Examining the Outcomes of Hybrid Coronary Revascularization in Acute STEMI Patients from 2015 to 2022.

Background: The global rise of chronic diseases, especially cardiovascular disease (CVD), poses a significant public health challenge, being a leading cause of death and disability worldwide. In Iran, the surge in CVD incidence and its risk factors, along with a decrease in the age of onset, has notably increased the reliance on coronary artery bypass grafting (CABG) as a life-saving intervention. Staged hybrid coronary revascularization (HCR), which combines percutaneous coronary intervention with delayed CABG, offers a novel approach for patients with complex coronary artery disease, potentially improving survival and reducing complications. Considering the newness of this treatment method and the limitations of previous studies, we investigated the results of staged HCR in acute ST-elevation myocardial infarction (STEMI) patients in this study. Methods: This observational study was performed on consecutive patients with acute STEMI who underwent staged HCR and were referred to Valiasr and Razi hospitals in Birjand from 2015 to 2022. The required information (demographic information, angiography result, and operation side effects) was collected in a checklist. If necessary, the patients were contacted by phone. After collecting the data, they were entered into SPSS version 16 software. Results: This study was conducted on 33 patients with a mean age of 64.88 ± 9.24 years (69.7% male). The average hospital stay was 11.6 ± 8.9 days (3 to 72 days). The mean ejection fraction and syntax score were 36.5% ± 10.2% and 31.21 ± 6.7, respectively. Following surgery and during hospitalization, arrhythmias were observed, including 33.3% with premature ventricular contractions, 18.1% with atrial fibrillation, and 3.1% with ventricular tachycardia. The average number of pack cells (red blood cells that have been separated for blood transfusion) and creatinine changes before and after hybrid surgery were 640.9 ± 670.9 cc and 0.055 ± 0.07. In the follow-up, 9.09% of patients had late mortality, 6.1% of patients had urinary tract infections during hospitalization, 6.1% of patients had surgical site infections, 3.1% needed dialysis, and none of the studied patients had premature death or need for reintervention. Conclusions: The results of our study indicated that staged HCR performed early after an ACS is not associated with significant mortality or complications. Therefore, it is advisable to consider staged HCR as a surgical option in appropriate cases.

Comparison of the effect of incentive spirometry and deep breathing exercises on hemodynamic parameters of patients undergoing coronary artery bypass graft surgery: A Clinical Trial.

BACKGROUND AND OBJECTIVE: Hemodynamic changes are among the common complications after coronary artery bypass graft (CABG) surgery. Incentive spirometry (IS) and deep breathing exercises (DBEs) are widely used in patients undergoing CABG surgery. The aim of the present study was to compare the effect of IS and DBEs on hemodynamic and oxygenation parameters of patients undergoing CABG surgery. METHODS: This is a clinical trial that was performed on 40 patients with heart disease who were candidates for coronary artery bypass graft surgery. Participants were selected using convenience sampling and then randomly divided into two groups. One day before surgery, one group was taught how to perform DBE and the other group was taught how to use IS in practice. Hemodynamic and oxygenation indices were measured and recorded before the intervention, the first, second, and the third day after the intervention. Data analysis was carried out using SPSS ver.16 and descriptive and inferential statistical tests. RESULTS: The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) on the first day after the intervention in patients undergoing the IS group was significantly higher than the DBE group (p<0.05). On the third day after the intervention, the mean arterial oxygen saturation (SaO2) in patients of the IS group was significantly higher than the DBE group and the mean respiratory rate (RR) in patients in the IS group was significantly lower than the DBE group (p <0.05). However, there was no significant difference between the two groups in terms of other indices (p> 0.05). CONCLUSION: The results showed that IS has a greater effect on hemodynamic and oxygenation indices of patients undergoing CABG compared to DBE, so, it is recommended to use IS to improve hemodynamic and oxygenation indices in these patients.

Prognostic Value of Procalcitonin for Morbidity and Mortality in Patients after Cardiac Surgery.

BACKGROUND: The increased serum procalcitonin (PCT) level in cardiac patients is known as a sign of postoperative complications. OBJECTIVE: Considering the importance of predicting the incidence of both complications and mortality caused by coronary artery bypass graft (CABG) surgery, this study was conducted to determine the serum PCT level and its relationship with one-year morbidity and mortality among CABG patients. METHODS: This descriptive-analytical study was performed on 100 patients who underwent CABG surgery in Vali-e-Asr Hospital of Birjand, Iran. They were selected by a census sampling method from March 2014 to March 2015. The Elecsys BRAHMS PCT kit (Roche Company) was then used to measure the patients' serum PCT level. The required data were collected using the patients' medical records and telephone interviews with the patient or his/her relatives by passing one year from their discharge. The outcomes of this study comprised of mortality and morbidity causes (e.g., dysrhythmia, infection, and stroke). The data were then analyzed in SPSS version 16 by Mann-Whitney, chi-squared, and Fisher exact tests. RESULTS: The postoperative serum PCT level is significantly correlated with sternum wound infection (p=0.001), packed cells (PC) transfusion (p=0.003), and death (p=0.003). In addition, a significant relationship was found between dyslipidemia and hypertension and early mortality rate in patients with high levels of PCT. Of note, risk-adjusted death did not differ significantly between the serum PCT levels after one year (RR, 0.068; 95% CI 0.008-0.566). CONCLUSION: Higher PCT serum levels in CABG patients are associated with the increased early mortality rate, sternum wound infection, and PC transfusion. Additionally, the other factors associated with mortality in the patients under study included dyslipidemia and hypertension.

