in affected ...

  7. Spondylolisthesis mimicking the progression of dissection in a case of chronic Stanford type B aortic dissection.

    PubMed

    Göz, Mustafa; Torun, Mehmet Fuat; Mordeniz, Cengiz; Aydın, Mehmet Salih; Demirkol, Abbas Heval; Karabağ, Hamza

    2011-09-01

    Aortic dissection is an acute lethal cardiovascular condition. A 67-year-old hypertensive woman was admitted to our Emergency Department with an abrupt onset of tearing pain in the interscapular area. A thoracic computed tomography scan with contrast showed chronic type B aortic dissection. The patient was transferred to intensive care and medical therapy was initiated. Upon spread of the pain to the lumbar area, the dissection was thought to have progressed. The patient, being hemodynamically stable, was examined using ultrasonography, and the dissection did not show any progression. In the neurological examination for the lumbar pain, the lumbar processus spinosus was found to be sensitive, and the sciatic nerve stretch test was positive at 30 degrees. Magnetic resonance imaging revealed spondylolisthesis and a centrally located disc herniation at the L3-4 level. No operation for the dissection was planned, but discectomy and fusion surgery was scheduled. Since the patient refused surgery, she was discharged with medical therapy. Our aim in this report was to emphasize the importance of spondylolisthesis mimicking the progression of dissection in the differential diagnosis of a chronic type B aortic dissection case. PMID:22090335

  8. Endosalpingiosis in Conjunction with Ovarian Serous Cystadenoma Mimicking Metastatic Ovarian Malignancy

    PubMed Central

    Singhania, Namrata; Janakiraman, Neha; Coslett, Douglas; Ahmad, Navid

    2014-01-01

    Patient: Female, 26 Final Diagnosis: Endosalpingiosis Symptoms: Chronic pelvic pain Medication: — Clinical Procedure: Diagnostic laproscopy (conservative management) Specialty: Obstetrics and Gynecology Objective: Challenging differential diagnosis Background: Interesting and unusual case of endosalpingiosis mimicking ovarian malignancy presentation. Case Report: A 26-year-old G0P0 white female presented to our office with chronic pelvic pain. On vaginal examination, a nontender mass in left the adnexal region was palpable. Transvaginal ultrasound showed a left ovarian cyst. Laparoscopy was performed, which revealed diffuse bilateral ovarian excrescences with unusual multiple studdings throughout the peritoneum and abdominal cavity. Due to a suspicion of malignancy, a biopsy specimen was obtained for frozen sectioning. The specimen proved to be consistent with benign papillary serous cystadenofibroma. Gross appearance was still suspicious for malignancy and therefore left paraovarian cystectomy was performed. Additional specimens showed ovarian adenofibroma and endosalpingiosis. The patient’s complaint of pelvic pain improved after laparoscopy. Due to diffuse presentation of endosalpingiosis in the peritoneum, serial CT scan of abdomen and pelvis at 6-month intervals was recommended. Conclusions: To our knowledge, this is an unusual case of a young, nulliparous female presenting with diffuse-presentation endosalpingiosis in the abdomen and peritoneum, which on gross examination was suspicious for malignancy. By following a conservative approach and performing serial CT scans, the patient will be clinically monitored. PMID:25180540

  9. Bilateral axillary masses mimicking as accessory breast with multiple fibroadenoma and bilateral gigantomastia in HIV-positive patient

    PubMed Central

    Singh, Saumya; Mishra, Anand K; Tewari, S; Kumar, Sanjeev

    2013-01-01

    Accessory breast is a rare entity that can present as asymptomatic masses or can cause symptoms like heaviness, pain, restriction of arm movement and limitation in daily pursuits with allied apprehension and anxiety for the patient. We present a case of bilateral axillary masses mimicking as accessory breast with multiple fibroadenoma in a 28 years, nulliparous, Indian woman who is HIV positive, which proves to be a diagnostic dilemma. Excisional biopsy was diagnostic. The rarity of such cases imposes challenges on the management in terms of diagnosis, prognosis and therapeutic options. PMID:23813993

  10. Bilateral axillary masses mimicking as accessory breast with multiple fibroadenoma and bilateral gigantomastia in HIV-positive patient.

    PubMed

    Singh, Saumya; Mishra, Anand K; Tewari, S; Kumar, Sanjeev

    2013-01-01

    Accessory breast is a rare entity that can present as asymptomatic masses or can cause symptoms like heaviness, pain, restriction of arm movement and limitation in daily pursuits with allied apprehension and anxiety for the patient. We present a case of bilateral axillary masses mimicking as accessory breast with multiple fibroadenoma in a 28 years, nulliparous, Indian woman who is HIV positive, which proves to be a diagnostic dilemma. Excisional biopsy was diagnostic. The rarity of such cases imposes challenges on the management in terms of diagnosis, prognosis and therapeutic options. PMID:23813993

  11. Equivocal Pediatric Appendicitis: Unenhanced MR Imaging Protocol for Nonsedated Children-A Clinical Effectiveness Study.

    PubMed

    Dillman, Jonathan R; Gadepalli, Samir; Sroufe, Nicole S; Davenport, Matthew S; Smith, Ethan A; Chong, Suzanne T; Mazza, Michael B; Strouse, Peter J

    2016-04-01

    Purpose To determine retrospectively the clinical effectiveness of an unenhanced magnetic resonance (MR) imaging protocol for evaluation of equivocal appendicitis in children. Materials and Methods Institutional review board approval was obtained. Pediatric patients (≤18 years old) underwent unenhanced MR imaging and contrast material-enhanced computed tomography (CT) of the appendix between December 2013 and November 2014 and December 2012 and November 2013, respectively, within 24 hours after an abdominal ultrasonographic examination with results equivocal for appendicitis. Pertinent MR imaging and CT reports were reviewed for visibility of the appendix, presence of appendicitis and appendiceal perforation, and establishment of an alternative diagnosis. Surgical reports, pathologic reports, and 30-day follow-up medical records were used as reference standards. Diagnostic performance with MR imaging and CT was calculated with 95% confidence intervals (CIs) for diagnosis of appendicitis and appendiceal perforation. The Fisher exact test was used to compare proportions; the Student t test was used to compare means. Results Diagnostic performance with MR imaging was comparable to that with CT for equivocal pediatric appendicitis. For MR imaging (n = 103), sensitivity was 94.4% (95% CI: 72.7%, 99.9%) and specificity was 100% (95% CI: 95.8%, 100%); for CT [n = 58], sensitivity was 100% (95% CI: 71.5%, 100%), specificity was 97.9% (95% CI: 88.7%, 100%). Diagnostic performance with MR imaging and CT also was comparable for detection of appendiceal perforation, with MR imaging (n = 103) sensitivity of 90.0% (95% CI: 55.5%, 99.8%) and specificity of 85.7% (95% CI: 42.1%, 99.6%) and CT (n = 58) sensitivity of 75.0% (95% CI: 19.4%, 99.4%) and specificity of 85.7% (95% CI: 42.1%, 99.6%). The proportion of examinations with identifiable alternative diagnoses was similar at MR imaging to that at CT (19 of 103 [18.4%] vs eight of 58 [13.8%], respectively; P = .52). The

  12. Appendicitis during pregnancy in a Greenlandic Inuit woman; antibiotic treatment as a bridge-to-surgery in a remote area.

    PubMed

    Dalsgaard Jensen, Trine; Penninga, Luit

    2016-01-01

    Appendicitis during pregnancy causes severe diagnostic problems, and is associated with an increase in perforation rate and morbidity compared to that in the normal population. In addition, it may cause preterm birth and fetal loss. In remote areas, appendicitis during pregnancy, besides presenting diagnostic problems, also creates treatment difficulties. In Northern Greenland, geographical distances are vast, and weather conditions can be extreme. We report a case of a Greenlandic Inuit woman who presented with appendicitis during pregnancy. The nearest hospital with surgical and anaesthetic care was located nearly 1200 km away, and, due to extreme weather conditions, she could not be transferred immediately. She was treated with intravenous antibiotic treatment, and after weather conditions had improved, she was transferred by aeroplane and underwent appendicectomy. She recovered without complications. Our case suggests that appendicitis during pregnancy may be treated with antibiotics in remote areas until surgical treatment is available. PMID:27194672

  13. Endometriosis Mimicking an Advanced Malignant Tumor.

    PubMed

    Wang, Taisong; Xing, Yan; Zhao, Jinhua

    2016-08-01

    A 27-year-old woman with swelling left leg, groin pain, and increased serum CA125 level underwent FDG PET/CT to evaluate a pelvic mass revealed by an MRI performed from an outside hospital. A large hypermetabolic solid mass in the left pelvic wall and several lymph nodes with elevated FDG activity were noted, which indicated malignancy. However, histopathological examination demonstrated endometriosis. PMID:27187736

  14. Isolated plexiform neurofibroma mimicking a vascular lesion.

    PubMed

    Stefano, Paola Cecilia; Apa, Sebastian Nicolas; Lanoël, Agustina Maria; María, Josefina Sala; Sierre, Sergio; Pierini, Adrián Martin

    2016-04-01

    Plexiform neurofibromas are benign tumors originating from peripheral nerve sheaths, generally associated with Neurofibromatosis Type 1 (NF1). They are diffuse, painful and sometimes locally invasive, generating cosmetic problems. This report discusses an adolescent patient who presented with an isolated, giant plexiform neurofibroma on her leg that was confused with a vascular lesion due to its clinical aspects. Once the diagnosis was confirmed by surgical biopsy, excision of the lesion was performed with improvement of the symptoms. PMID:27192529

  15. Microfabricated adhesive mimicking gecko foot-hair

    NASA Astrophysics Data System (ADS)

    Geim, A. K.; Dubonos, S. V.; Grigorieva, I. V.; Novoselov, K. S.; Zhukov, A. A.; Shapoval, S. Yu.

    2003-07-01

    The amazing climbing ability of geckos has attracted the interest of philosophers and scientists alike for centuries. However, only in the past few years has progress been made in understanding the mechanism behind this ability, which relies on submicrometre keratin hairs covering the soles of geckos. Each hair produces a miniscule force ~10-7 N (due to van der Waals and/or capillary interactions) but millions of hairs acting together create a formidable adhesion of ~10 N cm-2: sufficient to keep geckos firmly on their feet, even when upside down on a glass ceiling. It is very tempting to create a new type of adhesive by mimicking the gecko mechanism. Here we report on a prototype of such 'gecko tape' made by microfabrication of dense arrays of flexible plastic pillars, the geometry of which is optimized to ensure their collective adhesion. Our approach shows a way to manufacture self-cleaning, re-attachable dry adhesives, although problems related to their durability and mass production are yet to be resolved.

  16. Gallbladder melanoma mimicking acute acalculous cholecystitis.

    PubMed

    De Simone, P; Mainente, P; Bedin, N

    2000-06-01

    Gallbladder (GB) melanoma is a rare entity with a dismal prognosis. Its primary or secondary status is difficult to establish in the absence of an overt cutaneous localization. We report herein the case of a misdiagnosed GB melanoma mimicking acute acalculous cholecystitis that was treated by means of laparoscopic cholecystectomy (LC). A 54-year-old man was referred to our institution for acute cholecystitis. Apart from the ablation of some nevocytic nevi 7 years before admission, the patient's medical history was unremarkable. The ultrasound (US) examination showed a slightly enlarged acalculous gallbladder with thickened walls and a well-circumscribed polypoid mass in the fundus. The patient was treated medically and referred to LC. At surgery, some satellite nodules were visualized in the GB hepatic bed. The GB was removed, and two hepatic nodules were excised. Histology showed a pT3 melanoma. The patient underwent an open hepatic wedge resection 3 weeks after laparoscopy. No recurrence was observed at 6-month follow-up. To date, only one case of melanoma of the gallbladder treated with LC has been reported. GB melanoma is a diagnostic challenge when there is no evidence of a primary lesion. However, the occurrence of acalculous cholecystitis and a GB polyp in patients with a positive history of mole ablation should alert surgeons to the possibility of a melanoma. PMID:11265063

  17. Non-harmful insertion of data mimicking computer network attacks

    DOEpatents

    Neil, Joshua Charles; Kent, Alexander; Hash, Jr, Curtis Lee

    2016-06-21

    Non-harmful data mimicking computer network attacks may be inserted in a computer network. Anomalous real network connections may be generated between a plurality of computing systems in the network. Data mimicking an attack may also be generated. The generated data may be transmitted between the plurality of computing systems using the real network connections and measured to determine whether an attack is detected.

