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Retrocecal Appendicitis


Presentation

  • Atypical presentation may be related to the position of the appendix.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: More than half of patients with ascending retrocecal appendicitis presented with atypical clinical presentation.[ncbi.nlm.nih.gov]
  • INTRODUCTION: A case of fasciitis and septic shock complicating retrocecal appendicitis is presented.[ncbi.nlm.nih.gov]
  • Here, we present a patient with acute subhepatic-retrocecal appendicitis in whom the clinical and US findings mimicked acute cholecystitis.[ncbi.nlm.nih.gov]
  • We report two pediatric patients with retrocecal appendicitis that presented with perinephric abscess. A 3-year-old girl presented with high fever and right flank pain for more than 1 week.[ncbi.nlm.nih.gov]
Massive Splenomegaly
  • Splenomegaly 387 C Laparoscopic Splenectomy 389 D MinimalAccess Open Splenectomy 392 E Preoperative Splenic Artery Embolization 399 F Conclusions 400 32 Insulinoma of Tail of Pancreas 405 C Laparoscopic Distal Pancreatectomy Without Splenectomy 406 D[books.google.com]
Disability
  • Painful disability of the right lower extremity and apparent signs of peritonitis at the right lower abdomen were disclosed. Laboratory results revealed leukocytosis and an elevated C-reactive protein level.[ncbi.nlm.nih.gov]
Splenectomy
  • […] for Massive Splenomegaly 387 C Laparoscopic Splenectomy 389 D MinimalAccess Open Splenectomy 392 E Preoperative Splenic Artery Embolization 399 F Conclusions 400 32 Insulinoma of Tail of Pancreas 405 C Laparoscopic Distal Pancreatectomy Without Splenectomy[books.google.com]
Sneezing
  • IWorsens with sneezing, coughing, and deep breathing Pain may increase with movement, loss of appetite , nausea , vomiting , swelling of the abdomen,abdomen feels hard,onstipation,mild diarrhea ,slight fever . ...Read more See 1 more doctor answer 18[healthtap.com]
Abdominal Pain
  • Ascending retrocecal appendicitis presenting with right upper abdominal pain may be clinically indistinguishable from acute pathology in the gallbladder, liver, biliary tree, right kidney and right urinary tract.[ncbi.nlm.nih.gov]
  • RESULTS: Patients presented with right lower abdominal pain (49%, 16/33), right flank pain (24%, 8/33), right upper abdominal pain (18%, 6/33), and periumbilical pain (15%, 5/33).[ncbi.nlm.nih.gov]
  • Abstract We report a child of elongated retrocecal appendicitis who presented with abdominal pain over the right upper quadrant and circular skin erythema over the right flank. Sonography showed an elongated tubular structure over the right abdomen.[ncbi.nlm.nih.gov]
  • Keywords: Computed tomography Retrocecal appendicitis Upper abdominal pain Issue Date: 2009 Citation: Ong, E.M.W., Venkatesh, S.K. (2009). Ascending retrocecal appendicitis presenting with right upper abdominal pain: Utility of computed tomography.[scholarbank.nus.edu.sg]
  • A 6-year-old girl had lower abdominal pain for 3 days and high fever on the day of admission.[ncbi.nlm.nih.gov]
Acute Abdomen
  • Clinical science Summary Appendicitis refers to acute inflammation of the appendix, and is the most common cause of acute abdomen requiring emergency surgery.[amboss.com]
  • Case report: Ultrasonographic demonstration of portal vein thrombosis in the acute abdomen. Clin Radiol 1986;37:101-2. 8. Yanez FP, Ramirez R. Portal vein thrombosis in children. Presentation, treatment and outcome (abstract).[journals.lww.com]
  • Contrast-enhanced CT has reasonable accuracy in diagnosing appendicitis and can also reveal other causes of an acute abdomen.[msdmanuals.com]
  • Other causes of acute recurrent abdominal pain with the clinical picture of an acute abdomen include: hereditary angioedema, porphyria, familial Mediterranean fever, urinary tract infection , gastrointestinal malfunction, and psychophysiological pain.[meddean.luc.edu]
Obturator Sign
  • sign raise the patient's right leg with the knee flexed rotate the leg internally at the hip increased abdominal pain indicates a positive obturator sign Rovsing's sign pressure over the descending colon causes pain in the RLQ Evaluation Labs absolute[medbullets.com]
  • O bturator (Cope’s obturator) sign: Flexion and medial rotation at hip produces pain due to irritation of obturator muscle in pelvic appendicits. 5.[medchrome.com]
  • A psoas or obturator sign is considered positive when contact between the psoas or the obturator muscle and the inflamed appendix elicits pain.[clinicaladvisor.com]
  • sign : RLQ pain with flexion and internal rotation of the right leg Pain in the Pouch of Douglas : pain elicited by palpating the recto-uterine pouch on rectal examination Baldwin's sign : pain in the flank area when bending the right leg (suggests an[amboss.com]
Right Flank Pain
  • A 3-year-old girl presented with high fever and right flank pain for more than 1 week. Ultrasonography showed a right perinephric fluid collection with normal renal parenchyma and collecting system.[ncbi.nlm.nih.gov]
  • RESULTS: Patients presented with right lower abdominal pain (49%, 16/33), right flank pain (24%, 8/33), right upper abdominal pain (18%, 6/33), and periumbilical pain (15%, 5/33).[ncbi.nlm.nih.gov]
  • Jul 28, 2009; 15(28): 3576-3579 Published online Jul 28, 2009. doi: 10.3748/wjg.15.3576 Figure 3 A 34-year-old man with colicky right flank pain and clinical diagnosis of right ureteric colic.[wjgnet.com]
  • Two years later, she presented with fever, limping gait, and right flank pain. Ultrasound revealed fixed dilated bowel loops, a fecalith and a heterogeneous hypoechoic lesion (3.7 3.6 3.3 cm) at right psoas muscle, suspecting PA.[omicsonline.com]
  • Two years later, she presented with fever, limping gait, and right flank pain for 3 days. An abdominal ultrasound showed a heterogenous hypoechoic lesion (3.7 3.6 3.3 cm) at right psoas muscle, suspecting PA.[omicsonline.org]
Upper Abdominal Pain
  • Ascending retrocecal appendicitis presenting with right upper abdominal pain may be clinically indistinguishable from acute pathology in the gallbladder, liver, biliary tree, right kidney and right urinary tract.[ncbi.nlm.nih.gov]
  • Keywords: Computed tomography Retrocecal appendicitis Upper abdominal pain Issue Date: 2009 Citation: Ong, E.M.W., Venkatesh, S.K. (2009). Ascending retrocecal appendicitis presenting with right upper abdominal pain: Utility of computed tomography.[scholarbank.nus.edu.sg]
  • RESULTS: Patients presented with right lower abdominal pain (49%, 16/33), right flank pain (24%, 8/33), right upper abdominal pain (18%, 6/33), and periumbilical pain (15%, 5/33).[ncbi.nlm.nih.gov]
  • Ascending retrocecal appendicitis presenting with right upper abdominal pain: Utility of computed tomography. World J Gastroenterol 2009; 15(28): 3576-3579 URL: DOI:[wjgnet.com]
Limping Gait
  • Two years later, she presented with fever, limping gait, and right flank pain. Ultrasound revealed fixed dilated bowel loops, a fecalith and a heterogeneous hypoechoic lesion (3.7 3.6 3.3 cm) at right psoas muscle, suspecting PA.[omicsonline.com]
  • Unfortunately, 4 months later, she was readmitted with a 2-day history of fever, limping gait and pain in the right groin.[omicsonline.org]
Pelvic Pain
  • McBurney sign ) pelvic pain, diarrhea and tenesmus (pelvic appendix) flank pain (retrocecal appendix) groin pain - appendix within an inguinal hernia ( Amyand hernia ) or a femoral hernia ( De Garengeot hernia) leukocytosis nausea and vomiting atypical[radiopaedia.org]
  • In pelvic inflammatory disease, including salpingitis and tubo-ovarian abscess, there is a longer duration of symptoms, higher fever, greater leucocytosis and more pelvic pain. Gonococcal and chlamydial infection are the most common causes.[surgwiki.com]

