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 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sterilization by tubal occlusive methods is not always successful. This fact is not, however, well recognized among general surgeons. When failures occur, ectopic pregnancy is the usual outcome, most commonly in the Fallopian tube. Ectopic pregnancy has a reported mortality of approximately 3.5/1000, with the majority of deaths associated with delay in diagnosis. The failure to consider this possibility of ectopic pregnancy after tubal ligation when female patients present with right-sided abdominal pain causes health personnel to commonly misdiagnose the condition of appendicitis. A 26 year old woman presented to the Accident and Emergency Department of the Royal Hobart Hospital with lower abdominal pain mainly in the right iliac fossa. Pain was intermittent for two weeks prior to presentation. On the morning of presentation, the pain became severe and was exacerbated by coughing and movements. The patient was nauseated, but had not vomited; there was neither fever nor rigors. Four years earlier, in England, the patient had undergone elective laparoscopic sterilization. Sexually active, she believed that she was menstruating at the time of presentation, especially since her last menstruation occurred four weeks previously. The patient was noted upon examination to have a "grey look," pulse rate of 80 beats/minute, blood pressure of 120/80 mmHg, and a generally tender abdomen, maximally in the right iliac fossa. There were no bowel sounds and rectal examination proved to be extremely painful in all directions. The accident and emergency staff took blood for a full blood count, serum human chorionic gonadotrophin, and arranged surgical consultation. The surgical diagnosis was for acute appendicitis and the patient was transferred to the operating theater for appendectomy. Just prior to anesthetic induction, the pathology results became available, indicating a hemoglobin of 10.3 g/dl and a positive serum HCG. The diagnosis was thus revised to ruptured ectopic pregnancy and laparotomy was performed through a Pfannenstiel incision. 1000 ml of blood was removed from the peritoneal cavity, a ruptured tubal pregnancy was found in the right distal tube, and the appendix was normal. A right salpingo-oophorectomy was performed after which the patient recovered uneventfully and was discharged five days postoperatively. Histopathology confirmed a ruptured ectopic gestation.
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PMID:Misdiagnosis of appendicitis in tubally sterilized women. 846 65

Idiopathic or spontaneous segmental infarction of the greater omentum (ISIGO) is a rare cause of acute right-sided abdominal pain. The symptoms simulate acute appendicitis in 66% of cases and cholecystitis in 22%. Progressive peritonitis usually dictates laparotomy, and an accurate diagnosis is rarely made before surgery. The etiology of the hemorrhagic necrosis is unknown, but predisposing factors such as anatomic variations in the blood supply to the right free omental end, obesity, trauma, overeating, coughing, and a sudden change in position may play a role in the pathogenesis. We present herein the case of a 37-year-old man in whom ISIGO, precipitated by obesity and overeating, was successfully diagnosed and treated by laparoscopy. Resection of the necrotic part of the greater omentum is the therapy of choice, and ensures fast recovery and pain control. Serohemorrhagic ascites is a common finding in ISIGO, and careful exploration of the whole abdominal cavity should be performed. The laparoscopic approach allows both exploration and surgical intervention.
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PMID:Idiopathic segmental infarction of the greater omentum successfully treated by laparoscopy: report of case. 1081 85

Giving an analgesic to patients with right lower quadrant (RLQ) pain causes greater alteration of abdominal signs predictive of appendicitis than placebo. A randomized double-blinded controlled trial of 68 patients who received either tramadol or placebo. Absence or presence of seven abdominal signs (tenderness on light and deep palpation, tenderness in the RLQ and elsewhere, rebound, cough, and percussion tenderness) and pain (100 mm Visual Analog Scale [VAS]) at 0 and 30 minutes were recorded. The predictive value of each physical finding (PF) was measured using an 11-point PF score weighted by likelihood ratios. There was significant reduction in mean VAS of 14.2 mm (95% CI 5.6 to 22.8) in analgesic group versus 6.5 mm (95% CI 1.6 to 11.4) in placebo group. The analgesic group had less normalization of signs as measured by the PF score in all patients [32 of 154 (20.8%) versus 40 of 121 (33.1 %) (P = .031)] and in those with proven appendicitis [4 of 33 (12.1%) versus 10/22 (45.5%) (P = .014)]. Parenteral use of tramadol in emergency department patients with RLQ pain resulted in significant levels of pain reduction without concurrent normalisation of abdominal examination findings indicative of acute appendicitis.
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PMID:Prospective randomized study of analgesic use for ED patients with right lower quadrant abdominal pain. 1110 23