  18. Sacral Insufficiency Fractures Mimicking Lumbar Spine Pathology

    PubMed Central

    K. L., Kalra; Acharya, Shankar; Chahal, Rupinder

    2016-01-01

    Sacral insufficiency fractures (SIFs) are a common cause of back pain in the elderly. SIFs mimic the symptoms of lumbar spine pathology and so are commonly missed or underdiagnosed. Here we present four cases of missed SIFs that were subsequently identified and treated. One patient was treated as mechanical lower back ache, another patient underwent root block and two patients underwent surgery for lumbar canal stenosis. None experienced relief of their symptoms after these procedures. Retrospective analysis of X-ray and magnetic resonance imaging data revealed SIFs that were confirmed by computed tomography scans. All four patients were treated for underlying osteoporosis. Two patients who underwent surgery were treated conservatively and other two were treated by sacroplasty involving injection of cement into the fracture. Sacroplasty produced immediate pain relief and early mobilization compared to the conservative group. SIFs should always be considered in the differential diagnosis of an elderly patient presenting with low back symptoms. Sacroplasty can be considered for immediate pain relief and rapid mobilization. PMID:27340538

  19. Sacral Insufficiency Fractures Mimicking Lumbar Spine Pathology.

    PubMed

    Sudhir, G; K L, Kalra; Acharya, Shankar; Chahal, Rupinder

    2016-06-01

    Sacral insufficiency fractures (SIFs) are a common cause of back pain in the elderly. SIFs mimic the symptoms of lumbar spine pathology and so are commonly missed or underdiagnosed. Here we present four cases of missed SIFs that were subsequently identified and treated. One patient was treated as mechanical lower back ache, another patient underwent root block and two patients underwent surgery for lumbar canal stenosis. None experienced relief of their symptoms after these procedures. Retrospective analysis of X-ray and magnetic resonance imaging data revealed SIFs that were confirmed by computed tomography scans. All four patients were treated for underlying osteoporosis. Two patients who underwent surgery were treated conservatively and other two were treated by sacroplasty involving injection of cement into the fracture. Sacroplasty produced immediate pain relief and early mobilization compared to the conservative group. SIFs should always be considered in the differential diagnosis of an elderly patient presenting with low back symptoms. Sacroplasty can be considered for immediate pain relief and rapid mobilization. PMID:27340538

  20. A case of scrotal swelling mimicking testicular torsion preceding Henoch-Schönlein vasculitis.

    PubMed

    Akgun, C

    2012-01-01

    Henoch-Schönlein purpura, is one of the most common types of multisystemic vasculitis seen in childhood. The major clinical manifestations are cutaneous purpura, arthritis, abdominal pain, gastrointestinal bleeding, and nephritis. Isolated central nervous system vasculitis, seizures, coma and hemorrhage, Guillan--Barré syndrome, ataxia and central and peripheral neuropathy, ocular involvement, orchitis, epididymitis or testicular torsion are medical or surgical complications. In this study, we report a 7-year-old boy with scrotal swelling mimicking testicular torsion with ultrasonographic and clinical findings that the typical clinical features of Henoch-Schönlein purpura including rashes and arthritis were developed after one week of surgery (Ref. 15). PMID:22693978

  1. Hypogammaglobulinemic patient with polyarthritis mimicking rheumatoid arthritis finally diagnosed as septic arthritis caused by Mycoplasma hominis.

    PubMed

    Sato, Hiroe; Iino, Noriaki; Ohashi, Riuko; Saeki, Takako; Ito, Tomoyuki; Saito, Maki; Tsubata, Yutaka; Yamamoto, Suguru; Murakami, Shuichi; Kuroda, Takeshi; Tanabe, Yoshinari; Fujisawa, Junichi; Murai, Takehiro; Nakano, Masaaki; Narita, Ichiei; Gejyo, Fumitake

    2012-01-01

    Hypogammaglobulinemia is a reduction or absence of immunoglobulin, which may be congenital or associated with immunosuppressive therapy. In addition to infectious diseases, autoimmune diseases have also been reported in patients with hypogammaglobulinemia. A 26-year-old man with hypogammaglobulinemia had multiple joint pain and swelling with erosive changes in the proximal interphalangeal joint of the right middle finger on X-ray film, mimicking rheumatoid arthritis (RA). As polyarthritis remained after immunoglobulin replacement therapy and there was no finding indicating any infection at that time, a diagnosis of RA was made. Prednisolone and etanercept were started. However, his polyarthritis did not improve and he developed meningitis and massive brain ischemia. Finally, a diagnosis of disseminated Mycoplasma hominis infection was made. The differential diagnosis of polyarthritis in patients with hypogammaglobulinemia should strictly exclude Mycoplasma infection by culture with special media or longer anaerobic culture, and molecular methods for mycoplasma. PMID:22333381

  2. Low-grade adenocarcinoma of endolymphatic sac mimicking jugular paraganglioma at clinical and neuroradiological examination.

    PubMed

    Roncaroli, F; Giangaspero, F; Piana, S; Andreoli, A; Ricci, R

    1997-01-01

    We report a case of low-grade adenocarcinoma of endolymphatic sac origin mimicking jugular paraganglioma at clinical and neuroradiological examination. The lesion occurred in a 72-year-old male who presented with a long-standing history of right-sided hearing loss and a few-week history of progressive facial nerve palsy and right aural pain. At histology, the tumor was composed of pseudoglandular spaces with papillary infoldings. Lumina contained colloid-like material. The lesion was surgically removed with suboccipital approach following endoarterial embolization. This study emphasizes that low-grade adenocarcinomas of endolymphatic sac origin extending to posterior cranial fossa and jugular paraganglioma may be indistinguishable preoperatively at clinical and radiological levels. PMID:9323449

  3. Diagnostic peritoneal lavage in evaluating acute abdominal pain.

    PubMed

    Barbee, C L; Gilsdorf, R B

    1975-06-01

    A study was performed to determine the value of peritoneal lavage in the acute abdomen not related to trauma. Lavage was performed in 33 patients in the evaluation of abdominal pain of sufficient degree to warrant consideration for surgical intervention. Peritoneal lavage was truly positive or truly negative in 64% of the cases. It showed false negative results in 28% and false positive results in 8%. The lavage was most accurate in the evaluation of appendicitis, colonic disease, and intra abdominal bleeding. It was highly inaccurate in the evaluation of cholecystitis and peptic ulcer disease. It was concluded that the peritoneal lavage can be a useful adjunct in the evaluation of patients with abdominal pain and should be considered in difficult diagnostic problems but not routinely employed. PMID:1138636

  4. Understanding pain, part 2: pain management.

    PubMed

    Godfrey, Helen

    This article is the second in a two-part series which explores pain and its management from a physiological perspective. Nurses play an important role in assessing and managing pain. Effective pain management by nurses requires them to have an understanding of the biological basis of the pain interventions which may be used to control pain. This article emphasizes the importance of pain assessment as a precursor for effective pain management and explores the biological basis of pain interventions which contribute to pain control. The role of non-pharmacological approaches in alleviating pain and their actions which contribute to pain relief are explored. The three main types of pharmaceutical agents used, non-opioids, opioids and adjuvant drugs, are introduced and their mechanisms of actions discussed. PMID:16224328

  5. Functional Rudimentary Horn as a Rare Cause of Pelvic Pain: A Case Report

    PubMed Central

    Arab, Maliheh; Mehdighalb, Sepideh; Khosravi, Donya

    2014-01-01

    Introduction: Pelvic pain results from many causes such as primary dysmenorrhea, uterine anomalies, menstrual outflow obstruction, endometriosis, myoma and adenomyosis. This study reports on a rare case of non-communicating functional rudimentary horn. Case Presentations: A 15-year-old nulligravida young woman with a history of severe intermittent pelvic pain presented a 4-5 centimeter mass. A surgical procedure for appendicitis was previously performed on this patient. Per-operative diagnosis was myoma and suspicion of leismus sarcoma. Laparotomy revealed left rudimentary horn, non-communication was confirmed by postoperative hysterosalpingogram (HSG) and magnetic resonance imaging (MRI). Resection of mass and left fallopian tube was done during the second surgery. Conclusions: Rudimentary horn should be considered in differentiation of pelvic pain and mass in young females. Early diagnosis and horn resection prevents emergency surgery and reliefs pain. PMID:25763218

  6. Appendicitis and appendectomies among non-service member beneficiaries of the Military Health System, 2002-2011.

    PubMed

    2012-12-01

    Among non-service member beneficiaries of the Military Health System, there were 79,820 cases of appendicitis and 98,385 appendectomies during 2002 to 2011; from the fi rst to last year of the period, the annual number of appendicitis cases increased by 61.1 percent. Perforated acute appendicitis occurred in one quarter of all cases; the proportion of perforated cases was higher among males (30.2%) than females (23.3%). The annual number of total appendectomies decreased during the period; however, outpatient appendectomies increased 5-fold. Th e proportion of inpatient appendectomies that were incidental was greater in females (15.6%) than males (8.8%). During the period, the number of nonincidental appendectomies that were not associated with diagnoses of appendicitis ("negative appendectomies") decreased by 65 percent, and the mean number of inpatient bed days per appendicitis case decreased by one day (21.1%). The findings likely reflect more frequent uses of and advances in diagnostic imaging to detect and characterize appendicitis and a shift in surgical treatment to the outpatient setting with increasing use of laparoscopy for appendectomies. PMID:23311331

  7. Neck pain

    PubMed Central

    2008-01-01

    Introduction Non-specific neck pain has a postural or mechanical basis and affects about two thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but may become chronic in about 10% of people. Whiplash injuries follow sudden acceleration–deceleration of the neck, such as in road traffic or sporting accidents. Up to 40% of people continue to report symptoms 15 years after the accident, although this varies between countries. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for people with non-specific neck pain without severe neurological deficit? What are the effects of treatments for acute whiplash injury? What are the effects of treatments for chronic whiplash injury? What are the effects of treatments for neck pain with radiculopathy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 91 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of the evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, biofeedback, drug treatments (analgesics, antidepressants, epidural steroid injections, muscle relaxants, non-steroidal anti-inflammatory drugs [NSAIDs]), early mobilisation, early return to normal activity, exercise, heat or cold, manipulation (alone or plus exercise), mobilisation, multimodal treatment, patient education, percutaneous radiofrequency neurotomy

  8. The Houdini effect--an unusual case of blunt abdominal trauma resulting in perforative appendicitis.

    PubMed

    O'Kelly, F; Lim, K T; Hayes, B; Shields, W; Ravi, N; Reynolds, J V

    2012-03-01

    We present a unique case of perforative appendicitis that occurred in an adult following blunt abdominal trauma. This case represents the first such reported case from Ireland. It also represents a modern practical example of Laplace's theory of the effect of increased pressure on colonic wall tension leading to localized perforation, and serves to highlight not only the importance in preoperative imaging for blunt abdominal trauma, but also the importance of considering appendiceal perforation. PMID:22558817

  9. Determination of surgical priorities in appendicitis based on the probability of undetected appendiceal perforation

    PubMed Central

    Lee, Sang Chul; Park, Geon; Choi, Byung-Jo; Kim, Say-June

    2015-01-01

    AIM: To identify risk factors of actual appendiceal perforation when computed tomography (CT) scans suggest nonperforated appendicitis and accordingly determine surgical priority. METHODS: We collected database of 1362 patients who underwent an appendectomy for acute appendicitis between 2006 and 2013. A single radiologist selected 1236 patients whose CT scans were suggestive of nonperforated appendicitis. Patients were divided into 2 groups: actual nonperforation group and actual perforation group according to intraoperative and pathologic features. Comparison of the 2 groups were made using binary logistic regression. RESULTS: Of 1236 patients, 90 (7.3%) were found to have actual appendiceal perforation. Four risk factors related with actual appendiceal perforation were identified: body temperature ≥ 37.6  °C (HR = 1.912, 95%CI: 1.161-3.149; P = 0.011), out-of-hospital symptom duration ≥ 72 h (HR = 2.454, 95%CI: 1.292-4.662; P = 0.006), age ≥ 35 years (HR = 3.358, 95%CI: 1.968-5.728; P < 0.001), and appendiceal diameter on CT scan ≥ 8 mm (HR = 4.294, 95%CI: 1.034-17.832; P = 0.045). Actual appendiceal perforation group showed longer operation time, later initiation of diet, longer use of parenteral narcotics, longer hospital stay, and higher incidence of postoperative complications (P < 0.05). CONCLUSION: We proposed here new criteria to select patients with adverse clinical outcomes after appendectomy among the patients with radiologically nonperforated appendicitis. Surgical appendectomy outcomes could be improved by determining the surgical priority according to our criteria. PMID:25717248

  10. Diagnostic accuracy at several reduced radiation dose levels for CT imaging in the diagnosis of appendicitis

    NASA Astrophysics Data System (ADS)

    Zhang, Di; Khatonabadi, Maryam; Kim, Hyun; Jude, Matilda; Zaragoza, Edward; Lee, Margaret; Patel, Maitraya; Poon, Cheryce; Douek, Michael; Andrews-Tang, Denise; Doepke, Laura; McNitt-Gray, Shawn; Cagnon, Chris; DeMarco, John; McNitt-Gray, Michael

    2012-03-01

    Purpose: While several studies have investigated the tradeoffs between radiation dose and image quality (noise) in CT imaging, the purpose of this study was to take this analysis a step further by investigating the tradeoffs between patient radiation dose (including organ dose) and diagnostic accuracy in diagnosis of appendicitis using CT. Methods: This study was IRB approved and utilized data from 20 patients who underwent clinical CT exams for indications of appendicitis. Medical record review established true diagnosis of appendicitis, with 10 positives and 10 negatives. A validated software tool used raw projection data from each scan to create simulated images at lower dose levels (70%, 50%, 30%, 20% of original). An observer study was performed with 6 radiologists reviewing each case at each dose level in random order over several sessions. Readers assessed image quality and provided confidence in their diagnosis of appendicitis, each on a 5 point scale. Liver doses at each case and each dose level were estimated using Monte Carlo simulation based methods. Results: Overall diagnostic accuracy varies across dose levels: 92%, 93%, 91%, 90% and 90% across the 100%, 70%, 50%, 30% and 20% dose levels respectively. And it is 93%, 95%, 88%, 90% and 90% across the 13.5-22mGy, 9.6-13.5mGy, 6.4-9.6mGy, 4-6.4mGy, and 2-4mGy liver dose ranges respectively. Only 4 out of 600 observations were rated "unacceptable" for image quality. Conclusion: The results from this pilot study indicate that the diagnostic accuracy does not change dramatically even at significantly reduced radiation dose.

