Multispiral computed tomography in the detection and differential diagnosis of acute appendicitis

Despite the results of technological progress in medicine, which has made high-resolution methods of medical imaging available, the problem of differential diagnosis of acute appendicitis does not lose its’ relevance. This can be explained by the fact that the symptoms of acute appendicitis are variable, non-specific, and can mimic other diseases with similar symptoms.Three cases of rare diseases of the gastrointestinal tract that simulates acute appendicitis were presented. Those are primary torsion of the greater omentum with necrosis, caecum cancer with lengthy necrosis in a young patient and Crohn's disease that simulates appendicular infiltrate. All patients underwent surgery. Signs of acute appendicitis were indications for surgery. Laparoscopic resection of greater omentum was performed in the first case. In the second case caecum necrosis with peritonitis was revealed by laparoscopy. Conversion laparoscopy to laparotomy was performed. Caecum necrosis with caecum wall perforation and necrosis of terminal part of the ileum was diagnosed. right hemicolectomy with ileo-transverso anastomosis was carried out. Complicated case of Crohn’s disease was suspected. Nevertheless, the diagnosis of colorectal cancer is established by pathomorphology only. This case is interesting because of rare complication of colon cancer – the caecum and the ileum wall necrosis that was manifestation of the disease. In the third case of Crohn’s disease in a young patient the diagnosis of appendicular infiltrate and surgical policy were wrong. At the first laparotomy by McBurney was performed. A dense infiltrate was found in the right iliac fossa. The intervention was finished by local abdominal package. In the early postoperative period an intestinal fistula was formed. The patient underwent relaparotomy and right hemicolectomy with ileo-transversal anastomosis was carried out. Despite the diagnosis of Crohn's disease was questionable patomorphology and was established after half a year only by colonoscopy. The presented cases illustrate the complexity of acute appendicitis and the importance of modern approaches to diagnosis: irreplaceability of laparoscopy and the feasibility of using diagnostic scales. When the right diagnosis is not clear the intervention might be late for using methods of instrumental diagnostics.

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Difficult cases of differential diagnosis of acute appendicitis

Отдельнов

Мастюкова

2021

Issled. prakt. med. (Print)

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Laparoscopic appendectomy in a postcovid period

Міщенко

Пустовойт²,

Vododіuk

et al. 2021

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Objective. Determination of the role and place of laparoscopic appendectomy in a postcovid period. Materials and methods. Laparoscopic appendectomy was performed in 73 patients, who have carried COVID–19. The Alvarado Scale was applied for verification of an acute appendicitis diagnosis. Results. The term of establishing of an acute appendicitis diagnosis in 87.7% of patients have constituted 6 h and more, while the term of preoperative observation – (12.7 ± 3.1) yr. Phlegmonous form of inflammation of processus vermiformis have constituted 61.4% of cases. Antibodies IgMSARSCov–2 (COVID–19) and IgGSARSCov–2 (COVID–19) were revealed in 100% of patients, suffering an acute appendicitis. Thus, laparoscopic appendectomy in the patients, who have carried COVID–19, is secure. Conclusion. The acute appendicitis course in the patients, who have carried COVID–19, owed certain clinical peculiarities. Diagnosis of an acute appendicitis in such patients must be rapid and precise. Appendectomy in patients in a postcovid period must be performed before the development of an acute appendicitis complications. Laparoscopic appendectomy in patients, who have carried COVID–19, must become a «gold standard» of operations in an acute appendicitis.

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Multispiral computed tomography in the detection and differential diagnosis of acute appendicitis

Cited by 2 publications

References 10 publications

Difficult cases of differential diagnosis of acute appendicitis

Difficult cases of differential diagnosis of acute appendicitis

Laparoscopic appendectomy in a postcovid period

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