An 88-year-old woman was admitted with acute appendicitis. She had been treated with prednisolone and home oxygen therapy for interstitial pneumonia. Her respiratory state on admission was Grade 2 of Hugh-Jones' classification, and plasma KL-6 and SP-D levels were high. Seven days after the admission, appendectomy was performed under spinal anesthesia. Spinal anesthesia was initiated by injecting 0.5% hyperbaric bupivacaine 2.0ml into L3-4 interspace, and achieved block level was up to T4. During the operation, her respiratory state was stable, but after the operation, dry cough, increase of body temperature, and dyspnea were observed. Chest roentgenogram revealed severe ground glass appearance and reticular shadows bilaterally. Steroid therapy for acute exacerbation of interstitial pneumonia was initiated, but she died on the 13th POD. This case teaches us to take a lot of care in the management of a patient with high plasma level of KL-6 and SP-D.
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PMID:[A case of acute exacerbation of interstitial pneumonia after appendectomy managed with spinal anesthesia]. 2336 73

BACKGROUND Paracoccidioidomycosis is an endemic mycosis in Central and South America caused by the thermally dimorphic fungus Paracoccidioides brasiliensis. Despite its self-limited course and usually asymptomatic infection, some patients may present with a systemic illness mimicking multiple conditions and thus question the general state of their immune system. CASE REPORT A 28-year-old male presented to the hospital with fever, dry cough, and non-pruritic rash with no characteristic distribution for the past 10 days. Past medical history revealed that the patient had worked as a farmer three years ago, had abused cocaine paste over the same period, and also had in the last month presented to the hospital for acute appendicitis. Initial laboratory tests revealed hypereosinophilia greater than 10,000 eosinophils/mL. Infection of P. brasiliensis was confirmed by lymph node, skin, and colonoscopy biopsies. After treatment with itraconazole, the patient's eosinophil count returned to normal and his symptoms resolved. CONCLUSIONS Paracoccidioidomycosis may present as a systemic illness with only marked eosinophilia on initial diagnostic tests. Furthermore, in our patient's case, the high degree of eosinophilia may have contributed towards the patient's appendicitis in the weeks preceding the subacute infection. It is possible that the patient's history of working at a farm and abusing cocaine paste may have contributed to the initial colonization by the fungus.
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PMID:Hypereosinophilia Secondary to Disseminated Paracoccidioidomycosis. 2904 30

Typical presentations of Coronavirus Disease 2019 (Covid-19) including respiratory symptoms (cough, respiratory distress and hypoxia), fever and dyspnoea are considered main symptoms in adults, but atypical presentation in children could be a diagnostic challenge. We report three children whose initial presentation was gastrointestinal, and in whom Covid-19 infection was found, concluding that cases of acute appendicitis, mesenteric adenitis and flank tenderness may mask an infection with this virus, and should therefore be investigated.
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PMID:Atypical and novel presentations of Coronavirus Disease 2019: a case series of three children. 3255 15

Efforts to recognize SARS-CoV-2 infection have focused on respiratory symptoms such as cough and shortness of breath. Although it is also well known that SARS-CoV-2 infection can cause gastrointestinal symptoms such as abdominal pain, nausea, vomiting and diarrhoea, there are emerging reports of SARS-CoV-2 infection causing surgical pathology. We present the first case report of SARS-CoV-2 infection directly causing acute appendicitis, first suspected due to highly atypical histological features and later confirmed as polymerase chain reaction positive appendicular tissue sample.
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PMID:SARS-CoV-2 isolation from an appendix. 3285 98