  11. Acute appendicitis: diagnostic value of nonenhanced CT with selective use of contrast in routine clinical settings.

    PubMed

    Tamburrini, Stefania; Brunetti, Arturo; Brown, Michèle; Sirlin, Claude; Casola, Giovanna

    2007-08-01

    The purposes of this study were to determine the (1) frequency with which nonenhanced computed tomography (CT) (NECT) permits conclusive diagnosis of acute appendicitis, (2) accuracy of NECT when findings are conclusive, and (3) overall accuracy of a CT protocol consisting of NECT with selective use of contrast. Five hundred and thirty-six patients underwent a NECT protocol with selective use of contrast. Diagnostic accuracy was then determined separately for (1) patients with conclusive initial NECT, (2) patients with inconclusive initial NECT, and (3) all patients. NECT was conclusive on initial interpretation in 404/536 patients and inconclusive in 132/536. Of 132 inconclusive studies, 126 were repeated with contrast (intravenous, oral or rectal). Sensitivity, specificity, and positive and negative predictive value for diagnosis of acute appendicitis were (1) 90%, 96.0%, 84.8%, and 97.4% in patients with conclusive NECT (n = 404); (2) 95.6%, 92.3%, 73%, and 99% in patients with inconclusive NECT followed by repeat CT with contrast; and (3) 91.3%, 95%, 82%, and 98% in all patients. The initial diagnosis of appendicitis may be made by NECT in 75% of patients, with contrast administration reserved for inconclusive NECT studies. PMID:17180324

  12. The Frequency of Enterobius Vermicularis Infections in Patients Diagnosed With Acute Appendicitis in Pakistan

    PubMed Central

    Ahmed, Muhammad Umer; Bilal, Muhammad; Anis, Khurram; Khan, Ali Mahmood; Fatima, Kaneez; Ahmed, Iqbal; Khatri, Ali Mohammad; Shafiq-ur-Rehman

    2015-01-01

    Introduction: The main aim of this study was to determine the frequency of Enterobius Vermicularis infections and other unique histopathological findings in patients diagnosed with acute appendicitis. Materials: This retrospective study was conducted in a tertiary care hospital of Karachi, Pakistan over a time period of 9 years from 2005 to 2013. The recorded demographic and histopathological data for the 2956 appendectomies performed during this time frame were extracted using a structured template form. Negative and incidental appendectomies were excluded from the study. Results: Out of the 2956 patients diagnosed with acute appendicitis, 84 (2.8%) patients had Enterobius Vermicularis infections. Malignancy (n=2, 0.1%) and infection with Ascaris (n=1, 0.1%) was found very rarely among the patients. Eggs in lumen (n=22, 0.7%), mucinous cystadenoma (n=28, 1.0%), mucocele (n=11, 0.4%), lymphoma (n=9, 0.3%), obstruction in lumen (n=17, 0.6%) and purulent exudate (n=37, 1.3%) were also seldom seen in the histopathological reports. Conclusion: Enterobius Vermicularis manifestation is a rare overall but a leading parasitic cause of appendicitis. Steps such as early diagnosis and regular de worming may help eradicate the need for surgeries. PMID:26156929

  13. Diagnostic Accuracy of Noncontrast CT in Detecting Acute Appendicitis: A Meta-analysis of Prospective Studies.

    PubMed

    Xiong, Bing; Zhong, Baishu; Li, Zhenwei; Zhou, Feng; Hu, Ruying; Feng, Zhan; Xu, Shunliang; Chen, Feng

    2015-06-01

    The aim of the study is to evaluate the diagnostic accuracy of noncontrast CT in detecting acute appendicitis. Prospective studies in which noncontrast CT was performed to evaluate acute appendicitis were found on PubMed, EMBASE, and Cochrane Library. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were assessed. The summary receiver-operating characteristic curve was conducted and the area under the curve was calculated. Seven original studies investigating a total of 845 patients were included in this meta-analysis. The pooled sensitivity and specificity were 0.90 (95% CI: 0.86-0.92) and 0.94 (95% CI: 0.92-0.97), respectively. The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio was 12.90 (95% CI: 4.80-34.67), 0.09 (95% CI: 0.04-0.20), and 162.76 (95% CI: 31.05-853.26), respectively. The summary receiver-operating characteristic curve was symmetrical and the area under the curve was 0.97 (95% CI: 0.95-0.99). In conclusion, noncontrast CT has high diagnostic accuracy in detecting acute appendicitis, which is adequate for clinical decision making. PMID:26031278

  14. Disseminated Pleural Siliconoma Mimicking Malignant Pleural Mesothelioma.

    PubMed

    Tanaka, Toshiki; Tao, Hiroyuki; Hayashi, Tatsuro; Yoshiyama, Koichi; Furukawa, Masashi; Yoshida, Kumiko; Okabe, Kazunori

    2015-12-01

    A 48-year-old woman with a 3-month history of back pain was admitted for further examination of multiple left pleural nodules. She had undergone bilateral breast augmentation with silicone implants 10 years previously. Nine years after the operation, both ruptured implants were removed, and autologous fat was injected. Computed tomography revealed multiple pleural nodules suggestive of malignant pleural mesothelioma. Thoracoscopic exploration revealed multiple pleural nodules with massive pleural adhesions. The nodules were filled with viscous liquid and were histologically determined to be siliconomas. Disseminated pleural siliconoma should be recognized as a late adverse event of silicone breast implantation. PMID:26652527

  15. Osteomalacia mimicking spondyloarthropathy: a case report.

    PubMed

    Garip, Y; Dedeoglu, M; Bodur, H

    2014-07-01

    Osteomalacia is a metabolic bone disorder characterized by impaired mineralization of bone matrix. Symptoms of osteomalacia can be confused with other conditions such as spondyloarthropathy, polymyalgia rheumatica, polymyositis, and fibromyalgia. In this case, we report a patient with axial osteomalacia who developed low back pain, morning stiffness, and "grade 3 sacroiliitis" in pelvis X-ray, leading to the misdiagnosis as seronegative spondyloarthropathy. Serum biochemical studies revealed low serum phosphorus, low 25-hydroxy vitamin D3, normal calcium, elevated parathyroid hormone, and alkaline phosphatase levels. Her symptoms were relieved with vitamin D and calcium therapy. The diagnosis of osteomalacia should be considered in case of sacroiliitis and spondylitis. PMID:24760247

  16. Pseudomonas aeruginosa infection mimicking erythema annulare centrifugum.

    PubMed

    Czechowicz, R T; Warren, L J; Moore, L; Saxon, B

    2001-02-01

    A 3-year-old girl receiving chemotherapy for acute lymphocytic leukaemia developed a rapidly expanding red annular plaque on her thigh, initially without signs of systemic toxicity or local pain. Subsequently she developed Pseudomonas aeruginosa sepsis and purpura at the leading edge of the plaque. Skin biopsy showed an extensive necrotizing vasculitis with numerous Gram-negative bacilli in the blood vessel walls. In immunocompromised individuals, skin biopsy and culture of cutaneous lesions for bacteria and fungi should be considered even in the absence of signs of systemic toxicity or multiple lesions. PMID:11233725

  17. Retroperitoneal vascular malformation mimicking incarcerated inguinal hernia.

    PubMed

    Dubey, Indu Bhushan; Sharma, Anuj; Singh, Ajay Kumar; Mohanty, Debajyoti

    2011-01-01

    A 30-year-old man presented to the Department of Surgery with a painful groin swelling on right side. Exploration revealed a reddish-blue hemangiomatous mass in the scrotum extending through inguinal canal into the retroperitoneum. On further dissection swelling was found to be originating from right external iliac vein. The swelling was excised after ligating all vascular connections. The histopathological examination of excised mass confirmed the diagnosis of venous variety of vascular malformation. This is the first reported case of vascular malformation arising from retroperitoneum and extending into inguinoscrotal region, presenting as incarcerated inguinal hernia. PMID:21633582

  18. Anisakidosis: a fortuitous mimicker of gastrointestinal malignancy.

    PubMed

    Khan, Mohammad Qasim; Williams, Jonathan

    2016-01-01

    A 51-year-old woman presented with epigastric pain, vomiting and diarrhoea. Her sister was recently diagnosed with duodenal adenocarcinoma, manifesting similar symptoms. Imaging revealed thickened gastric antrum with enlarged local lymph nodes. Endoscopy illustrated 3 worms embedded in the antral wall, identified as Anisakis simplex larvae. Larvae removal and a 2-week albendazole regimen treated the symptoms. With globalisation of cultural culinary practices, physicians must be vigilant of anisakidosis. Its ability to mimic peptic ulcer disease, chronic gastritis and malignancy necessitates broader differential diagnoses and lower thresholds for endoscopy. PMID:27600057

  19. Primary actinomycosis of the liver mimicking malignancy.

    PubMed

    Lange, C M; Hofmann, W P; Kriener, S; Jacobi, V; Welsch, C; Just-Nuebling, G; Zeuzem, S

    2009-10-01

    A 71-year old women presented with fever, a significant loss of body weight and abdominal pain in the upper right quadrant since approximately six months. Abdominal ultrasonography and magnetic resonance imaging (MRI) showed an irregularly shaped, inhomogeneous and hypointense lesion of the right liver lobe (6 x 8 cm in segment 7 and 8) with multiple satellite lesions. Irregular shape, hypovascular presentation during gadolinium enhancement, hypointensity in T 1-weighted images and dilation of peripheral bile ducts were suggestive for cholangiocarcinoma or metastasis. However, histological investigations revealed a rare case of primary actinomycosis of the liver which was successfully treated with antibiotics. PMID:19809957

  20. Incidental finding of silent appendicitis on (18)F-FDG PET/CT in a patient with small cell lung adenocarcinoma.

    PubMed

    Bourgeois, Sophie; Van Den Berghe, Ivo; De Geeter, Frank

    2016-01-01

    We report the incidental diagnosis of acute asymptomatic appendicitis on a fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography ((18)F-FDG PET/CT) performed for staging of a non small cell lung carcinoma. The patient was asymptomatic and laboratory tests were normal. The case illustrates: a) the possibility to diagnose appendicitis on (18)F-FDG PET/CT and b) the possibility of silent acute appendicitis, although this is a rare occurrence. PMID:27331212

  1. Retropharyngeal calcific tendinitis mimicking a retropharyngeal phlegmon.

    PubMed

    Gabra, Nathalie; Belair, Manon; Ayad, Tareck

    2013-01-01

    Background. Acute retropharyngeal tendinitis is a little known but not an uncommon condition. It was first described by Hartley in 1964 as an inflammation of the longus colli muscle secondary to calcium crystals deposition on its insertion. The calcifications are mostly located on the oblique portion of the muscle at the level of C1-C2. Methods. We will describe this disease through 4 cases that presented in our institution. Results. The most common symptoms are severe neck pain, odynophagia, and a painful restriction of neck movement. It is associated with mild fever and inflammatory lab findings such as a slight elevation of white blood cell count, erythrocyte sedimentation rate, and C-reactive protein. CT scan is recommended as the first-line imaging modality to establish a diagnosis. Treatments consist of NSAIDs and analgesics to accelerate the healing process. If symptoms are severe, a course of corticosteroids is required. Conclusion. Since the clinical and laboratory findings of this condition and those of a retropharyngeal abscess overlap, it is important to establish the right diagnosis in order to prevent more invasive procedures. A good knowledge of this clinical entity by otolaryngologists would prevent delays in hospital discharge and unnecessary anxiety. PMID:23862089

  2. Retropharyngeal Calcific Tendinitis Mimicking a Retropharyngeal Phlegmon

    PubMed Central

    Belair, Manon; Ayad, Tareck

    2013-01-01

    Background. Acute retropharyngeal tendinitis is a little known but not an uncommon condition. It was first described by Hartley in 1964 as an inflammation of the longus colli muscle secondary to calcium crystals deposition on its insertion. The calcifications are mostly located on the oblique portion of the muscle at the level of C1-C2. Methods. We will describe this disease through 4 cases that presented in our institution. Results. The most common symptoms are severe neck pain, odynophagia, and a painful restriction of neck movement. It is associated with mild fever and inflammatory lab findings such as a slight elevation of white blood cell count, erythrocyte sedimentation rate, and C-reactive protein. CT scan is recommended as the first-line imaging modality to establish a diagnosis. Treatments consist of NSAIDs and analgesics to accelerate the healing process. If symptoms are severe, a course of corticosteroids is required. Conclusion. Since the clinical and laboratory findings of this condition and those of a retropharyngeal abscess overlap, it is important to establish the right diagnosis in order to prevent more invasive procedures. A good knowledge of this clinical entity by otolaryngologists would prevent delays in hospital discharge and unnecessary anxiety. PMID:23862089

  3. Bladder Endometriosis Mimicking TCC - A Case Report.

    PubMed

    Gupta, Asish; Bhatnagar, Atul; Seth, B N; Dang, Arbinder; Gupta, Vineeta

    2016-02-01

    Endometriosis is the ectopic presence of endometrial tissue outside the uterus. Though on its own endometriosis is not a rare lesion, the involvement of the urinary tract is rare but with the bladder being the most commonly affected organ. Endometriosis is usually seen in females between the ages of 30-40 years and may occur due to fluctuating levels of oestrogen and progesterone. Clinically the patient maybe asymptomatic or show symptoms of dysmenorrhea, irregular or heavy periods, pain in the pelvic area, lower abdomen or in the back. It has been suggested that ultrasonography should be done either before or during menstruation as the lesion becomes more evident and a biopsy taken during this period is a strong aid in reaching a final diagnosis. We report here an unusual case of bladder endometriosis where the patient came with severe pelvic pain and an endoluminal mass seen on the ultrasonographic report. Based on these findings a differential of transitional cell carcinoma was given which was ruled out based on the cystoscopic findings. PMID:27042525

