ABSTRACT
ABSTRACT A 34-years-old pregnant woman admitted in the emergency unit complaining about worsening right iliac fossa pain for 2 days. Acute appendicitis was the suspected diagnosis. Laboratory exams were ordered and results were within normal limits for infectious and inflammatory aspects. Ultrasound scan revealed a pregnancy in course without alterations and a thickness of the appendix wall without inflammatory signs in the surrounding tissue. Because the suspicion of acute appendicitis remained, a magnetic resonance was done and confirmed the diagnosis of a cecal appendix lipomatosis.
RESUMO Paciente de 34 anos, do sexo feminino, grávida, chega ao pronto-socorro com queixa de dor na fossa ilíaca direita piorando nos últimos 2 dias com suspeita de apendicite aguda. Foram solicitados exames laboratoriais, que estavam dentro dos limites de normalidade para aspectos infecciosos e inflamatórios. Exame de imagem também foi solicitado, sendo a ultrassonografia o método de escolha, que revelou gravidez em curso sem alterações e espessura da parede do apêndice sem sinais inflamatórios. Ainda com suspeita de apendicite aguda, foi realizada ressonância magnética, confirmando a hipótese de lipomatose do apêndice cecal.
Subject(s)
Humans , Female , Adult , Appendicitis/diagnostic imaging , Appendix/diagnostic imaging , Lipomatosis , Acute Disease , Ultrasonography , Diagnosis, DifferentialABSTRACT
INTRODUCTION: Femoral hernias have a high risk of strangulation or obstruction, and their acute presentations are associated with a high risk of mortality, occurring in up to 60% of cases with complications. The presence of the appendix within the femoral sac has been described in a maximum of 1% of cases, which has been called Garengeot hernia, but only 0.08% with concomitant appendicitis. CASE REPORT: Woman 56 years old, cholecystectomized, with no other relevant history, 5 months of evolution, right femoral region volume increase, consultation for 24 hours of evolution of habitual pain exacerbation, CT scan showing complicated hernia, with appendix inside of the hernial sac. The right inguinal approach is performed, the cecal appendix is the only content within the hernial sac, with signs of acute appendicitis, appendectomy and hernia repair with Prolene mesh. Diagnosis is confirmed with biopsy. DISCUSSION AND CONCLUSION: Acute appendicitis within De Garengeot's hernia is extremely rare and often difficult to diagnose. The diagnosis of a femoral hernia appendicitis is often obscured by nonspecific clinical findings that indicate a complicated hernia. Computed tomography may be useful to definitively diagnose acute appendicitis contained within a femoral hernia. It is important to always consider De Garengeot hernia as a differential diagnosis in patients with inguinal mass of acute pain, so as not to delay its detection and management.
Subject(s)
Humans , Female , Middle Aged , Appendix/diagnostic imaging , Hernia, Femoral/diagnostic imaging , Appendicitis/diagnosis , Appendix/surgery , Appendix/blood supply , Medical Records , Hernia, Femoral/surgery , Hernia, Femoral/complicationsABSTRACT
El apéndice cecal es un órgano pródigamente estudiado, debido a la gran frecuencia con que se producen inflamaciones agudas en él, no obstante, son menos conocidas las anomalías congénitas que resultan en una duplicación apendicular, por ser esta una entidad rara. Se presenta un caso de una paciente que se interviene quirúrgicamente por una apendicitis aguda, en la cual se encontró otro apéndice cecal. Se realiza discusión y revisión del tema(AU)
Cecal appendix is much studied organ due to the high frequency of its acute inflammations, however, the congenital anomalies are less associated resulting in a appendicular duplication because of it is a rare entity. This is the case of a female patient operated on due to acute appendicitis founding another cecal appendix(AU)
Subject(s)
Humans , Female , Adult , Appendix/diagnostic imaging , Appendectomy , Appendix/abnormalitiesABSTRACT
Abstract: The development of the US and CT has increased the request of exams to confirm or to discard the diagnosis of acute abdomen of appendicular origin. The objective of this paper is to characterize the appendix normal findings in helical unenhanced CT. 235 computed CT were reviewed. The average diameter of the appendix was of 6,18mm, with a standard deviation of 1,29mm; air was seen at the appendix lumen in 76% of them. The periappendicular fatty was normal in 98,9% of the patients.
El desarrollo del ultrasonido (US) y tomografía computada (TC) ha aumentado la solicitud de exámenes para confirmar o descartar el diagnóstico de abdomen agudo de origen apendicular. El objetivo del trabajo es caracterizar los hallazgos del apéndice normal en TC helicoidales efectuadas sin contraste. Se revisaron 235 TC. El diámetro promedio del apéndice fue de 6.18 mm con una desviación estándar de 1.29 mm; el 76% de ellos presentaban aire en su interior. En el 98.9% de los pacientes, el tejido adiposo periapendicular fue normal.
Subject(s)
Humans , Appendix/diagnostic imaging , Tomography, X-Ray Computed/methods , Abdomen, Acute/diagnostic imaging , Sensitivity and SpecificityABSTRACT
During a 10 month period high resolution sonography was used in the evaluation of 80 patients with an equivocal clinical diagnosis of acute appendicitis. The sonographic findings were correlated with the surgical and pathological outcome in 53 cases and with clinical follow-up in the remainder. This technique was found to be accurate in the diagnosis of acute appeudicitis with a specificity of 95%, a sensitivity of 86% and accuracy of 91%. The predicitve value of a positive test was 93%, that of negative test was 89%. The results showed that high resoluion sonography is indicated to establish the diagnosis of acute appendicitis in patients with equivocal clinical findings