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Retrocecal Appendicitis


Presentation

  • Atypical presentation may be related to the position of the appendix.[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]
  • More than half of patients with ascending retrocecal appendicitis presented with atypical clinical presentation.[ncbi.nlm.nih.gov]
  • A case of fasciitis and septic shock complicating retrocecal appendicitis is presented.[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]
Gastric Lavage
  • Without having shown great attention to pregnancy of the patient when appendicitis demands special vigilance, the duty infectiologist of a reception undertook a number of risky medical actions — a gastric lavage and a cleansing enema.[infomeds.net]
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]
  • 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]
  • 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]
  • In patients presenting with right abdominal pain with atypical clinical, laboratory and ultrasound (US) findings, acute appendicitis should be eliminated with computed tomography (CT).[ncbi.nlm.nih.gov]
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]
  • Anatomic basis for the obturator sign: inflamed appendix in the pelvis is in contact with the obturator internus muscle, which is stretched by this maneuver.[aafp.org]
  • 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]
Acute Abdomen
  • Clinical science Abstract Appendicitis refers to acute inflammation of the appendix , and is the most common cause of acute abdomen requiring emergency surgery.[amboss.com]
  • Abstract Diagnostics of Appendicitis in Particular Consideration of the Acupuncture Point Lanwei – a Prospective Study Background: In almost all Western industrial nations, appendicitis is the most frequent cause for acute abdomen.[karger.com]
  • It is diagnosed either after contrast enhanced computed tomography scan of abdomen or after diagnostic laparoscopy for acute abdomen. It is best to go for diagnostic laparoscopy in acute abdomen whenever there is diagnostic difficulty. References 1.[ispub.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]
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]
  • 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]
Right Lower Quadrant Tenderness
  • Appendicitis in a patient with a retrocecal appendix may present atypically, with less or poorly localized pain, discomfort on coughing or walking, or flank, rather than right lower quadrant, tenderness.[acuteabd.weebly.com]
  • In 80% of cases, physical examination will reveal right lower- quadrant tenderness with guarding and rebound. Pain is localized at McBurney point, or 1.5-2 inches from the anterior superior iliac spine on a line from the spine to the umbilicus.[clinicaladvisor.com]
  • The most important physical examination finding is right lower quadrant tenderness to palpation.[aafp.org]
  • Alvarado Scale for the Diagnosis of Appendicitis Manifestations Value Symptoms Migration of pain Anorexia 1 1 Signs Nausea and/or vomiting Right lower quadrant tenderness 1 2 Laboratory values Rebound Elevated temperature Leukocytosis Left shift in leukocyte[intranet.tdmu.edu.ua]
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
  • […] malignant mucoid adenocarcinoma pelvic pain caused by ovulation Should one remove the normal appendix with Crohn's disease found intraoperatively? yes unless the base of the appendix is involved with Crohn's disease[quizlet.com]
  • McBurney sign ) pelvic pain, diarrhoea and tenesmus (pelvic appendix) flank pain (retrocaecal appendix) groin pain - appendix within an inguinal hernia ( Amyand hernia ) or a femoral hernia ( De Garengeot hernia) leucocytosis 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]
  • It is especially well suited in evaluating right lower quadrant or pelvic pain in pediatric and female patients. A normal appendix (6 mm or less in diameter) must be identified to rule out appendicitis.[aafp.org]
  • The development of right lower quadrant or pelvic pain may be the first symptom. The diagnosis of ruptured ectopic pregnancy should be relatively easy. The presence of a pelvic mass and elevated levels of chorionic gonadotropin are characteristic.[intranet.tdmu.edu.ua]

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]
  • When appendiceal perforation was histopathologically confirmed (n 6), CRP was highly elevated showing an optimal cut-off point more than 121.5 mg/L (p These findings suggest that further diagnostic workup is immediately required in those patients to reduce[hoajonline.com]
  • Small-Bowel Obstruction Workup Approach Considerations If the diagnosis is unclear, admission and observation are warranted to detect early obstructions.[intranet.tdmu.edu.ua]
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]

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]
  • 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]
  • 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]
  • 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

  • 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]
  • 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]
  • 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]
  • Rarer appendiceal tumours such as adenocarcominoma have a worse prognosis.[gponline.com]
  • Treatment and prognosis Treatment is appendicectomy, 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 generalised peritonitis 5 .[radiopaedia.org]

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]
  • 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]
  • 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]
  • 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]
  • 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 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]
  • Section 1: Epidemiology and aetiology Embryological origin The vermiform (worm-like) appendix is a continuation of the caecum found at the junction of the small and large bowel.[gponline.com]
  • […] acute appendicitis K35.2 : acute appendicitis with generalized peritonitis K35.3 : acute appendicitis with localized peritonitis K35.8 : other and unspecified acute appendicitis K35.80 : unspecified acute appendicitis K35.89 : other acute appendicitis Epidemiology[pathologyoutlines.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]
  • Haematoma or oedema of the appendiceal wall with consequent luminal obstruction has been proposed as initiating the pathophysiological event in the development of post-traumatic acute appendicitis [ 9 ] .[oapublishinglondon.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]
  • […] 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, Prevention[medbullets.com]
  • Timely surgical intervention by exploratory laparotomy and drainage of the abscess by single or multiple incisions can prevent morbidity and mortality.[medresearch.in]
  • Interval appendectomy is recommended after initial non-operative management of complicated appendicitis to prevent the formation of secondary PA.[omicsonline.org]
  • 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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