  4. Inherited Pain

    PubMed Central

    Eberhardt, Mirjam; Nakajima, Julika; Klinger, Alexandra B.; Neacsu, Cristian; Hühne, Kathrin; O'Reilly, Andrias O.; Kist, Andreas M.; Lampe, Anne K.; Fischer, Kerstin; Gibson, Jane; Nau, Carla; Winterpacht, Andreas; Lampert, Angelika

    2014-01-01

    Inherited erythromelalgia (IEM) causes debilitating episodic neuropathic pain characterized by burning in the extremities. Inherited “paroxysmal extreme pain disorder” (PEPD) differs in its clinical picture and affects proximal body areas like the rectal, ocular, or jaw regions. Both pain syndromes have been linked to mutations in the voltage-gated sodium channel Nav1.7. Electrophysiological characterization shows that IEM-causing mutations generally enhance activation, whereas mutations leading to PEPD alter fast inactivation. Previously, an A1632E mutation of a patient with overlapping symptoms of IEM and PEPD was reported (Estacion, M., Dib-Hajj, S. D., Benke, P. J., Te Morsche, R. H., Eastman, E. M., Macala, L. J., Drenth, J. P., and Waxman, S. G. (2008) NaV1.7 Gain-of-function mutations as a continuum. A1632E displays physiological changes associated with erythromelalgia and paroxysmal extreme pain disorder mutations and produces symptoms of both disorders. J. Neurosci. 28, 11079–11088), displaying a shift of both activation and fast inactivation. Here, we characterize a new mutation of Nav1.7, A1632T, found in a patient suffering from IEM. Although transfection of A1632T in sensory neurons resulted in hyperexcitability and spontaneous firing of dorsal root ganglia (DRG) neurons, whole-cell patch clamp of transfected HEK cells revealed that Nav1.7 activation was unaltered by the A1632T mutation but that steady-state fast inactivation was shifted to more depolarized potentials. This is a characteristic normally attributed to PEPD-causing mutations. In contrast to the IEM/PEPD crossover mutation A1632E, A1632T failed to slow current decay (i.e. open-state inactivation) and did not increase resurgent currents, which have been suggested to contribute to high-frequency firing in physiological and pathological conditions. Reduced fast inactivation without increased resurgent currents induces symptoms of IEM, not PEPD, in the new Nav1.7 mutation, A1632T

  5. Central Neuropathic Pain Syndromes.

    PubMed

    Watson, James C; Sandroni, Paola

    2016-03-01

    Chronic pain is common in patients with neurologic complications of a central nervous system insult such as stroke. The pain is most commonly musculoskeletal or related to obligatory overuse of neurologically unaffected limbs. However, neuropathic pain can result directly from the central nervous system injury. Impaired sensory discrimination can make it challenging to differentiate central neuropathic pain from other pain types or spasticity. Central neuropathic pain may also begin months to years after the injury, further obscuring recognition of its association with a past neurologic injury. This review focuses on unique clinical features that help distinguish central neuropathic pain. The most common clinical central pain syndromes-central poststroke pain, multiple sclerosis-related pain, and spinal cord injury-related pain-are reviewed in detail. Recent progress in understanding of the pathogenesis of central neuropathic pain is reviewed, and pharmacological, surgical, and neuromodulatory treatments of this notoriously difficult to treat pain syndrome are discussed. PMID:26944242

  6. Descending pain modulation and chronification of pain

    PubMed Central

    Ossipov, Michael H.; Morimura, Kozo; Porreca, Frank

    2015-01-01

    Purpose of review Chronic pain is an important public health problem that negatively impacts quality of life of affected individuals and exacts an enormous socio-economic cost. Currently available therapeutics provide inadequate management of pain in many patients. Acute pain states generally resolve in most patients. However, for reasons that are poorly understood, in some individuals, acute pain can transform to a chronic state. Our understanding of the risk factors that underlie the development of chronic pain is limited. Recent studies have suggested an important contribution of dysfunction in descending pain modulatory circuits to pain ‘chronification’. Human studies provide insights into possible endogenous and exogenous factors that may promote the conversion of pain into a chronic condition. Recent findings Descending pain modulatory systems have been studied and characterized in animal models. Human brain imaging techniques, deep brain stimulation and the mechanisms of action of drugs that are effective in the treatment of pain confirm the clinical relevance of top-down pain modulatory circuits. Growing evidence supports the concept that chronic pain is associated with a dysregulation in descending pain modulation. Disruption of the balance of descending modulatory circuits to favour facilitation may promote and maintain chronic pain. Recent findings suggest that diminished descending inhibition is likely to be an important element in determining whether pain may become chronic. This view is consistent with the clinical success of drugs that enhance spinal noradrenergic activity, such as serotonin/norepinephrine reuptake inhibitors (SNRIs), in the treatment of chronic pain states. Consistent with this concept, a robust descending inhibitory system may be normally engaged to protect against the development of chronic pain. Imaging studies show that higher cortical and subcortical centres that govern emotional, motivational and cognitive processes

  7. Low Back Pain

    MedlinePlus

    ... Low Back Pain Overview What is low back pain? Low back pain is a common problem for many people. It can be caused by many ... lift and exercise correctly. Symptoms When is low back pain serious? Call your family doctor if: Pain goes ...

  8. Regional soft tissue pains: alias myofascial pain?

    PubMed

    Tunks, E; Crook, J

    1999-06-01

    This chapter deals with four main questions: what is the evidence that 'myofascial pain' syndromes exist?; what is the evidence that the myofascial pain concept is clinically useful?; what is the evidence that managing patients in terms of the myofascial pain diagnosis confers benefits?; and what is the evidence-based management of myofascial pain? The purpose of a diagnosis is to provide boundaries around subgroups of illness in a population since each subgroup presumably has a different mechanism, natural history, prognosis, course and response to treatment. The current literature is divided in its conceptual approach to the problem of regional musculoskeletal pain. Some authors regard myofascial pain as being distinct from regional musculoskeletal pain while others regard these as synonymous. A postulated theory of the pathophysiology of myofascial pain is discussed. This contrasts with a view that regional myofascial pain represents a non-specific localized pain arising from multiple regional, systemic and psychosocial factors. In order to consider myofascial pain as a distinct diagnosis, it would be necessary to resolve reliability issues in the identification of its critical diagnostic features. Beyond reliability issues, there are also problems of sensitivity and specificity--i.e. of the patient population that it identifies--which must be resolved if controlled trials are to be conducted. The clinical usefulness of the myofascial pain diagnosis is considered with regard to what is believed about the course of healing, the determinants of disability, the course of regional versus widespread musculoskeletal pain, the relationship of musculoskeletal injury to pain, and the evidence-based management of musculoskeletal pain. An epidemiological perspective is proposed with regard to regional musculoskeletal pain. This allows for the identification of operationally defined strata of regional musculoskeletal pain and permits studies in course, prognosis and

  9. Late onset spondyloarthropathy mimicking polymyalgia rheumatica.

    PubMed

    Aydeniz, Ali; Altındağ, Ozlem; Oğüt, Evrim; Gürsoy, Savaş

    2012-05-01

    We report a 55-year-old woman with late onset spondyloarthropathy who had widespread body pain and pitting oedema of both ankles. She had been followed up for polymyalgia rheumatica for nearly 10 years. On laboratory examination, ESR: 62 mm/h and CRP: 16.1 mg/dl. HLA was positive. There was tenderness on both of her ankles. We diagnosed late onset spondyloarthropathy according to clinic and radiographic findings. The patient was treated with sulphasalazine 200 mg/day and indomethacin 100 mg/day. As a conclusion, LoSPA may mimic a variety of rheumatic conditions such as PMR and reflex sympathetic dystrophy syndrome. Careful examination should be warranted in such conditions. PMID:20237931

  10. Case 219: Pelvic Actinomycosis Mimicking Malignant Tumor.

    PubMed

    Morland, David; Hassler, Stéphanie

    2015-07-01

    A 53-year-old woman presented with a 3-month history of left inguinocrural and lumbar pain and anorexia with weight loss. No fever was reported. The patient had no prior pelvic surgery. Physical examination revealed a palpable nontender mass in the left groin area. There was no bloody or purulent discharge. Laboratory findings revealed inflammation with an increased C-reactive protein level (127 mg/L [1209 nmol/L]), leukocytosis (13 800/mm(3)), and microcytic anemia (hemoglobin level, 7.2 g/dL). Computed tomography (CT), fluorine 18 ((18)F) fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT, and magnetic resonance (MR) imaging were performed. PMID:26101924

  11. Lipomatosis coli, a mimicker of familial polyposis.

    PubMed

    Zarrin-Khameh, Neda; Haas, Eric M; Ro, Jae; Thrall, Michael J

    2013-04-01

    Multiple intestinal lipomas (lipomatous polyposis) are quite rare, and they can be quite challenging to diagnose because this condition may be clinically confused with familial adenomatous polyposis with a suggestive family history. Herein, we present a case of lipomatous polyposis that was presented with abdominal pain and, in colonoscopy, had more than 100 polyps. The patient was admitted for surgery with diagnosis of familial polyposis. Resected colon specimen had multiple polyps ranging from 0.1 to 1.5 cm. Microscopically, the polyps were composed of mature adipose tissue with normal overlying mucosa. There were also increased fat cells in the submucosa of the colon adjacent to the polyps. Lipomatous polyposis rarely occurs and can be confused with familial polyposis. Polypectomy is a simple and cost-effective procedure to help in diagnosis and prevent a major surgery. PMID:22056034

  12. Lumbar Epidural Varix Mimicking Disc Herniation

    PubMed Central

    Bursalı, Adem; Guvenal, Ahmet Burak; Yaman, Onur

    2016-01-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4–5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method. PMID:27446525

  13. Lumbar Epidural Varix Mimicking Disc Herniation.

    PubMed

    Bursalı, Adem; Akyoldas, Goktug; Guvenal, Ahmet Burak; Yaman, Onur

    2016-07-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4-5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method. PMID:27446525

  14. Ocular surface foreign bodies: novel findings mimicking ocular malignant melanoma

    PubMed Central

    Maudgil, A; Wagner, B E; Rundle, P; Rennie, I G; Mudhar, H S

    2014-01-01

    Purpose Malignant melanoma of the eye is an uncommon condition that is important to recognise. We describe three cases in which ocular foreign bodies have masqueraded as ocular malignant melanoma. Methods Interventional case reports. Results Case 1 describes diathermy-induced carbon particle implantation, during plaque therapy for the treatment of uveal melanoma, mimicking recurrence with extra-scleral invasion. Case 2 shows a foreign body called ‘mullite' mimicking conjunctival melanoma. Case 3 demonstrates a conjunctival foreign body called ‘illite' that mimicked a limbal melanocytic lesion, clinically thought to be either melanocytoma or melanoma. Conclusion This report highlights the importance of careful history taking, examination, and appropriate biopsy in cases of suspected malignant melanoma, to prevent unnecessary and potentially radical treatment. PMID:25104745

  15. Spontaneous Bacterial Peritonitis due to Actinomyces Mimicking a Perforation of the Proximal Jejunum

    PubMed Central

    Eenhuis, Louise L.; de Lange, Marleen E.; Samson, Anda D.; Busch, Olivier R.C.

    2016-01-01

    Patient: Female, 42 Final Diagnosis: Spontaneous pelvic-abdominal peritonitis due to actinomyces Symptoms: Abdominal distension • abdominal pain • acute abdomen • fever • intermenstrual bleeding • nausea • sepsis • septic shock Medication: — Clinical Procedure: — Specialty: Surgery Objective: Unusual clinical course Background: Pelvic-abdominal actinomycosis is a rare chronic condition caused by an anaerobic, gram-negative rod-shaped commensal bacterium of the Actinomyces species. When Actinomyces becomes pathogenic, it frequently causes a chronic infection with granulomatous abscess formation with pus. Due to diversity in clinical and radiological presentation, actinomycosis can easily be mistaken for several other conditions. Peritonitis without preceding abscess formation caused by Actinomyces species has been described in only few cases before in literature. Case report: We report a case of spontaneous pelvic-abdominal peritonitis with presence of pneumoperitoneum and absence of preceding abscesses due to acute actinomycosis mimicking a perforation of the proximal jejunum in a 42-year-old female with an intra-uterine contraceptive device in place. Explorative laparotomy revealed 2 liters of odorless pus but no etiological explanation for the peritonitis. The intra-uterine contraceptive device was removed. Cultivation showed growth of Actinomyces turicensis. The patient was successfully treated with penicillin. Conclusions: In the case of primary bacterial peritonitis or lower abdominal pain without focus in a patient with an intrauterine device in situ, Actinomyces should be considered as a pathogen. PMID:27561364

  16. What Is Back Pain?

    MedlinePlus

    ... Back Pain Find a Clinical Trial Journal Articles Back Pain PDF Version Size: 127 KB Audio Version Time: ... Size: 12.5 MB November 2014 What Is Back Pain? Fast Facts: An Easy-to-Read Series of ...

  17. Central Pain Syndrome

    MedlinePlus

    ... intolerable bursts of sharp pain similar to the pain caused by a dental probe on an exposed nerve. Individuals may have numbness in the areas affected by the pain. The burning and loss of touch sensations are ...

