A Case of Ascending Colon Diverticulitis with Perforation in a Child / 대한소아소화기영양학회지

A diverticulum is a blind pouch communicating with the gut. The term "diverticulitis" indicates inflammation of a diverticulum or diverticula, which is commonly accompanied by gross or microscopic perforation. Acute diverticuitis is a rare disorder in early childhood. Itis difficult to diagnose acute right colon diverticulitis from common causes of RLQ pain. We report a case of acute diverticulitis in the right colon in a 6-year-old girl. She complained of typical RLQ pain mimicking acute appendicitis,but was diagnosed with acute diverticulitis by CT scanning. Conservative treatment failed because of peritonitis due to perforation of an inflamed diverticulum. After the diverticulcetomy, the symptoms resolved.

A Case of Ascending Colon Diverticulitis with Perforation in a Child / 대한소아소화기영양학회지

A diverticulum is a blind pouch communicating with the gut. The term "diverticulitis" indicates inflammation of a diverticulum or diverticula, which is commonly accompanied by gross or microscopic perforation. Acute diverticuitis is a rare disorder in early childhood. Itis difficult to diagnose acute right colon diverticulitis from common causes of RLQ pain. We report a case of acute diverticulitis in the right colon in a 6-year-old girl. She complained of typical RLQ pain mimicking acute appendicitis,but was diagnosed with acute diverticulitis by CT scanning. Conservative treatment failed because of peritonitis due to perforation of an inflamed diverticulum. After the diverticulcetomy, the symptoms resolved.

An unusal cause of RLQ abdominal pain in premenarcheal girl: A case of torsion of normal adnexal torsion / 대한산부인과학회지

Torsion of a normal adnexa is rare, but can occurs. For premenarcheal girls, gynecologic disorders are less commonly considered in differential diagnosis because they occur infrequently. Generally, girls with right lower quadrant pain are considered to have appendicitis untill proven otherwise. An immediate diagnosis is very important because early surgical intervention is the only way to save the ovary from necrosis. The author reviews the clinical presentation, ultrasonographic and MRI feature and treatment of torsion of normal uterine adnexa.

Right Lower Quadrant Pain in Patients with Acute Myeloid Leukemia

PURPOSE: Acute appendicitis and typhlitis are difficult problems in acute myeloid leukemia (AML) patients. Whereas the treatment of typhlitis is primarily conservative, acute appendicitis is managed by surgery. The difficulty lies in distinguishing between the two becauae they both present similar conditions, and before surgery or autopsy, differentiation of these disease is nearly impossible. Careful evaluation is necessary before considering surgical treatment. In order to determinate proper treatment, we have reviewed our experiences with the right lower quadrant (RLQ) abdominal pain in patients with AML. METHODS: From July 1990 to December 2001, at St. Mary's hospital, Seoul, Korea, the records of AML patients that were consulted to the surgical department for RLQ abdominal pain were reviewed. Thirty patients were consulted and 12 out of the 30 patients underwent surgery. RESULTS: The average age of the patients who underwent operation was 33.9, with 9 males and 3 females. Six patients were in complete remission, and the other 6 were in the active state. RLQ pain was the first symptom of AML in four patients. All 12 patients had RLQ pain and 10 had rebound tenderness. In three patients, the white blood cell (WBC) count was less than 1, 000/mm3. Appendectomy was performed in five patients, appendectomy with drainage was performed in five, and laparoscopic appendectomy was performed in two patients. The final diagnosis was periappendicial abscess in four cases, leukemic cell infiltration in three cases, adenocarcinoma in one case, and typhlitis in three patients. Four patients developed wound infection and one patient died due to sepsis 7 days after the operation. For the patients who were treated medically, the average age was 36, with 11 males and 7 females. Seven patients were in the active state, three patients were in CR, four patients were in the refractory state, and two patients were in relapse. Six patients died within one month because of sepsis or pneumonia. CONCLUSION: Surgery is safe and is the sole method that can improve the survival rate in patients with AML and RLQ abdominal pain. Furthermore, complications related to surgery may be reduced through the laparoscopic surgery.

Clinical Evaluation about RLQ Pain Seconary to Chronic Constipation (or Fecal Impaction): About DDx from caute appendicitis

There are many causes of the right lower quadrant(RLQ) abdominal pain. Although the most common underlying cause may be acute appendicitis, chronic constipation(or fecal impaction) is the cause in some portions. In review of 120 patients with chronic constipation between 1990 and 1996, we evaluated the clinical characteristics of the RLQ pain secondary to chronic constipation. In case of the RLQ pain secondary to chronic constipation, the key points in the DDx from the RLQ pain due to acute appendicitis are as follows. (1) RLQ pain in chronic constipation is characterized by dull pain and usually it has been complained for several weeks, several months or even several years in more than half. (2) The patients don't have accompanying G-I symptoms(such as anorexia, nausea, vomiting, and epigastric pain) in more than 90%. (3) The patient complains of mild tenderness in RLQ area in some cases but no rebound tenderness was found in any cases. (4) In almost all cases, WBC count in patient's blood is within normal limits and body temperature is under 37.0degrees C. (5) For the most part, simple abdomen X-ray finding shows large or moderate amount of fecal material in the colon. So I suggest that (a) DDx in the RLQ pain could be made between acute appendicitis & chronic constipation by above findings and (b) In case of chronic constipation we need not perform negative appendectomy and it could be managed by conservative management such as enema, laxatives, high fiber diet, etc. Conclusively, I mention that the rate of negative appendectomy would be able to be reduced a little by taking these points into consideration in the clinic.