Unusual case of acute appendicitis with left upper quadrant abdominal pain

Tawk, Charbel; Zgheib, Rana R.; Mehanna, Seba

doi:10.1016/j.ijscr.2012.05.002

Cited by 10 publications

(14 citation statements)

References 6 publications

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“…Usualmente, se presenta como un dolor sordo epigástrico o periumbilical, acompañado de náuseas o emesis, fiebre e hiporexia. Horas después, se irradia y se localiza en el cuadrante inferior derecho 4,15 . No obstante, su presentación en el cuadrante inferior izquierdo es infrecuente 6 , y puede relacionarse con dos defectos congénitos: situs inversus y rotación intestinal anormal 7 .…”

Section: Discussionunclassified

“…Su incidencia es, aproximadamente, de 1,33 por cada 1.000 hombres y de 0,99 por cada 1.000 mujeres 2 . La sintomatología se caracteriza por dolor abdominal localizado en el cuadrante inferior derecho, principalmente asociado con signos de irritación peritoneal 3,4 . Durante el transcurso de la enfermedad, se pueden presentar signos y síntomas inespecíficos, como fiebre y anorexia 3 , los cuales se encuentran en 50 a 60 % de los pacientes 5 .…”

Section: Introductionunclassified

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Apendicitis aguda en paciente adulto con rotación intestinal anormal y defecto cardiovascular: presentación de caso y revisión temática

et al. 2018

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Citar como:. Villabona AN, Sorzano LI, Rodríguez HM, Espinosa LA, Villabona SA. Apendicitis aguda en paciente adulto con rotación intestinal anormal y defecto cardiovascular: presentación de caso y revisión temática. Rev Colomb Cir. 2018;33:220. https ResumenLa apendicitis aguda es la enfermedad quirúrgica que se presenta con mayor frecuencia en los servicios de urgencias. Su diagnóstico es predominantemente clínico; alrededor de dos terceras partes de los pacientes con apendicitis presentan un dolor típico localizado en el cuadrante inferior derecho. Sin embargo, hay manifestaciones atípicas, infrecuentes, como el dolor en el cuadrante inferior izquierdo. Se hace pues, importante conocer la existencia de ciertas enfermedades que puedan explicar estos síntomas para así tenerlas en cuenta en el momento de abordar un paciente con dolor abdominal. Estas son la rotación intestinal anormal y, con mayor frecuencia, el situs inversus, que explican el dolor abdominal secundario a la apendicitis en una localización diferente a la clásica para hacer el diagnóstico y dar tratamiento oportuno, con el fin de prevenir complicaciones. Además, los estudios complementarios son importantes en estos pacientes para descartar otras alteraciones o malformaciones, como defectos cardiovasculares, los que se han relacionado con anomalías en la formación y la rotación gastrointestinal en 27 % de los casos, aproximadamente. Se presenta el caso de hombre joven, con un cuadro clínico de dolor abdominal que se inició en el epigastrio y después se localizó en el cuadrante inferior izquierdo, acompañado de signos de irritación peritoneal y alteración de los exámenes paraclínicos. Los estudios de imagen confirmaron la presencia de rotación intestinal anormal y apendicitis aguda izquierda. Durante el seguimiento del paciente, se practicó una ecocardiografía transesofá-gica por dolor torácico, la cual demostró insuficiencia valvular aórtica secundaria a valvulopatía aórtica bivalva. Palabras clave: apendicitis; diagnóstico; apendicectomía; laparotomía; situs inversus; cardiopatías congénitas. AbstractAcute appendicitis is the most frequent surgical pathology at the emergency departments and its diagnosis is predominantly clinical. Around 2/3 of the patients with this pathology present typical pain, located in the right lower quadrant. However, abdominal pain in the left lower quadrant secondary to acute appendicitis is of

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Apendicitis aguda en paciente adulto con rotación intestinal anormal y defecto cardiovascular: presentación de caso y revisión temática

et al. 2018

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“…The typical presentation of appendicitis include periumbilical onset of abdominal pain associated with nausea gradually shifting to the McBurney's point in the right iliac fossa. Although various scoring systems exist such as modified Alvarado score, Ohmann score and Eskelinen score, none of these predict appendicitis in all the patients [3]. The diagnosis is often confirmed by abdominal ultrasound and computed tomography.…”

Section: Discussionmentioning

confidence: 99%

Left sided Acute Appendicitis in a Patient with Midgut Malrotation

Shah¹

2014

JCR

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Abstract:Appendicitis is typically established when a patient presents with peri-umbilical abdominal pain associated with nausea or vomiting and subsequent radiation of the pain to the right iliac fossa. Rarely, left sided appendicitis has been reported in the literature and when it occurs invariably it is associated with a congenital anomaly of the abdomen either situs inversus or intestinal malrotation. We present here, a case of acute appendicitis in a patient with intestinal malrotation.

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“…Acute appendicitis is an emergent surgically treated disease generally represented by right lower abdominal pain [1]. The most common location of the appendix is descending intraperitoneal [2,3].…”

Section: Introductionmentioning

confidence: 99%

“…Left-sided appendicitis generally presents with left lower abdominal pain and is confused with diverticulitis or gynecological pathologies. Inguinal canal and femoral canal-located appendicitis can present with groin pain [1,7]. In such cases ultrasonography (US) is the first-choice modality for diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Computed Tomography (CT) Findings of a Diagnostic Dilemma: Atypically Located Acute Appendicitis

2016

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SummaryBackgroundAcute appendicitis is an emergent surgically treated disease generally represented by right lower abdominal pain. The most common location of the appendix is descending intraperitoneal. However, it can also show atypical locations such as inguinal canal, femoral canal, subhepatic, retrocecal, intraperitoneal abdominal midline and left side in situs inversus or intestinal malrotation patients. Atypical location can lead to atypical clinical presentations. Ultrasonography is the first choice modality for imaging. However, it can be insufficient for demonstration of the appendix. Therefore, computed tomography (CT) is needed for further examination. We aim to review the CT findings of atypically located acute appendicitis with cases and remind the clinicians and radiologists the importance of the prompt diagnosis.Case ReportWe presented five atypically-located appendix cases, including four with acute appendicitis that presented to our emergency department with acute abdominal pain. Two of the acute appendicitis cases had normal, the other two had elevated white blood cell count, but all of them had elevated CRP. Ultrasonography imaging was performed as a first-line imaging modality. Because of the inconclusive results of both clinical-laboratory findings and ultrasonography, CT imaging was performed. Abdominal CT demonstrated all of the atypically localised appendices successfully, which were left-sided in a malrotated patient, retrocecal, subhepatic, retrocecal ascending, intraperitoneal abdominal midline localised.ConclusıonsAtypically located acute appendicitis can show atypical presentation and result in misdiagnosis. If ultrasonograpgy is inconclusive, we suggest abdominal CT in such confusing, complicated cases, because misdiagnosis or delay in the right diagnosis can result in complications and increased morbidity and mortality rates.

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Unusual case of acute appendicitis with left upper quadrant abdominal pain

Abstract: An examining physician should not be mislead by the atypical presentation of acute appendicitis and should bear in mind the diagnosis to avoid serious complications.

Cited by 10 publications

References 6 publications

Apendicitis aguda en paciente adulto con rotación intestinal anormal y defecto cardiovascular: presentación de caso y revisión temática

Apendicitis aguda en paciente adulto con rotación intestinal anormal y defecto cardiovascular: presentación de caso y revisión temática

Left sided Acute Appendicitis in a Patient with Midgut Malrotation

Computed Tomography (CT) Findings of a Diagnostic Dilemma: Atypically Located Acute Appendicitis

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