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Query: UMLS:C0085693 (acute appendicitis)
 3,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Appendectomy for appendicitis is one of the most common procedures performed in the United States. Residual tissue left after an initial appendectomy risks the development of stump appendicitis. A comprehensive review of the English-language literature revealed 36 reported cases of stump appendicitis. Typically, patients present with signs and symptoms similar to acute appendicitis; however, due to prior surgery, the diagnosis is difficult and the rate of appendiceal stump perforation is extremely high. Herein, we present a case of a 32-year-old female presenting with right lower quadrant pain, nausea, and fever 5 months after laparoscopic appendectomy. Upon surgery, an appendiceal stump was discovered.
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PMID:Stump appendicitis: a comprehensive review of literature. 1653 49

Today sonography is the first line imaging method for diagnosing acute appendicitis. Experienced investigators will have an accuracy of more than 90%. Sonography can diagnose many conservatively managed diseases. The most important differential diagnoses are infectious ileocoecitis, right sided diverticulitis, appendagitis, adnexitis, ruptured or torque ovarian cysts, ectopic pregnancies. Ureterolithiasis, cholecystitis, haematomas in the psoas muscle or in the rectus muscle are rarer causes of right lower quadrant pain. Sonography can reduce the high rate of false positive clinical examinations concerning acute appendicitis. It has to be stated that an exclusion of appendicitis can only be made sonographically if the normal appendix can be seen in its full length and/or an other differential diagnosis can be depicted that explains the clinical symptoms. Mucoceles are rare cystoid lesions of the appendix. They exhibit a typical onion skin sign structure caused by different mucus viscosities. In large mucoceles a tumor causes this lesion.
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PMID:[Sonography of acute appencitis and the main differential diagnoses]. 1668 Nov 56

Right-sided diverticulitis is difficult to distinguish from other sources of right-sided abdominal pain and, in particular, is frequently indistinguishable from acute appendicitis preoperatively. Because of the problems concerning preoperative diagnosis and controversies in the management, the choice of the best therapy on the surgeon's part is still open. A total of 1150 patients with a clinical diagnosis of right acute abdomen observed in our surgical department from 1995 to 2003 was analysed. Three patients had a pathologically confirmed diagnosis of caecal diverticulitis. The mean age of the patients was 37 years. Right lower quadrant pain and local tenderness were the only clinical findings in 95.3% of the cases, with a preoperative diagnosis of acute appendicitis in 2 of 3 patients. The operative findings were an inflammatory mass in the caecum and the presence of a minimal amount of free peritoneal fluid. Two patients underwent laparoscopic ileocecectomy and one had a diverticulectomy. The postoperative course was uneventful. Because of the difficulties in diagnosis and surgical treatment, caecal diverticulitis has been the subject of much discussion in the literature and many questions remain unanswered. Right-sided diverticulitis is easily confused with acute appendicitis because it occurs at a somewhat younger age than sigmoid diverticulitis. Caecal diverticulitis needs a high index of suspicion for achieving a preoperative diagnosis. Diverticulectomy should be performed in patients with small diverticula with a limited inflammatory reaction. Right colectomy should be performed in patients with perforation of the diverticulum, caecal phlegmon or abscess formation. A correct intraoperative diagnosis is therefore crucial for selection of the surgical procedure. Laparoscopic treatment of a solitary, acutely infected colon diverticulum is feasible in this setting. A minimally invasive procedure could be performed, therefore, in patients with right acute abdomen, allowing not only the right diagnosis but also the treatment of the commonest pathologies responsible for this clinical picture.
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PMID:Laparoscopic treatment of caecal diverticulitis. 1672 10

Infrequent causes of right lower quadrant pain that mimic acute appendicitis include infarcted epiploic appendages. Although usually located in the colon, we report the very rare case of an infarcted epiploic appendage located directly on the serosal surface of the appendix itself. In a patient with right lower quadrant pain, the diagnosis of infarcted epiploic appendages is rarely made preoperatively and the incidence is rare. Definitive treatment is excision.
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PMID:Infarcted epiploic appendage of the vermiform appendix masquerading as acute appendicitis. 1721 81

At our institution, helical CT of the abdomen and pelvis with intravenous and rectal contrast (CTRC) has become the modality of choice for investigation of patients with right lower quadrant pain and clinical suspicion of acute appendicitis. CTRC has proven useful for the diagnosis of acute appendicitis (AA) and at the same time identifies alternative diagnoses mimicking AA. This pictorial assay illustrates the imaging findings of AA and its mimickers including primary epiploic appendagitis, right-sided diverticulitis, torsion of Meckel's diverticulum, gynecologic disorders, obstructive uropathy, right lower lobe pneumonia, and other conditions.
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PMID:Alternative diagnoses of acute appendicitis on helical CT with intravenous and rectal contrast. 1732 Jul 73