  18. Low Back Pain

    MedlinePlus

    ... focuses on their pain as well as their perception of its severity. Pain that becomes chronic also ... that stimulating the nervous system can modify the perception of pain. Early studies of TENS suggested that ...

  19. Pain: Hope through Research

    MedlinePlus

    ... illness, our very lives. Pain is a complex perception that differs enormously among individual patients, even those ... that the two peptides are involved in the perception of pain sensations, especially moderate-to-severe pain. ...

  20. Complex regional pain syndrome

    MedlinePlus

    Complex regional pain syndrome (CRPS) is a chronic pain condition that can affect any area of the ... Bailey A, Audette JF. Complex regional pain syndrome. In: Frontera ... of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, ...

  1. Medications for back pain

    MedlinePlus

    ... help with your back pain. OVER-THE-COUNTER PAIN RELIEVERS Over-the-counter means you can buy them ... and tell your provider. If you are taking pain relievers for more than a week, tell your provider. ...

  2. Palliative care - managing pain

    MedlinePlus

    End of life - pain management; Hospice - pain management ... Bookbinder M, McHugh ME. Symptom management in palliative care and end of life care. Nurs Clin North Am . 2010;45:271-327. Mercadente S. Challenging pain problems. In: ...

  3. Pain medications - narcotics

    MedlinePlus

    Painkillers; Drugs for pain; Analgesics; Opioids ... Narcotics are also called opioid pain relievers. They are used only for pain that is severe and is not helped by other types of painkillers. When used ...

  4. Munchausen syndrome mimicking psychiatric disease with concomitant genuine physical illness

    PubMed Central

    Almeida, Jaime; da Silva, Joaquim Alves; Xavier, Miguel; Gusmão, Ricardo

    2010-01-01

    Munchausen syndrome is a disorder in which patients intentionally produce symptoms mimicking physical or psychiatric illnesses with the aim to assume the sick role and to gain medical attention. Once a patient receives a Munchausen syndrome diagnosis every complaint made thence tends to be regarded with scepticism by clinical staff. However, it is possible that a bona fide illness, which might be disregarded, may coexist in these patients. We report a case of MS mimicking psychiatric disease with concomitant genuine acute physical illness. Despite the initial doubts about the veracity of the latter, due to its prompt recognition, treatment was successful. PMID:22798096

  5. 'Hip' pain.

    PubMed

    Zacher, Josef; Gursche, Angelika

    2003-02-01

    'Hip' pain is usually located in the groin, upper thigh or buttock and is a common complaint. Slipped capital femoral epiphysis, avascular femoral head necrosis and apophyseal avulsion are the most common diagnoses in childhood and adolescents. Strains and fractures are common in sport-active adults. Osteoarthritis occurs in middle-aged and older adults. Trauma may result in femoral head fracture or typical muscle and tendon sprains and bursitis. Septic or inflammatory arthritis can occur at every age. Septic arthritis, fractures and acute epiphyseal slipping are real emergency cases. Congenital dysplasia of the hip joint may lead to labral tears and early osteoarthritis. The most important hip problems in children, adolescents, adult and older people are discussed; these problems originate from intra-articular disorders and the surrounding extra-articular soft tissues. Medical history, clinical examination and additional tests, including imaging, will be demonstrated. Principles of treatment are given for specific disorders. PMID:12659822

  6. Dental (Odontogenic) Pain

    PubMed Central

    Renton, Tara

    2011-01-01

    This article provides a simple overview of acute trigeminal pain for the non dentist. This article does not cover oral mucosal diseases (vesiculobullous disorders) that may cause acute pain. Dental pain is the most common in this group and it can present in several different ways. Of particular interest for is that dental pain can mimic both trigeminal neuralgia and other chronic trigeminal pain disorders. It is crucial to exclude these disorders whilst managing patients with chronic trigeminal pain. PMID:26527224

  7. Propulsion efficiency of bodies appended with multiple flapping fins: When more is less

    NASA Astrophysics Data System (ADS)

    Bandyopadhyay, Promode R.; Leinhos, Henry A.

    2013-04-01

    Underwater animals propel themselves by flapping their pectoral and caudal fins in a narrow range of frequencies, given by Strouhal number St, to produce transitional vortex jets (St is generally expressed non-dimensionally as the product of flapping frequency and stroke (arc) length divided by forward speed). The organized nature of the selection of St and of the vortex jet is thought to maximize hydrodynamic efficiency, although the exact mechanism is not known. Our recent Stuart-Landau equation models, which have self-regulation properties, indicate that the fin and its jet vortices couple. Temporal maps of forces in single isolated fins show a bimodal behavior in certain ranges of the transitional Reynolds number; this behavior bears resemblance to neural bifurcation properties that owe their origin to the self-regulation mechanism. In view of our theoretical and biorobotic evidence of self-regulation in single flapping fins, we explore if this property is altered in a fin-appended body, the goal being to understand how the narrow selection of St, self-regulation, and maximization of hydrodynamic efficiency are related. Swimming vehicles of 1-m scale have been built where a rigid cylindrical body is appended with six flapping fins, three at each end. The fins are rigid, have a rounded leading edge and a laminar section (NACA 0012), and are hinged at one end. The planform is an abstracted version of the penguin wing; it has low aspect ratio and a chord Reynolds number that varies in the transitional range from 10 000 to 60 000. The fin geometry, Reynolds number range, and the nonflexible nature of the main body are in common with those in penguins, and the length and displacement volume are similar to those of sharks. The maximum hydrodynamic efficiency of the fin-appended body (0.40) is lower than that of the single fin (0.57), but is close to that of a fish using several fins. The propulsion density (kW/m3 of displacement volume) of the fin-appended cylinder

  8. Orofacial pain: a primer.

    PubMed

    De Rossi, Scott S

    2013-07-01

    Orofacial pain refers to pain associated with the soft and hard tissues of the head, face, and neck. It is a common experience in the population that has profound sociologic effects and impact on quality of life. New scientific evidence is constantly providing insight into the cause and pathophysiology of orofacial pain including temporomandibular disorders, cranial neuralgias, persistent idiopathic facial pains, headache, and dental pain. An evidence-based approach to the management of orofacial pain is imperative for the general clinician. This article reviews the basics of pain epidemiology and neurophysiology and sets the stage for in-depth discussions of various painful conditions of the head and neck. PMID:23809298

  9. Single-Port Laparoscopic Interval Appendectomy for Perforated Appendicitis With a Periappendiceal Abscess

    PubMed Central

    Bae, Sung Uk; Jeong, Woon Kyung

    2016-01-01

    Purpose Nonoperative management followed by an interval appendectomy is a commonly used approach for treating patients with perforated appendicitis with abscess formation. As minimally-invasive surgery has developed, single-port laparoscopic surgery (SPLS) is increasingly being used to treat many conditions. We report our initial experience with this procedure using a multichannel single-port. Methods The study included 25 adults who underwent a single-port laparoscopic interval appendectomy for perforated appendicitis with periappendiceal abscess by using a single-port with or without needlescopic grasper between June 2014 and January 2016. Results Of the 25 patients, 9 (36%) required percutaneous drainage for a median of 7 days (5–14 days) after insertion, and 3 (12%) required conversion to reduced-port laparoscopic surgery with a 5-mm port insertion because of severe adhesions to adjacent organs. Of 22 patients undergoing SPLS, 13 underwent pure SPLS (52.0%) whereas 9 patients underwent SPLS with a 2-mm needle instrument (36.0%). Median operation time was 70 minutes (30–155 minutes), and a drainage tube was placed in 9 patients (36.0%). Median total length of incision was 2.5 cm (2.0–3.0 cm), and median time to soft diet initiation and length of stay in the hospital were 2 days (0–5 days) and 3 days (1–7 days), respectively. Two patients (8.0%) developed postoperative complications: 1 wound site bleeding and 1 surgical site infection. Conclusion Conservative management followed by a single-port laparoscopic interval appendectomy using a multichannel single-port appears feasible and safe for treating patients with acute perforated appendicitis with periappendiceal abscess. PMID:27437392

  10. Differential diagnosis of pain around the hip joint.

    PubMed

    Tibor, Lisa M; Sekiya, Jon K

    2008-12-01

    The differential diagnosis of hip pain is broad and includes intra-articular pathology, extra-articular pathology, and mimickers, including the joints of the pelvic ring. With the current advancements in hip arthroscopy, more patients are being evaluated for hip pain. In recent years, our understanding of the functional anatomy around the hip has improved. In addition, because of advancements in magnetic resonance imaging, the diagnosis of soft tissue causes of hip pain has improved. All of these advances have broadened the differential diagnosis of pain around the hip joint and improved the treatment of these problems. In this review, we discuss the causes of intra-articular hip pain that can be addressed arthroscopically: labral tears, loose bodies, femoroacetabular impingement, capsular laxity, tears of the ligamentum teres, and chondral damage. Extra-articular diagnoses that can be managed arthroscopically are also discussed, including: iliopsoas tendonitis, "internal" snapping hip, "external" snapping hip, iliotibial band and greater trochanteric bursitis, and gluteal tendon injury. Finally, we discuss extra-articular causes of hip pain that are often managed nonoperatively or in an open fashion: femoral neck stress fracture, adductor strain, piriformis syndrome, sacroiliac joint pain, athletic pubalgia, "sports hernia," "Gilmore's groin," and osteitis pubis. PMID:19038713

  11. A murine model of appendicitis and the impact of inflammation on appendiceal lymphocyte constituents

    PubMed Central

    Watson Ng, W S; Hampartzoumian, T; Lloyd, A R; Grimm, M C

    2007-01-01

    Data indicate that appendicectomy for intra-abdominal inflammation protects against inflammatory bowel disease (IBD). This suggests an important role for the appendix in mucosal immunity. There is no established model of appendicitis. We therefore developed a murine model of appendicitis and examined the effect of inflammation on appendiceal lymphocyte constituents. The caecal patch of specific pathogen-free (SPF)-Balb/c mice was transformed into an obstructed ‘appendiceal pouch’ by standardized suction and band ligation. Mice were killed and ‘pouches’ removed for histology and phenotypic analysis of leucocytes by flow cytometry. Serum C-reactive protein (CRP) was determined by enzyme-linked immunosorbent assay. All ‘pouches’ developed features resembling human appendicitis – mucosal ulceration, transmural inflammation with neutrophils, lymphocytes and occasional eosinophils, and serositis. These changes were most evident between days 7 and 10. There was significant elevation of serum CRP (8·0 ± 0·3 ng/ml to 40·0 ± 3·1 ng/ml; P < 0·01), indicating systemic inflammation. Following the initial neutrophil-predominant response, there was an increase in CD4− (15·3% ± 1·2% to 31·0 ± 2·0%; P < 0·01) and CD8− T lymphocytes (3·7% ± 0·6% to 9·2 ± 0·8%; P < 0·01). CD25− forkhead box P3 (FoxP3)− regulatory T lymphocytes were increased by 66% (P < 0·01). Furthermore, significant increases in CD8− FoxP3− regulatory T lymphocytes were restricted to younger mice (age < 10 weeks, P < 0·003). This is the first description of a murine model of appendicitis. Inflammation resulted in T lymphocyte accumulation associated with an increase in regulatory T lymphocytes, which might explain the age-dependent protective phenomenon. Further exploration will provide insights into the mechanisms of intestinal immune homeostasis and the immunopathogenesis of IBD. PMID:17680826

  12. Laparoscopy-Assisted Single-Port Appendectomy in Children: Safe Alternative also for Perforated Appendicitis?

    PubMed

    Sesia, Sergio B; Berger, Eliane; Holland-Cunz, Stefan; Mayr, Johannes; Häcker, Frank-Martin

    2015-12-01

    Because of its low complication rate, favorable safety, cost-effectiveness, and technical ease, mono-instrumental, laparoscopy-assisted single-port appendectomy (SPA) has been the standard therapy for appendicitis in our department since its introduction 10 years ago. We report our experience with this technique and compare its outcome to open appendectomy (OA). The records of all children who underwent appendectomy at our institution over a period of 8 years were analyzed retrospectively. Patient baseline data, markers of inflammation, operative time, length of hospital stay, complication rate according to the classification of Clavien-Dindo, and histologic grading were assessed to compare the 2 surgical techniques (SPA and OA). The chi square test, the Student's t test and the Wilcoxon-Mann-Whitney test were used to analyze the data and the comparisons of the mean values. A P value < 0.05 was considered significant. Overall, 975 patients were included in the study. A total of 555 children had undergone SPA and 420 had been treated by OA. Median operative time of SPA was longer than that of OA (60.8  min vs 57.4  min; P < 0.05). Length of hospital stay after SPA was shorter than after OA (4.4 days and 5.9 days, respectively; P < 0.001). The overall complication rate was lower for SPA than that for OA (4.0% vs 5.7%), but the difference of complications for SPA and OA was not statistically significant (P < 0.22). SPA was successfully performed in 85.9% of children. In 53.8% of patients with perforated appendicitis, no conversion was required. In the group of children with perforated appendicitis, the complication rate of ∼20% was independent of the surgical technique applied. With respect to operative time, length of hospital stay, and postoperative complication rate, SPA is not inferior to OA. SPA is safe and efficient, even in the management of perforated appendicitis. PMID:26683962

  13. [The prevention and treatment of suppurative-septic complications in patients with acute appendicitis].

