Incidental Finding of Acute Appendicitis During Laparoscopic Cholecystectomy for an Acute Calculous Cholecystitis

Abstract

Acute cholecystitis and appendicitis are among the most common conditions encountered by general surgeons; however, they are rarely described simultaneously. We are reporting a rare incidental finding of early acute appendicitis during laparoscopic cholecystectomy for a 36-year-old lady who presented to our emergency department with signs and symptoms of acute calculous cholecystitis. Laparoscopy has proved to be a highly useful and ideal tool in the diagnosis and treatment of such surgical situations.

Synchronous Acute Appendicitis and Acute Cholecystitis: A Case Report

“…Physical examination results typically showed tenderness to palpation and Murphy's sign. Many of the physical examinations had a positive McBurney's point in the patient, and CT scans and ultrasound confirmed the combined AA and AC diagnosis, hence suggesting laparoscopic procedures in the patients [11][12][13][14][15][16][17][18][19]. This result is consistent with well-documented common symptoms of AA, which include RLQ pain, and common symptoms of AC, which include pain in the severe RUQ or epigastrium pain and possible radiation to the right shoulder or back [6,7].…”

“…However, unlike in the case of combined AA and AC, McBurney's point is only seen in about 50% of patients with isolated AA [3]. The duration of symptoms and abnormalities in vital signs and laboratory results were inconsistent and hence are not a reliable basis of diagnosis in these patients [11][12][13][14][15][16][17][18][19]. Ultrasound is the most often used imaging modality for the initial diagnosis of AC, although CT and MRI are often also performed for possible complications, and laparoscopic cholecystectomy is the gold-standard treatment [1,3,[6][7][8].…”

Synchronous Acute Appendicitis and Acute Cholecystitis

“…According to the literature, patients with those two simultaneous conditions are difficult to evaluate in the emergency room. They generally present with right upper quadrant pain and right-sided or diffuse abdominal tenderness, so it can be challenging to reach a high level of suspicion based on the clinical picture alone [ 3 , 5 ]. Each pathology has characteristic findings on the physical examination; for example, McBurney’s, Rovsing’s, and Blumberg’s signs are regularly present in acute appendicitis as Murphy’s sign is in acute cholecystitis.…”

“…Alkhurmudi et al [ 5 ], in a previous report, discussed two theories that can explain the occurrence of this synchronous presentation. One consists of secondary appendicitis that can develop in conjunction with other intra-abdominal inflammatory pathologies when the appendix lies near the site of inflammation.…”