Workup

  • Most often, however a workup including lab tests and imaging is required. Workup Laboratory studies There is no single lab test specific for the diagnosis of appendicitis.[cdemcurriculum.com]
Pericardial Effusion
  • Her hospital course was complicated with empyema, peritonitis, and pericardial effusion. A 6-year-old girl had lower abdominal pain for 3 days and high fever on the day of admission.[ncbi.nlm.nih.gov]
Staphylococcus Aureus
  • Pyogenic psoas abscess is most commonly a primary process associated with Staphylococcus aureus in children.[omicsonline.com]

Treatment

  • Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances.[books.google.com]
  • A combined treatment of ultrasound or CT-guided percutaneous drainage and systemic antibiotics for psoas abscess has been successfully recently and has become the preferred method for treatment [ 27 ].[omicsonline.org]
  • It has been 3 weeks after I finished treatment but still have discomfort and pain, specially if I walk, or move. Doctor said this is "normal" but I am starting to feel a little more pain than before.[ourhealth.com]
  • Diagnosis and treatment of pylephlebitis or appendicular origin (in German). Vestnik Khir Im I I Grek 1989;142:25-8. 17. Ford RD, Passinault WJ, Morse ME.[journals.lww.com]
  • The patient was a case of ruptured appendicitis with successful conservative treatment. The patient missed the follow-up schedule for elective interval appendectomy. Two years later, she presented with fever, limping gait, and right flank pain.[omicsonline.com]