    PubMed

    Korotkiĭ, V N; Geleskul, V F; Kolosovich, I V; Butyrin, S A

    1993-01-01

    In the experiment on mongrel dogs, the absorption of indigo carmine dye after its retroperitoneal administration with 10% dimexide solution into the lymphatic and venous systems was studied. More rapid delivery of a dye into the portal system, including the cases with portal hypertension, and into the lymphatic system was established. A method for retroperitoneal administration of antibiotics with 10% dimexide solution for prevention and treatment of purulent-septic complications in patients with acute appendicitis has been developed. The method was used in 120 patients, the result of treatment is good. PMID:10912051

  14. Acute appendicitis presenting as thigh abscess in a child: a case report.

    PubMed

    Sharma, S B; Gupta, Vipul; Sharma, S C

    2005-04-01

    A case of retrocecal appendicitis is described in a 6-year-old male child who presented with thigh abscess. The presence of a positive psoas stretch test, feculent discharge, an enteric growth on bacteriological examination, and intraabdominal fluid collection on abdominal ultrasound provided clues to the presence of an intraabdominal source of sepsis. Laparotomy revealed a perforated retrocecal appendix with surrounding collection communicating into the thigh. Appendectomy with drainage of retroperitoneal and thigh collections under adequate antibiotic coverage resulted in a satisfactory recovery. We describe our experience with the present case and discuss the pertinent literature. PMID:15756560

  15. Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient.

    PubMed

    Forster, Michael-J; Akoh, Jacob-A

    2008-03-21

    Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons. Sometimes too much reliance is put on investigations that can lead to a misdiagnosis. This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase, which led to an assumed diagnosis of pancreatitis. She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis, with no evidence of pancreatitis. Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen. PMID:18350613

  16. Randomized, prospective, and double-blind trial of new beta-lactams in the treatment of appendicitis.

    PubMed Central

    Lau, W Y; Fan, S T; Chu, K W; Suen, H C; Yiu, T F; Wong, K K

    1985-01-01

    A prospective, randomized, and double-blind study was conducted with 864 patients operated on for appendicitis. In early cases, including normal and acute appendicitis, one dose of antibiotic was given. The rate of postappendectomy septic complications in patients who received cefotaxime, cefoperazone, or moxalactam was very low (about 3%), and there was no statistical difference between the drugs. For late cases, including gangrenous and perforated appendicitis, the antibiotics were continued for 5 days. Moxalactam decreased significantly the septic complications in these patients when compared with the other two drugs. It is safe, free from serious toxic side effects, and more convenient and easier to administer than combination antibiotic therapy. The main disadvantage of moxalactam is its high cost, but this has to be balanced against the savings in nursing time, the cost of monitoring renal function and serum level when aminoglycosides are used, and the reduced usage and manipulation of infusion sets. PMID:3911877

  17. Evaluation of procalcitonin as a biomarker of diagnosis, severity and postoperative complications in adult patients with acute appendicitis

    PubMed Central

    Vaziri, Mohammad; Ehsanipour, Fahimeh; Pazouki, Abdolreza; Tamannaie, Zeinab; Taghavi, Roohollah; Pishgahroudsari, Mohaddese; Jesmi, Fatemeh; Chaichian, Shahla

    2014-01-01

    Background: Delay in diagnosis and treatment of acute appendicitis (AA) results in an increased rate of perforation, postoperative morbidity, mortality and hospital length of stay. Several biochemical parameters including white blood cell (WBC) count, C-reactive protein (CRP), interleukin-6 (IL6) and Procalcitonin (PCT) have been used to further improve the clinical diagnosis of AA. The aim of this study was to assess the value of procalcitonin as a predictor of diagnosis and severity of appendicitis in order to improve the clinical decision making, since other studies have been unable to demonstrate a diagnostic value for PCT elevation in acute appendicitis. Methods: One-hundred patients who underwent open appendectomy, including 75 men and 25 women with a mean age of 28 years were included in this study. Procalcitonin values were measured by an immunofluorescent method). Serum PCT>0.5 ng/ml was considered positive. The PCT serum values were measured in four different categories, including ˂0.5ng/ml, 0.5-2 ng/ml, 2-10ng/ml and more than 10ng/ml. Results: The sensitivity and specificity of PCT level measurement for acute appendicitis diagnosis were 44% and 100% respectively. The value of PCT increased with the severity of appendicitis and also with the presence of peritonitis and infection, at the site of surgery. Conclusions: Procalcitonin measurement cannot be used as a diagnostic test for adult patients with acute appendicitis and its routine use in such patients is not cost effective and conclusive. Procalcitonin values can be used as a prognostic marker and predictor of infectious complications following surgery and it can help to carry out timely surgical intervention which is highly recommended in patients with PCT values more than 0.5ng/ml. PMID:25405116

  18. A Feasibility Study of Real-Time Remote CT Reading for Suspected Acute Appendicitis Using an iPhone.

    PubMed

    Kim, Changsun; Kang, Bossng; Choi, Hyuk Joong; Park, Joon Bum

    2015-08-01

    We aimed to evaluate the feasibility of an iPhone-based remote control system as a real-time remote computed tomography (CT) reading tool for suspected appendicitis using a third-generation (3G) network under suboptimal illumination. One hundred twenty abdominal CT scans were selected; 60 had no signs of appendicitis, whereas the remaining 60 had signs of appendicitis. The 16 raters reviewed the images using the liquid crystal display (LCD) monitor of a picture archiving and communication system (PACS) workstation, as well as using an iPhone connected to the PACS workstation via a remote control system. We graded the probability of the presence of acute appendicitis for each examination using a five-point Likert scale. The overall sensitivity and specificity for the diagnosis of suspected appendicitis using the iPhone and the LCD monitor were high, and they were not significantly different (sensitivity P = 1.00, specificity P = 0.14). The average areas under the receiver operating characteristic curves for all CT readings with the iPhone and LCD monitor were 0.978 (confidence interval 0.965-0.991) and 0.974 (0.960-0.988), respectively, and the two devices did not have significantly different diagnostic performances (P = 0.55). The inter-rater agreement for both devices was very good; the kappa value for the iPhone was 0.809 (0.793-0.826), and that for the LCD monitor was 0.817 (0.801-0.834). Each rater had moderate-to-very good intra-observer agreement between the two devices. We verified the feasibility of an iPhone-based remote control system as a real-time remote CT reading tool for identifying suspected appendicitis using a 3G network and suboptimal illumination. PMID:25700617

  19. Cutaneous lymphoid hyperplasia mimicking cutaneous lymphoma in a hyperthyroid cat

    PubMed Central

    Snead, Elisabeth; Kerr, Moira; MacDonald, Valerie

    2013-01-01

    A 12-year-old neutered male domestic shorthair cat presented for chronic, localized, swelling and crusting of the left upper lip, weight loss, sporadic vomiting, and focal alopecia between the scapulae was diagnosed with hyperthyroidism and regional eosinophilic lymphadenitis. Treatment with methimazole exacerbated an underlying hypersensitivity disorder leading to marked generalized lymphadenopathy that histologically mimicked lymphoma. PMID:24155419

  20. Diffuse Large B Cell Lymphoma Mimicking Granulomatosis with Polyangiitis

    PubMed Central

    Horowitz, Netanel; Ben-Itzhak, Ofer; Braun-Moscovici, Yolanda

    2016-01-01

    In a patient with systemic multiorgan disease with overlapping features, the differential diagnosis included infectious diseases, malignancies, and systemic autoimmune or inflammatory diseases. We present an unusual case of a young male with B cell lymphoma who presented with symptoms mimicking systemic vasculitis and review the existing literature. PMID:27293945

  1. Bronchial Aneurysms Mimicking Aortic Aneurysms: Endovascular Treatment in Two Patients

    SciTech Connect

    Vernhet, Helene; Bousquet, Claudine; Jean, Betty; Lesnik, Alvian; Durand, Gerard; Giron, Jacques; Senac, Jean Paul

    1999-05-15

    Bronchial artery dilatation and aneurysm formation is a potential complication of local inflammation, especially in bronchiectasis. When the bronchial artery has an ectopic origin from the inferior segment of the aortic arch, aneurysms may mimick aortic aneurysms. Despite this particular location, endovascular treatment is possible. We report two such aneurysms that were successfully embolized with steel coils.

  2. Mesenteric castleman disease mimicking superior mesenteric artery aneurysm.

    PubMed

    Lee, Ji-Soo; Park, Yang Jin; Kim, Young-Wook

    2015-02-01

    Castleman disease (CD) is known as a lymphoproliferative disorder, which is most commonly located in the mediastinum. CD occurring in the mesentery is very rare. We report a case of CD in the mesentery, which is mimicking a superior mesenteric artery aneurysm on computed tomography image. PMID:25463333

  3. Ectopic decidual reaction mimicking inguinal lymphoma on ultrasound

    PubMed Central

    Prangsgaard, T; Lorentzen, T

    2014-01-01

    Ectopic decidual reaction has been described in various intraperitoneal locations. We present a case of unusual ectopic decidual reaction in the groin mimicking inguinal lymphoma on ultrasound in a pregnant woman. This case contributes evidence illustrating the variability of the clinical presentation of ectopic decidual reaction.

  4. Electrocardiographic artifact due to a mobile phone mimicking ventricular tachycardia.

    PubMed

    Duan, Xu

    2014-01-01

    A case of electrocardiographic artifact due to mobile a phone mimicking ventricular tachycardia was presented. The artifact was discriminated by close scrutiny of ECG and was attributed to a mobile phone because it was simultaneous with mobile phone game. PMID:24581928

  5. Postoperative fungal arteritis mimicking vasospasm--case report.

    PubMed

    Piotrowski, W P; Pilz, P

    1994-05-01

    Intracranial arteritis due to fungal infection is an uncommon complication of neurosurgical operations. A 36-year-old female developed arteritis caused by Aspergillus fumigatus at the site of the temporary clip following the clipping of an initially uncomplicated intracranial aneurysm. The inflammatory, slowly progressing vascular occlusion mimicked the vasospasm common in subarachnoid hemorrhage. PMID:7519756

  6. Left ventricular post-infraction pseudoaneurysm mimicking mitral valve endocarditis

    PubMed Central

    2013-01-01

    In this report we present a patient who was initially diagnosed as suffering from mitral valve endocarditis. The proper use of diagnostic modalities revealed a pseudo aneurysm of the left ventricle which was mimicking mitral valve vegetations. This allowed better planning of the subsequent operation. The optimal preoperative diagnostic studies are discussed along with the proper surgical treatment. PMID:24228621

  7. Left ventricular post-infraction pseudoaneurysm mimicking mitral valve endocarditis.

    PubMed

    Dedeilias, Panagiotis; Koukis, Ioannis; Roussakis, Antonios; Tsipas, Pantelis; Rouska, Effie

    2013-01-01

    In this report we present a patient who was initially diagnosed as suffering from mitral valve endocarditis. The proper use of diagnostic modalities revealed a pseudo aneurysm of the left ventricle which was mimicking mitral valve vegetations. This allowed better planning of the subsequent operation. The optimal preoperative diagnostic studies are discussed along with the proper surgical treatment. PMID:24228621

  8. Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis

    PubMed Central

    2012-01-01

    Background Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis of acute appendicitis is based on careful history, physical examination, laboratory and imaging investigation. The aim of the study is to analyze the role of C-reactive protein (CRP), white blood count (WBC) and Neutrophil percentage (NP) in improving the accuracy of diagnosis of acute appendicitis and to compare it with the intraoperative assessment and histopathology findings. Materials and methods This investigation was a prospective double blinded clinical study. The study was done on 173 patients surgically treated for acute appendicitis. The WBC, NP, and measurement of CRP were randomly collected pre-operatively from all involved patients. Macroscopic assessment was made from the operation. Appendectomy and a histopathology examination were performed on all patients. Gross description was compared with histopathology results and then correlated with CRP, WBC, and NP. Results The observational accuracy was 87,3%, as compared to histopathological accuracy which was 85.5% with a total of 173 patients that were operated on. The histopathology showed 25 (14.5%) patients had normal appendices, and 148 (85.5%) patients had acutely inflamed, gangrenous, or perforated appendicitis. 52% were male and 48% were female, with the age ranging from 5 to 59 with a median of 19.7. The gangrenous type was the most frequent (52.6%). The WBC was altered in 77.5% of the cases, NP in 72.3%, and C-reactive protein in 76.9% cases. In those with positive appendicitis, the CRP and WBC values were elevated in 126 patients (72.8%), whereas NP was higher than 75% in 117 patients (67.6%). Out of 106 patients with triple positive tests, 101 (95.2%) had appendicitis. The sensitivity, specificity, and positive predictive values of the 3 tests in combination were 95.3%, 72.2%, and 95.3%, respectively. Conclusion The raised value of the CRP was directly related to the severity of inflammation (p

  9. [Ultrasonography in acute pelvic pain].