The aim of this study was to identify ultrasonographic findings that show the normal faecal-impacted appendix, in order to avoid unnecessary surgery via a misdiagnosis of acute appendicitis. Of 160 patients who underwent ultrasonography between January 2004 and July 2005 for right lower quadrant pain, 22 cases (including 7 cases confirmed pathologically and 15 confirmed clinically and on follow-up ultrasonography) were diagnosed as a normal faecal-impacted appendix. The criteria that we used to distinguish a faecal-impacted appendix from acute appendicitis include preservation of the normal wall layering of the appendix, maximum mural thickness, presence of peri-appendiceal fat infiltration and increased blood flow in the appendiceal wall. The maximum measured outer diameter of a normal faecal-impacted appendix was 0.54-1.03 cm, with a mean diameter of 0.68 cm. The maximum mural thickness ranged from 0.08 cm to 0.26 cm, with a mean thickness of 0.15 cm. The normal wall layers of the appendix were preserved and no evidence was seen of peri-appendiceal fat infiltration in any case. No demonstrably increased blood flow in the appendiceal wall was observed. In conclusion, faecal impaction increases the outer transverse diameter of the normal appendix, frequently leading to a misdiagnosis of acute appendicitis. Recognition of preservation of the normal layering of the appendiceal wall, smaller maximal outer diameter, thinner maximal mural thickness, the absence of peri-appendiceal mesenteric infiltration and no demonstrably increased blood flow in the appendiceal wall should help to prevent unnecessary surgery.
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PMID:Ultrasonographic findings identifying the faecal-impacted appendix: differential findings with acute appendicitis. 1787 92

Acute abdomen is a common presentation to the emergency department (ED), accounting for 5% to 10% of ED visits. Of these, 10% require surgery, and 25% go undiagnosed. Usually, most of the cases of undiagnosed abdominal pain are in young women with pelvic etiologies, although occasionally, unusual causes of abdominal pain lead to diagnostic dilemmas and can have adverse clinical outcomes. We present an unusual etiology of abdominal pain in a young man, who presented with acute onset of right lower quadrant pain accompanied by nausea and vomiting. He was an amateur boxer who had recently intensified his training regimen and admitted to binge drinking for several days before presentation. The initial diagnosis was acute appendicitis, but a computed tomographic scan done revealed a normal appendix. Creatine kinase level was then checked and found to be significantly elevated, and a diagnosis of isolated abdominal wall rhabdomyolysis was made.
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PMID:Rhabdomyolysis: a lesson on the perils of exercising and drinking. 1841 Aug 42

A healthy 26-year-old man visited the Emergency Department due to right lower quadrant pain of 2 days' duration that developed after wakeboarding. There was no history of direct trauma to the abdomen. Physical examination revealed tenderness and rebound tenderness on the right lower quadrant area. There was no palpable abdominal mass. Computed tomography (CT) of the abdomen was undertaken to discern the causes of acute abdomen, including acute appendicitis. CT revealed a small-size rectus sheath hematoma beneath the lower end of the right rectus muscle. The patient was admitted for supportive care including pain control and was discharged with improvement after 5 days. Rectus sheath hematoma can be caused by not only a direct blow but also non-contact strenuous exercise, for example, wakeboarding in this case. Although the majority of rectus sheath hematomas are self-limiting, some can cause peritoneal irritation signs, mimicking acute abdomen, and eventually lead to unnecessary laparotomy without clinical suspicion and ancillary tests including CT scan and ultrasonography.
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PMID:Rectus sheath hematoma caused by non-contact strenuous exercise mimicking acute appendicitis. 1872 39

Appendicolithiasis is a condition characterized by a concretion in the vermiform appendix. Appendicoliths are found in 10% of patients with acute appendicitis, but they are seen more frequently in perforated appendicitis and in abscess formation. We herein report a case of acute appendicitis due to appendicolithiasis, which mimics acute disorders of the genitourinary tract and causes diagnostic confusion. A38- year-old man presented to our emergency department with a history of intense, acute, recurrent, crampy right lower quadrant pain radiating to the right groin region, accompanied by nausea. Physical examination revealed muscular defense and rebound tenderness in the right lower quadrant, tenderness in the line of the right ureter and right costovertebral angle tenderness. On X-ray examination, a right kidney stone was identified as was an incidental 3-cm density in the right lower quadrant. The patient underwent appendectomy. The diagnosis was made by operation and also X-ray examination of the appendectomy material showing appendicolithiasis. Acute appendicitis may manifest as a variety of genitourinary disorders. The possibility of an appendicolith with or without acute appendicitis must always be considered in the differential diagnosis of acute lower abdominal and pelvic disorders, and in the consideration of common acute urological disorders.
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PMID:Appendicolithiasis causing diagnostic dilemma: a rare cause of acute appendicitis (report of a case). 1898 58

The diagnosis of acute appendicitis has been based on the presence of right lower quadrant pain and guarding. Occasionally, the pain disappears, even in the presence of a continuing appendicular process. This phenomenon is called "the fools' paradise". We report two male patients aged 19 and 17 years with an acute appendicitis confirmed by an abdominal ultrasound in one and an abdominal CAT scan in the other, in whom the abdominal pain disappeared during the evolution. Despite of the absence of pain, both were operated, based on imaging and laboratory studies, confirming the presence of an inflamed appendix.
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PMID:[Painless acute appendicitis: "The fools'paradise": report of two cases]. 1935 Jan 73


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