Mimicry of Appendicitis Symptomatology in Congenital Anomalies and Diseases of the Genitourinary System and Pregnancy

Abstract

Introduction: Appendicitis is a prevailing cause of acute abdomen, but is often difficult to diagnose due to its wide range of symptoms, anatomical variations, and developmental abnormalities. Urological disorders of the genitourinary tract may be closely related to appendicitis due to the close proximity of the appendix to the genitourinary tract. This review provides a summary of the urological complications and simulations of appendicitis. Both typical and urological symptoms of appendicitis are discussed, as well as recommended diagnostic and treatment methods. Methods: Medline searches were conducted via PubMed in order to incorporate data from the recent and early literature. Results: Urological manifestations of appendicitis affect the adrenal glands, kidney, retroperitoneum, ureter, bladder, prostate, scrotum, and penis. Appendicitis in pregnancy is difficult to diagnose due to variations in appendiceal position and trimester-specific symptoms. Ultrasound, CT, and MRI are used in diagnosis of appendicitis and its complications. Treatment of appendicitis may be done via open appendectomy or laparoscopic appendectomy. In some cases, other surgeries are required to treat urological complications, though surgery may be avoided completely in other cases. Conclusion: Clinical presentation and complications of appendicitis vary among patients, especially when the genitourinary tract is involved. Appendicitis may mimic urological disorders and vice versa. Awareness of differential diagnosis and proper diagnostic techniques is important in preventing delayed diagnosis and possible complications. MRI is recommended for diagnosis of pregnant patients. Ultrasound is preferred in patients exhibiting typical symptoms.

Ectopic kidney mimicking appendicular abscess

“…While the management of appendicular mass is conservative, followed later by interval appendicectomy, nephrectomy is the treatment for pyonephrosis. [ 2 ] This underlines the paramount importance in differentiating these two entities. A thorough history focusing on previous urological complaints supplemented by a focused clinical examination is the first step in arriving at the correct diagnosis.…”

“…Dalpiaz et al ., in their review of genitourinary anomalies presenting with appendicitis-like symptoms, point out that ectopic kidneys, nephroptosis, ectopic ureter, ureteric duplication, bladder diverticula, and ureteric obstruction can all mimic appendicular pathologies. [ 2 ] However, pyonephrosis mimicking appendicular pathology has not been reported. On the other hand, appendicitis can itself be a manifestation of underlying genitourinary pathology.…”

“…Acute appendicitis can also cause inflammation of the nearby organs such as adrenals, kidneys, ureters, bladder, prostate, scrotum, and penis producing symptoms pertaining to these organs. [ 2 ] Pelvic kidney with pyelonephritis mimicking acute appendicitis has been reported in the literature. Taylor and Steen report a case of pyelonephritis with ureteric calculus in an ectopic kidney presenting with right iliac fossa pain and rebound tenderness, thereby mimicking acute appendicitis.…”

Acute appendicitis coexisting with acute pyelonephritis causing diagnostic dilemma: a case report

“…Appendicitis is an inflammation of the vermiform appendix and is considered to be the most common cause of acute abdomen. Symptom diversity is high due to developmental anomalies and topographic variations [11]. The most common symptoms are lower right quadrant pain, vomiting, and fever.…”

“…The proximity of the genitourinary system to the appendix may cause confusion during the diagnosis. The genitourinary simulations of appendicitis symptomatology also may be variable [11]. In some cases, anomalies of the genitourinary system may mask themselves as acute appendicitis.…”