    PubMed

    Kupesić, Sanja; Aksamija, Alenka; Vucić, Niksa; Tripalo, Ana; Kurjak, Asim

    2002-01-01

    Acute pelvic pain may be the manifestation of various gynecologic and non-gynecologic disorders from less alarming rupture of the follicular cyst to life threatening conditions such as rupture of ectopic pregnancy or perforation of inflamed appendix. In order to construct an algorithm for differential diagnosis we divide acute pelvic pain into gynecologic and non-gynecologic etiology, which is than subdivided into gastrointestinal and urinary causes. Appendicitis is the most common surgical emergency and should always be considered in differential diagnosis if appendix has not been removed. Apart of clinical examination and laboratory tests, an ultrasound examination is sensitive up to 90% and specific up to 95% if graded compression technique is used. Still it is user-depended and requires considerable experience in order to perform it reliably. Meckel's diverticulitis, acute terminal ileitis, mesenteric lymphadenitis and functional bowel disease are conditions that should be differentiated from other causes of low abdominal pain by clinical presentation, laboratory and imaging tests. Dilatation of renal pelvis and ureter are typical signs of obstructive uropathy and may be efficiently detected by ultrasound. Additional thinning of renal parenchyma suggests long-term obstructive uropathy. Ruptured ectopic pregnancy, salpingitis and hemorrhagic ovarian cysts are three most commonly diagnosed gynecologic conditions presenting as an acute abdomen. Degenerating leiomyomas and adnexal torsion occur less frequently. For better systematization, gynecologic causes of acute pelvic pain could be divided into conditions with negative pregnancy test and conditions with positive pregnancy test. Pelvic inflammatory disease may be ultrasonically presented with numerous signs such as thickening of the tubal wall, incomplete septa within the dilated tube, demonstration of hyperechoic mural nodules, free fluid in the "cul-de-sac" etc. Color Doppler ultrasound contributes to more

  10. Medications for back pain

    MedlinePlus

    Back pain often goes away on its own over several weeks. In some people, back pain persists. It may not go away completely or ... at times. Medicines can also help with your back pain. OVER-THE-COUNTER PAIN RELIEVERS Over-the-counter ...

  11. Thai perspectives on pain.

    PubMed

    Mongkhonthawornchai, Siriporn; Sangchart, Bumpenchit; Sornboon, Ariya; Chantarasiri, Jongkolnee

    2013-09-01

    This qualitative research aimed to study the meaning, the characteristics, and the dimensions of pain from a Thai point of view. It was conducted under the research project on the development of the quality of pain management for people in the hospital. The subjects were 62 patients, experiencing pain and receiving treatment in 4 hospitals in northeast Thailand. Data were analyzed through content analysis. The findings included: 1) concept from experience of pain, perceived pain as suffering physically and psychologically, 2) different characteristics between acute and chronic pain, 3) four levels of pain intensity: mild, moderate, high and severe, 4) pain effects on four dimensions: physical, psychological, behavioral and societal (family-social-economy), 5) two factors related to pain: alleviating factor and predisposing factor, and 6) pain management relies on beliefs, culture and religion i.e. good deeds in Buddhism affected six dimensions: physical, psychological, social, spiritual, treatment seeking and asking health personnel for help. The results of the present study revealed the influence of culture beliefs on the meaning of pain, pain characteristics, and the effects of pain as well as pain management in terms of cultural contexts. The findings may be implemented for the development of pain assessment and the model development of pain management more appropriately according to cultural contexts. PMID:24386747

  12. Painful Traumatic Trigeminal Neuropathy.

    PubMed

    Rafael, Benoliel; Sorin, Teich; Eli, Eliav

    2016-08-01

    This article discusses neuropathic pain of traumatic origin affecting the trigeminal nerve. This syndrome has been termed painful traumatic trigeminal neuropathy by the International Headache Society and replaces atypical odontalgia, deafferentation pain, traumatic neuropathy, and phantom toothache. The discussion emphasizes the diagnosis and the early and late management of injuries to the trigeminal nerve and subsequent painful conditions. PMID:27475512

  13. Effect of prophylactic antibiotics in acute nonperforated appendicitis: a prospective, randomized, double-blind clinical study.

    PubMed Central

    Busuttil, R W; Davidson, R K; Fine, M; Tompkins, R K

    1981-01-01

    A prospective, randomized, double-blind clinical study was performed to determined the efficacy of short-term (24 hr) perioperative antibiotics in preventing septic complications after emergency appendectomy for nonperforated appendicitis. The patients were stratified into three clinical arms: Group I (placebo, n = 45), Group II (cefamandole, n = 46) and Group III (cefamandole plus carbenicillin, n = 45). The three groups of patients were similar in regard to age, sex, duration of operation and pathologic classification of the appendix. The overall incidence of infection in the study was 5.1%. The infection rates in Groups II (2.2%) and III (0%) were significantly lower than Group I (placebo) (13.3%), (p less than 0.05). No difference was observed between cefamandole alone and cefamandole plus carbenicillin. Average postoperative hospital days per patient for each group was: Group I - 3.8 days; Group II - 2.9 days; Group III - 3.1 days. Cost analysis of hospitalization including cost of prophylactic antibiotics revealed a $247.99 per patient saving for Group II versus Group I and $95.53 for Group III versus Group I. Systemic prophylactic antibiotics can successfully reduce septic complications after appendectomy for nonperforated appendicitis, and a single drug (cefamandole) directed at the facultative pathogens is as effective as double drug therapy, which includes specific anaerobic coverage. PMID:7025769

  14. Previous appendicitis may affect peritoneal overlap of the mesh in laparoscopic inguinal hernia repair.

    PubMed

    Vecchio, R; Di Martino, M; Lipari, G; Sambataro, L

    2002-02-01

    Laparoscopic inguinal hernia repair is now increasingly performed in bilateral and recurrent groin hernias. The avoidance of direct exposure of the commonly used meshes to the abdominal viscera is considered essential to reduce the risk of bowel adhesions. We report a case of bilateral inguinal hernia repair in a patients who had had an appendectomy performed 8 years earlier for a perforated appendicitis. Probably as a result of previous inflammation, any attempt to dissect the preperitoneal layer in the right side resulted in peritoneal lacerations. Since the peritoneum could not be used to cover the mesh, we decided to position an expanded polytetrafluoroethylene (e-PTFE) mesh to avoid postoperative adhesions. The mesh was fixed with tacks to the symphysis pubis, Cooper's ligament, the ilio-pubic tract, and the transversalis fascia 2 cm above the hernia defect. This case suggests that in patient with previous appendicitis, a difficult preperitoneal dissection can be expected. In such cases, especially in young patients for whom future surgical operations cannot be excluded, any attempt to reduce adhesions is justified. At the present time, the use of e-PTFE meshes, which induce no tissue reaction, is a good option in this situation. PMID:11967702

  15. Histopathological study of Enterobius vermicularis among appendicitis patients in Gaza strip, Palestine.

    PubMed

    Hamdona, Shereen M; Lubbad, Abdel Monem; Al-Hindi, Adnan I

    2016-03-01

    Enterobius vermicularis is one of the most common intestinal parasite in human. The main objective of this study is to determine the role of E. vermicularis in appendicitis through histopathological examination. A cross sectional study included 200 patients who had appendectomy from three hospitals in Gaza strip. The inflamed appendix was the cause of attending the hospital. Histopathological examination for each appendix was carried out. A questionnaire was designed (interview with patients who underwent appendectomy), and information were obtained from patient and analyzed by using SPSS. The study showed that 30 (15.0 %) of 200 appendices had E. vermicularis in histopathological examination. It was found that ages of patients with histologically proven E. vermicularis in appendices less than 18 years old was found to be (18.2 %). Regarding sex, (16.5 %) of females, (14.0 %) of males patients had E. vermicularis in appendices. Patients who had the highest infection with E. vermicularis were students (17.3 %). In conclusion E. vermicularis occurs more frequently inflamed appendices than in normal. From these results we can conclude that E. vermicularis could be associated to cause of appendicitis in Gaza strip. PMID:27065621

  16. Carbohydrate-appended photocytotoxic (imidazophenanthroline)-oxovanadium(IV) complexes for cellular targeting and imaging.

    PubMed

    Banik, Bhabatosh; Somyajit, Kumar; Hussain, Akhtar; Nagaraju, Ganesh; Chakravarty, Akhil R

    2014-01-21

    Oxovanadium(IV) complexes [VO(aip)(L)](ClO4)2 (L = phtpy, 1; stpy, 2) and [VO(pyip)(L)](ClO4)2 (L = phtpy, 3; stpy, 4), where aip is 2-(9-anthryl)-1H-imidazo[4,5-f][1,10]phenanthroline, pyip is [2-(1-pyrenyl)-1H-imidazo[4,5-f][1,10]phenanthroline, phtpy is (4'-phenyl)-2,2':6',2''-terpyridine and stpy is (2,2':6',2''-terpyridin-4'-oxy)ethyl-β-D-glucopyranoside, were prepared, characterized and their DNA binding and photocleavage activity, cellular uptake and photocytotoxicity in visible light were studied. The complexes are avid binders to calf thymus DNA (K(b) ~10(5) mol(-1)). They efficiently cleave pUC19 DNA in red light of 705 nm via the formation of HO˙ species. The glucose appended complexes 2 and 4 showed higher photocytotoxicity in HeLa and Hep G2 cells over the normal HEK 293T cells. No such preference was observed for the phtpy complexes 1 and 3. No significant difference in IC50 values was observed for the HEK 293T cells. Cell cycle analysis showed that the glucose appended complexes 2 and 4 are more photocytotoxic in cancer cells than in normal cells. Fluorescence microscopy was done to study the cellular localization of complex 4 having a pendant pyrenyl group. PMID:24193217

  17. Once Daily Dosing of Ceftriaxone and Metronidazole in Children With Perforated Appendicitis

    PubMed Central

    Ally, Saudia; Kelly, Brian; Kays, David; Thames, Lisa

    2016-01-01

    OBJECTIVES: The aim of this study was to compare hospital length of stay and rate of infectious complications in children with perforated appendicitis based on the postoperative antibiotic administered. METHODS: This study was a retrospective analysis of children with perforated appendicitis who underwent an appendectomy at a large academic medical center from 2008 to 2013. The primary outcome was hospital length of stay. The secondary outcomes were rates of abscess formation, wound infection, and 30-day readmissions. RESULTS: One hundred and twenty-three patients were included. Sixty-six patients (53%) were administered ceftriaxone and metronidazole once daily; 57 (47%) were administered other antibiotic regimens, which consisted of single, double, or triple antibiotic therapy with a beta-lactam backbone. There was no difference between the groups in terms of postoperative length of stay (5.7 versus 5.8 days, p = 0.83), postoperative abscess rate (8% versus 4%, p = 0.57), postoperative wound infection rate (5% versus 2%, p = 0.73), and 30-day readmissions (3% versus 11%, p = 0.19). CONCLUSIONS: While there was no statistically significant difierence in the outcomes evaluated, the rate of infectious complications was twofold higher in those given ceftriaxone and metronidazole than in others. A larger prospective randomized controlled trial is warranted to better understand the risks of using these agents. PMID:27199621

  18. Pain, emotion, headache.

    PubMed

    Bussone, Gennaro; Grazzi, Licia; Panerai, Alberto E

    2012-10-01

    Pain has been considered as part of a defensive strategy whose specific role is to signal an immediate active danger to the organism. This definition fits well for acute pain. It does not work well, however, for chronic pain that is maintained even in absence of an ongoing, active threat. Currently, acute and chronic pain are considered to be separate conditions. What follows is a review of the different theories about pain and its history. Different hypotheses regarding pain mechanisms are illustrated. New data emerging from scientific research on chronic pain (migraine in particular) involving innovative imaging techniques are reported and discussed. PMID:23030540

  19. The Brain in Pain

    PubMed Central

    AHMAD, Asma Hayati; ABDUL AZIZ, Che Badariah

    2014-01-01

    Pain, while salient, is highly subjective. A sensation perceived as painful by one person may be perceived as uncomfortable, not painful or even pleasant to others. Within the same person, pain may also be modulated according to its threat value and the context in which it is presented. Imaging techniques, such as functional magnetic resonance imaging and positron emission tomography, have identified a distributed network in the brain, the pain-relevant brain regions, that encode the sensory-discriminative aspect of pain, as well as its cognitive and affective/emotional factors. Current knowledge also implicates the prefrontal cortex as the modulatory area for pain, with its subdivisions forming the cortico-cortical pathway, an alternative pain modulatory pathway distinct from the descending modulatory pathway of pain. These findings from neuroimaging in human subjects have paved the way for the molecular mechanisms of pain modulation to be explored in animal studies. PMID:25941463

  20. Pain assessment and management.

    PubMed

    Leith, B A

    1999-09-01

    Little research is currently available related to pain management by neuroscience nurses. However, due to concerns about the potential for altering neurological status, some neurosurgery patients may not receive optimal pain management. This paper describes findings from a pain related survey which was distributed during the Canadian Association of Neuroscience Nurses June 1998 national conference. The survey was intended to assess Canadian neuroscience nurses pain management knowledge and to explore pain management techniques after intracranial surgery. While 60% of respondents answered four pain assessment and management case study related questions correctly, some respondents rated pain differently when it was expressed by a smiling or grimacing patient. The most common methods for pain control after intracranial surgery included intermittent codeine and/or morphine, often by intramuscular injection. Findings from this study suggest that some neuroscience nurses require further education about pain management and that many patients do not receive optimal pain management after intracranial surgery. PMID:10732518

  1. Differentiation of orofacial pain related to Lyme disease from other dental and facial pain disorders.

    PubMed

    Heir, G M

    1997-04-01

    The diagnostic process for the orofacial pain patient is often perplexing. Compounding the process of solving a diagnostic mystery is the multiplicity of etiologic factors. The propensity for Lyme disease to present with symptoms mimicking dental and temporomandibular disorders makes the task even more complex. It is hoped that the reader is cognizant of the fact that a pathologic process of dental structures--the teeth and their attachments to the mandible and maxilla, the temporomandibular joints, masticatory musculature, and vascular supply and sensory innervation of the oromandibular anatomy--may also be the source of facial pain. Although unique, similar complaints may also be manifestations of other causes, including pain associated with Lyme disease. The informed and fastidious clinician does not overlook these possibilities when evaluating the headache and facial pain patient. The clinician should be equipped with the knowledge and minimal armamentarium to evaluate the patient appropriately. To paraphrase from Sherlock Holmes, we must first eliminate the impossible, whatever is left is the truth, no matter how unlikely. A differential diagnosis must be achieved based on clinical experience, unbiased observations, and probability. PMID:9142482

  2. An unusual pain in the hip

    PubMed Central

    Bangera, Sachin; Dunkow, Paul; Weerasinghe, Suboda; Murugesan, Senthil V.