The compliance of surgical prophylactic antibiotics with standard protocols in Imam Reza teaching hospital of Birjand, Iran.

BACKGROUND AND OBJECTIVES: Taking unnecessary or inappropriate prophylactic antibiotics can cause infections with resistant organisms. The present study aimed to investigate administration prophylactic antibiotics in surgery ward and its compliance with standard protocol in Imam Reza teaching hospital of Birjand, Iran. MATERIALS AND METHODS: This descriptive-analytical study was performed to evaluate the pattern of prophylactic antibiotics on patients who underwent surgical operations from October to December 2019. A checklist including demographic information, type of prophylactic antibiotics, dose and duration of using drug, type of surgery, and compliance with standard protocol was used. The validity and reliability of the checklist were evaluated and confirmed prior to the study. All eligible patients were enrolled and the information of the prescribed drugs in the surgical wards was compared with the Schwartz's principles of surgery as standard protocol. RESULTS: Out of a total of 300 patients, 187 (62.3%) were male. Among the patients, 155 (51.7%) cases underwent general surgery, 119 (39.6%) cases orthopedic surgery, and 26 (8.7%) cases neurosurgery. The most popular prescribed antibiotics were cefazolin (170 cases) and ceftriaxone + metronidazole (67 cases). Furthermore, the maximum antibiotic administrations were two days (127 cases) and one day (93 cases). More importantly, 67.7% and 92.3% of the patients were in compliance with the standard protocol in terms of the type and time of administration, respectively. CONCLUSION: Our results showed that duration and route of administrating antibiotics were consistent with the standard protocol, but the type of drugs and indication did not match.

Rare report of concurrent metastasis on bilateral atrial myxoma masses.

BACKGROUND: This study simultaneously reports bilateral atrial tumor masses including the concurrent occurrence of metastatic carcinoma, consistent with metastatic breast carcinoma, on the main cardiac myxoma mass in the left atrium (LA) and metastatic carcinoma consistent with metastatic breast carcinoma for the right atrial (RA) mass. CASE REPORT: These masses were observed in a 79-year-old female patient who had received her pacemaker 6 months ago due to electrical conduction disease. However, no tumor/mass was found in her echocardiogram at the time of the pacemaker reception and mild chest pain and dyspnea were the only signs of her huge masses. Bilateral interseptal atrial cardiac masses protruded to the LA and RA were observed in both atrial chambers in echocardiography, and she underwent the surgical resection of masses. CONCLUSION: The findings of the current study represented a novel condition for a patient. More precisely, the patient had two different huge cardiac masses, and at the same time, the metastasis of breast cancer was reported on the other cardiac tumor/myxoma as well. In addition, metastatic carcinoma should be suspected in patients with cardiac myxoma mass consistent with heart block. The simultaneous presence of multiple masses inside the heart is not always evidence of myxoma, rather can be a metastatic lesion.

Effect of Ghrelin Hormone as a Diagnostic Factor on Appendicitis.

BACKGROUND: Appendicitis is the most common cause of surgery in people under 50. In America, it causes 250,000 cases per year and about 1 million days of hospitalization. METHODS: This cross-sectional study was performed on 20 patients under appendectomy with diagnosis of acute appendicitis. The statistical population was divided into two groups, proven appendicitis in pathology and rejection of appendicitis in pathology. Then, 10 patients were assigned into each group. RESULTS: A total of 20 patients were enrolled in this study, 9 of whom were female (45%) and 11 male (55%). The most common symptom was anorexia. However, there was no statistical difference between the two groups. The lowest level of serum ghrelin was 0.95 and the highest was 16.00 in the study group, which was the mean in people with appendicitis and nonappendicitis 6.24 ± 4.09 and 5.12 ± 4.85, respectively. These values were not significantly different between the two groups (T = 0.45, df = 18, p = 0.65). CONCLUSION: This conclusion may be due to the small number of cases introduced into the study, which suggests that further investigation is warranted with a larger sample size.

A rare case of patent ductus arteriosus diagnosed during coronary artery bypass grafting operation in a 73-year-old man.

