A Case Report: Unusual Presentation of a Common Disease
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 19, Issue 2
Abstract
Appendicitis is a common disease. However, tip appendicitis is found in 4-5% of all appendicitis. Tip appendicitis, complicated by internal herniation of caecum with small intestine resulting in small loop obstruction of small intestine, is more rare condition. Here, we report a case of tip appendicitis masquerading as caecal volvulus.The diagnosis of acute appendicitis is mainly clinical, and presentation of acute appendicitis may be typical or atypical. Typical presentation starts with vague peri-umbilical pain for several hours, which later migrates to the right iliac fossa (RIF), associated with lack of appetite, nausea or vomiting. Atypical histories may include pain in the right lower quadrant as an initial symptom [1]. Acute Appendicitis with Atypical Presentation: retrocecal location, malrotation by situs inversus, appendix with inguinal hernia, tip appendicitis, stump appendicitis and intraluminal appendiceal air. Appendicular Abnormalities Simulating Acute Appendicitis: appendicular dilatation, appendicular diverticulitis, appendicular inflammation by contiguity, tumors and mucocele. Distal appendicitis is the obstruction of the vermiform appendix frequently caused by an fecalith which may be located at any segment of the appendix. Because of this, a small percentage of cases show an obstruction at the level of the tip with the consequent initial inflammation of only just a small segment distal to the obstruction at a relative distance from the base and, the typical findings, such as the inflammatory involvement of the cecum, could be absent and the more insidious clinical symptoms make diagnoses more difficult. The typical MDCT (Multidetector Computed Tomography) findings in acute appendicitis are appendicular dilatation, increased wall thickness, signs of peri-appendicular inflammation and the presence of an faecolith [2]. Loss of the echogenic mucosal stripe reflects a. Ischemic ulceration, b. Loculated periappendiceal fluid is virtually diagnostic of perforated appendicitis, c. Mural hyperemia on color Doppler indicates inflammation; mural pneumatosis and lack of color Doppler flow are seen with gangrenous appendicitis, d. Increased periappendiceal and pericecal echogenicity is related to mesenteric and/or omental inflammation, e. Periappendiceal fluid, mesenteric adenopathy and a dynamic small bowel are less specific ultrasound findings [3].
Authors and Affiliations
Muhammed AS, Aye M, Harshad R, Malik KK
Keywords
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- EP ID EP620691
- DOI 10.26717/BJSTR.2019.19.003272
- Views 129
- Downloads 0
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