Prognosis

  • Prognosis Special patient groups Appendicitis in pregnancy Children, the elderly, and pregnant women are at higher risk of perforation! References: [8] [9] [10][amboss.com]
  • PID, ovarian torsion, gyn disorders, volvulus, gastroenteritis, ectopic pregnancy, pyelonephritis, diverticulits, colorectal cancer, IBD, cholecystitis, Meckel's, mesenteric ischemia Treatment Laparoscopic Appendectomy CT guided drainage of abscess Prognosis[medbullets.com]
  • With complications (rupture and development of an abscess or peritonitis) and/or advanced age, the prognosis is worse: Repeat operations and a long convalescence may follow.[msdmanuals.com]
  • Treatment and prognosis Treatment is appendectomy, which can be performed either open or laparoscopically 5. Mortality from simple appendicitis is approximately 0.1% but is as high as 5% in perforation with generalized peritonitis 5.[radiopaedia.org]
  • Ronnett BM, Kurman RJ, Zahn CM, Shmookler BM, Jablosnki KA, Kass ME, Sugarbaker MH (1995) Pseudomyxoma peritonei in women: a clinicopathologic analysis of 30 cases with emphasis on site of origin, prognosis, and relationship to ovarian mucinous tumors[link.springer.com]

Etiology

  • Leu SY, Leonard MB, Beart RW Jr, Dozois RR (1986) Psoas abscess: Changing patterns of diagnosis and etiology. Dis Colon Rectum 29: 694-698. Procaccino JA, Lavery IC, Fazio VW, Oakley JR (1991) Psoas abscess: difficulties encountered.[omicsonline.org]
  • Etiology Pathophysiology Early : mucosal hyperemia with edema and ulceration due to obstruction of the appendix ; reversible phase Suppurative : transmural spread of infection within the appendix Gangrenous : diffuse inflammatory changes in the entire[amboss.com]
  • Introduction Increased frequency 10-30 years of age More common in US due to low fiber diet Most common etiologies are lymphoid hyperplasia fecolith obstruction Presentation Symptoms loss of appetite, nausea, vomiting fever pain moves from periumbilical[medbullets.com]
  • Laparoscopy can be used for diagnosis as well as definitive treatment of appendicitis; it may be especially helpful in women with lower abdominal pain of unclear etiology.[msdmanuals.com]
  • ETIOLOGY 1. White race Dark race; Young males ; Middle class and rich 2. Diet rich in meat and lacking cellulose 3. Long retrocecal appendix (due to diminished blood supply) 4.[medchrome.com]

Epidemiology

  • The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990;132:910. PubMed Google Scholar Browne DS. Laparoscopic-guided appendicectomy. A study of 100 consecutive cases. Aust N Z J Obstet Gynaecol 1990;30:231–233.[link.springer.com]
  • Epidemiology Common cause of acute abdomen Lifetime risk : 8% Peak incidence : 10–19 years of age References: [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Epidemiology and pathophysiology Peak incidence at 10-30yo Thought to result from obstruction of the lumen of the appendix, e.g. due to stool, lymphoid hyperplasia, vegetable matter, parasites, or neoplasm) End result is mucosal ischemia and ulceration[faculty.washington.edu]
  • […] appendicitis with generalized peritonitis ICD-10: K35.3 - acute appendicitis with localized peritonitis ICD-10: K35.8 - other and unspecified acute appendicitis ICD-10: K35.80 - unspecified acute appendicitis ICD-10: K35.89 - other acute appendicitis Epidemiology[pathologyoutlines.com]
  • Addiss DG, Shaffer N, Fowler BS (1990)The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910. Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15:557.[transbiomedicine.com]
Sex distribution
Age distribution

Pathophysiology

  • Specific sections deal with Physiology and Pathophysiology, Clinical Presentation of Disease, Clinical Manifestations and Management (discussing the Mouth and Esophagus, The Stomach and Duodenum, The Intestine, and The Pancreas), Diagnosis of Gastrointestinal[books.google.com]
  • Epidemiology and pathophysiology Peak incidence at 10-30yo Thought to result from obstruction of the lumen of the appendix, e.g. due to stool, lymphoid hyperplasia, vegetable matter, parasites, or neoplasm) End result is mucosal ischemia and ulceration[faculty.washington.edu]
  • Etiology Pathophysiology Early : mucosal hyperemia with edema and ulceration due to obstruction of the appendix ; reversible phase Suppurative : transmural spread of infection within the appendix Gangrenous : diffuse inflammatory changes in the entire[amboss.com]
  • […] and young adults, most commonly occurring between early teens and 25 but may occur at any age; higher incidence in younger subjects likely related to increased lymphoid tissue More common with a low bulk Western diet, less common in Africa and Asia Pathophysiology[pathologyoutlines.com]

Prevention

  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.com]
  • To prevent conversion due to hemodynamic instability, it is mandatory to work with an ultralow intra-abdominal pressure under 8mmHg.[websurg.com]
  • Timely surgical intervention by exploratory laparotomy and drainage of the abscess by single or multiple incisions can prevent morbidity and mortality.[medresearch.in]
  • The most crucial aspect of treatment is timely intervention (laparoscopic or conventional open appendectomy ) to prevent progression to perforation and sepsis, as well as antibiotics.[amboss.com]

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