    2016-01-01

    A 68-year-old previously healthy man presented with increasing right hip pain of 6 months duration. On examination he was found to have a hard mass in the right hip arising from the pelvic bone. Imaging studies were in keeping with a sarcoma arising from the right iliac bone. However, biopsy of this bony lesion confirmed this to be a metastatic adenocarcinoma rather than a primary bone malignancy. Further imaging and a subsequent colonoscopy revealed the primary to be a colonic adenocarcinoma. The unique and unusual nature of this case was the presentation as a solitary bony metastasis from a colonic primary. There is no previously documented report in the literature of such a rare presentation of a colonic adenocarcinoma as a solitary bony lesion mimicking a primary sarcoma in the absence of other signs or symptoms. PMID:27617105

  3. An unusual pain in the hip.

    PubMed

    Bangera, Sachin; Dunkow, Paul; Weerasinghe, Suboda; Murugesan, Senthil V

    2016-09-01

    A 68-year-old previously healthy man presented with increasing right hip pain of 6 months duration. On examination he was found to have a hard mass in the right hip arising from the pelvic bone. Imaging studies were in keeping with a sarcoma arising from the right iliac bone. However, biopsy of this bony lesion confirmed this to be a metastatic adenocarcinoma rather than a primary bone malignancy. Further imaging and a subsequent colonoscopy revealed the primary to be a colonic adenocarcinoma. The unique and unusual nature of this case was the presentation as a solitary bony metastasis from a colonic primary. There is no previously documented report in the literature of such a rare presentation of a colonic adenocarcinoma as a solitary bony lesion mimicking a primary sarcoma in the absence of other signs or symptoms. PMID:27617105

  4. History of pain theories.

    PubMed

    Chen, Jun

    2011-10-01

    The concept of pain has remained a topic of long debate since its emergence in ancient times. The initial ideas of pain were formulated in both the East and the West before 1800. Since 1800, due to the development of experimental sciences, different theories of pain have emerged and become central topics of debate. However, the existing theories of pain may be appropriate for the interpretation of some aspects of pain, but are not yet comprehensive. The history of pain problems is as long as that of human beings; however, the understanding of pain mechanisms is still far from sufficient. Thus, intensive research is required. This historical review mainly focuses on the development of pain theories and the fundamental discoveries in this field. Other historical events associated with pain therapies and remedies are beyond the scope of this review. PMID:21934730

  5. The problem of pain.

    PubMed

    Nicholson, Keith; Martelli, Michael F

    2004-01-01

    Pain problems, especially posttraumatic headache, are very common following head trauma. Pain may be the most significant problem, more disabling than any brain or other injuries, and interfering with aspects of cognition or other function. However, posttraumatic headache and most other chronic posttraumatic pain problems remain poorly understood. This article reviews fundamental issues that should be considered in understanding the nature of chronic pain including the distinction between acute and chronic pain; neurobiological distinctions between the lateral and medial pain system; nociceptive versus neuropathic or other central pain; sensitization effects; the widely accepted view of chronic pain as a multidimensional subjective experience involving sensory, motivational-affective and cognitive-behavioral components; the problem of mind-body dualism; the role of psychosocial factors in the onset, maintenance, exacerbation or severity of pain; plus issues of response bias and malingering. PMID:14732827

  6. Pain and the ethics of pain management.

    PubMed

    Edwards, R B

    1984-01-01

    In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis, treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfilling these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if any, should override the right to refuse treatment where pain relief is of paramount concern. PMID:6710192

  7. A Novel Nitronyl Nitroxide with Salicylic Acid Framework Attenuates Pain Hypersensitivity and Ectopic Neuronal Discharges in Radicular Low Back Pain

    PubMed Central

    Han, Wen-Juan; Chen, Lei; Wang, Hai-Bo; Liu, Xiang-Zeng; Hu, San-Jue; Sun, Xiao-Li; Luo, Ceng

    2015-01-01

    Evidence has accumulated that reactive oxygen species and inflammation play crucial roles in the development of chronic pain, including radicular low back pain. Nonsteroid anti-inflammatory drugs (NSAIDs), for example, salicylic acid, aspirin, provided analgesic effects in various types of pain. However, long-term use of these drugs causes unwanted side effects, which limits their implication. Stable nitronyl (NIT) nitroxide radicals have been extensively studied as a unique and interesting class of new antioxidants for protection against oxidative damage. The present study synthesized a novel NIT nitroxide radical with salicylic acid framework (SANR) to provide synergistic effect of both antioxidation and antiinflammation. We demonstrated for the first time that both acute and repeated SANR treatment exerted dramatic analgesic effect in radicular low back pain mimicked by chronic compression of dorsal root ganglion in rats. This analgesic potency was more potent than that produced by classical NSAIDs aspirin and traditional nitroxide radical Tempol alone. Furthermore, SANR-induced behavioral analgesia is found to be mediated, at least in partial, by a reduction of ectopic spontaneous discharges in injured DRG neurons. Therefore, the synthesized NIT nitroxide radical coupling with salicylic acid framework may represent a novel potential therapeutic candidate for treatment of chronic pain, including radicular low back pain. PMID:26609438

  8. Mimicking Stem Cell Niches to Increase Stem Cell Expansion

    PubMed Central

    Dellatore, Shara M.; Garcia, A. Sofia; Miller, William M.

    2008-01-01

    Summary Niches regulate lineage-specific stem cell self-renewal vs. differentiation in vivo and are comprised of supportive cells and extracellular matrix components arranged in a 3-dimensional topography of controlled stiffness in the presence of oxygen and growth factor gradients. Mimicking stem cell niches in a defined manner will facilitate production of the large numbers of stem cells needed to realize the promise of regenerative medicine and gene therapy. Progress has been made in mimicking components of the niche. Immobilizing cell-associated Notch ligands increased the self-renewal of hematopoietic (blood) stem cells. Culture on a fibrous scaffold that mimics basement membrane texture increased the expansion of hematopoietic and embryonic stem cells. Finally, researchers have created intricate patterns of cell-binding domains and complex oxygen gradients. PMID:18725291

  9. Rational Design of Pathogen-Mimicking Amphiphilic Materials as Nanoadjuvants

    NASA Astrophysics Data System (ADS)

    Ulery, Bret D.; Petersen, Latrisha K.; Phanse, Yashdeep; Kong, Chang Sun; Broderick, Scott R.; Kumar, Devender; Ramer-Tait, Amanda E.; Carrillo-Conde, Brenda; Rajan, Krishna; Wannemuehler, Michael J.; Bellaire, Bryan H.; Metzger, Dennis W.; Narasimhan, Balaji

    2011-12-01

    An opportunity exists today for cross-cutting research utilizing advances in materials science, immunology, microbial pathogenesis, and computational analysis to effectively design the next generation of adjuvants and vaccines. This study integrates these advances into a bottom-up approach for the molecular design of nanoadjuvants capable of mimicking the immune response induced by a natural infection but without the toxic side effects. Biodegradable amphiphilic polyanhydrides possess the unique ability to mimic pathogens and pathogen associated molecular patterns with respect to persisting within and activating immune cells, respectively. The molecular properties responsible for the pathogen-mimicking abilities of these materials have been identified. The value of using polyanhydride nanovaccines was demonstrated by the induction of long-lived protection against a lethal challenge of Yersinia pestis following a single administration ten months earlier. This approach has the tantalizing potential to catalyze the development of next generation vaccines against diseases caused by emerging and re-emerging pathogens.

  10. [Muscle-skeletal pain].

    PubMed

    Vygonskaya, M V; Filatova, E G

    2016-01-01

    The paper is devoted to the most complicated aspects of low back pain. The differences between specific and nonspecific low back pain using the "red flags" system is highlighted. The authors consider the causes of pain chronification (the "yellow flags" system) and the necessity of using a biopsychosocial model. Main pathogenetic mechanisms of chronic muscle/skeletal pain are considered and the possible involvement of several mechanism in the pathogenesis of chronic pain as well as the use of complex therapy is discussed. The high efficacy and safety of ketorolac in treatment of nonspecific muscle/skeletal pain is demonstrated. PMID:27042717

  11. Pediatric pain management.

    PubMed

    Lederhaas, G

    1997-01-01

    It is now recognized that from the newborn period onwards, children are capable of experiencing pain. This includes the premature infant. The challenge for healthcare providers is to incorporate methods of pain assessment and treatment into their daily practices. The child's understanding of pain closely follows the cognitive and behavioral model developed by Jean Piaget. Based on these developmental stages, pain assessment measures have been developed. Pharmacologic advances have accompanied this improved understanding of infant, child, and adolescent psychology. While acute pain accounts for the majority of children's experiences, recurrent/chronic pain states do occur (e.g. sickle cell related and neuropathic) and can be effectively treated. PMID:9037997

  12. Epidural injections for back pain

    MedlinePlus

    ... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

  13. Managing your chronic back pain

    MedlinePlus

    ... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

  14. Chiropractic care for back pain

    MedlinePlus

    ... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

  15. Pineal toxoplasmosis mimicking pineal tumor in an AIDS patient.

    PubMed

    Poon, T P; Behbahani, M; Matoso, I; Kim, B

    1994-07-01

    A pineal mass in a patient with acquired immunodeficiency syndrome (AIDS) is reported. Computed tomography (CT) scan revealed a nodular mass in the pineal region with foci of calcification and obstruction of the aqueduct mimicking a pineal tumor. At autopsy, the brain revealed a well-circumscribed lesion with central necrosis in the pineal region suggestive of toxoplasma and involving the periaqueductal area. Susceptibility of a patient with AIDS to opportunistic infections should be considered. PMID:8064908

  16. Primary ovarian and pararectal hydatid cysts mimicking pelvic endometriosis.

    PubMed

    Bozkurt, Murat; Bozkurt, Duygu Kara; Çil, Ahmet Said; Karaman, Mehmet

    2012-01-01

    We report a case of 48-year-old woman with multiple hydatid cysts in pararectal region and right paraovarian localization with an unusual sonographic and computed tomographic presentation mimicking a pelvic endometriosis. During laparotomy, multiple pararectal and right ovarian cysts resembling endometriosis were resected. Pathologic examination gives the diagnosis of hydatid cysts. Retrospectively, we investigate the primary infection but the patient had no history of hepatic and liver involvement, it is a case of primary infection. PMID:23456529

  17. Biliary Ascariasis Mimicking Colonic Tumor Infiltration of the Biliary System.

    PubMed

    Sundriyal, Deepak; Mittal, Gyanendra; Kumar, Sushil; Manjunath, Suraj; Sharma, Navneet; Gupta, Mahesh

    2015-09-01

    Ascariasis is a common problem in developing countries with poor hygiene and sanitation. It is endemic in India and usually seen in the northern states. Biliary ascariasis is an uncommon cause of obstructive jaundice. We present a case of carcinoma of hepatic flexure of colon in which the patient developed biliary ascariasis and posed a diagnostic challenge as it mimicked tumor infiltration of the biliary system. PMID:27217679

  18. Traumatic Thumb Radial Sagittal Band Injury Mimicking EPL Rupture.

    PubMed

    Dissanayake, Ravi M; Moore, Peter; McCarten, Gregory M

    2016-06-01

    We present the case of a closed traumatic disruption of the thumb radial sagittal band (RSB) that sonographically mimicked rupture of the extensor pollicis longus (EPL) tendon. This injury was treated with primary repair of the RSB and lead to a good functional outcome for the patient. This case report highlights how early recognition and treatment can lead to a good functional outcome. PMID:27454647

  19. Juvenile Myelomonocytic Leukemia in a Premature Neonate Mimicking Neonatal Sepsis.

    PubMed

    Lee, Ming-Luen; Yen, Hsiu-Ju; Chen, Shu-Jen; Hung, Giun-Yi; Tsao, Pei-Chen; Soong, Wen-Jue

    2016-04-01

    Juvenile myelomonocytic leukemia (JMML) is a rare hematologic malignancy in children. Its presentations include anemia, thrombocytopenia, monocytosis, skin rash, marked hepatomegaly, and/or splenomegaly. Fever and respiratory involvement are common. Here, we report a case of a premature neonate with initial symptoms of respiratory distress. She gradually developed clinical manifestations of JMML that mimicked neonatal sepsis. Three weeks after birth, JMML was diagnosed. This is the first reported case of JMML presenting in a premature infant in Taiwan. PMID:24269860

  20. Osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis

    PubMed Central

    Gopinathan, Nirmal Raj; Prakash, Mahesh; Saibaba, Balaji; Das, Ashim

    2016-01-01

    Osteofibrous dysplasia or ossifying fibroma is an uncommon benign fibro-osseous lesion of childhood, commonly described in the maxilla and the mandible. Among long bones, it usually presents in the tibia as a painless swelling or anterior bowing. Ossifying fibroma of clavicle has never been reported in English literature, to the best of our knowledge. Here, we would like to present an unusual case of osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis. PMID:27413281