BACKGROUND: Although patent ductus arteriosus (PDA) is more prevalent among infants and children, it might be seen among adults as well. It is not usually seen among adults, since it is often diagnosed and treated in childhood. CASE REPORT: In the present case, a 73-year-old man referred to the hospital with symptoms including dyspnea, cold sweating, and chest pain with a burning nature which was lasting for 30 minutes. Angiography revealed coronary artery obstruction, so he became a coronary artery bypass grafting (CABG) candidate. Except for dilatation of the left atrium, no specific findings were reported in the patient's echocardiography report. When the pump was turned off by the surgeon, the patient's heart filled up and he was not able to get off the pump. Simultaneously, the patient started to have bloody respiratory secretions. With all that in mind, the surgeon suspected that he might suffer from a PDA, then he found an 8-mm PDA and closed it. Then, the patient was taken off the cardiorespiratory pump. CONCLUSION: Although PDA is more common among children and infants, it can be found among adults according to previous cases and our case as well. Since patients with PDA refer to physicians for other clinical issues, it is recommended to apply more precision in diagnostic methods such as taking a good history, echocardiography, and electrocardiogram (ECG). Moreover, it is recommended that if a patient has conditions similar to our patient, the surgeon must be sure of a possible PDA.

Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery Outcomes During 6 Years: A Prospective Cohort Study.

Given the ongoing controversy over the risks and benefits of on-pump versus off-pump coronary artery bypass graft surgery (CABG), we aimed to compare time trends in off- and on-pump CABG long-term outcomes. In this prospective cohort study, the patients who underwent primary isolated non-emergent CABG in Imam Reza Hospital in Mashhad, Iran, in 2006 were followed for 6 years. The patients were contacted to obtain long-term follow-up data such as death, rehospitalization, myocardial infarction, and normal physical activity. The obtained data were analyzed in SPSS software (V: 16) using t-test, Fisher's Exact, chi-square, and Mann-Whitney tests, and relative risk. The significant level was set at P<0.05.The study included 61 patients of whom n=40 (65.6%) underwent off-pump CABG. The mean age of the patients was 59.0±11.31 years, and n=43 (70.5%) were men. No significant differences were found between the two groups in terms of outcomes during the 6 years (e.g., death, rehospitalization, myocardial infarction, and normal physical activity). There was 1 (5.0%) death, overall. Risk-adjusted death did not differ significantly between the off-pump and on-pump groups during the 6 years (RR, 0.952; 95% CI 0.866 to 1.048).According to the results, the outcomes were similar between off-pump and on-pump CABG in patients who underwent primary isolated non-emergent CABG during the 6-year follow-up phase.

Comparing the Effects of 5% Albumin and 6% Hydroxyethyl Starch 130/0.4 (Voluven) on Renal Function as Priming Solutions for Cardiopulmonary Bypass: A Randomized Double Blind Clinical Trial.

BACKGROUND: The ideal strategy to prime the cardiopulmonary bypass (CPB) circuit in adult cardiac surgery is still a matter of debate. OBJECTIVES: In this retrospective study, we examined Albumin solution and hydroxyethyl starch (HES) for priming the CPB circuit and evaluated the differences in kidney function and bleeding and coagulation status in the two groups of patients. PATIENTS AND METHODS: Sixty consecutive patients undergoing elective coronary artery bypass grafting were studied. Patients were excluded due to emergency surgery, history of cardiac surgery, history of receiving medication with antiplatelet agents except ASA 80 (mg/day) within the previous five days, preoperative coagulation disorder, left ventricular ejection fraction less than 50%, preoperative renal dysfunction (serum creatinine > 1.4 mg/dL), preoperative hepatic dysfunction (serum aspartate/alanine amino transferase > 60 U/l), preoperative electrolyte imbalance, known hypersensitivity to HES and chronic diuretic therapy. The patients were divided randomly into two groups of HES (n = 30) and Albumin (n = 30). Hemodynamic parameters, serum creatinine concentrations and glomerular filtration rate, PT, PTT and INR were measured. Early bleeding was measured according to the first 24-hour drainage from the tube. Hemodynamics and all laboratory measurements were performed after induction of anesthesia and at the morning of the first, second and third postoperative days in the ICU. RESULTS: GFR differences were statistically lower in Albumin group in comparison with Group B at 24, 48 and 72 hours postoperation. Platelet count difference and postoperative bleeding were significantly lower in Albumin group. CONCLUSIONS: Administration of Albumin compared to HES in patients with a normal renal function results in a lower drop of GFR and platelet count, less bleeding and lower rise of serum creatinine.

Clinicopathological comparisons of open vein harvesting and endoscopic vein harvesting in coronary artery bypass grafting patients in Mashhad.

INTRODUCTION: Harvesting of the greater saphenous vein is almost an inevitable part of coronary artery bypass grafting (CABG) operations, and it is done by two main techniques, i.e., conventional or open vein harvesting (OVH) and the minimally-invasive endoscopic vein harvesting (EVH). This study aimed to compare these two techniques in off-pump CABG procedures with respect to clinical and pathological outcomes. METHODS: This cohort study was conducted on CABG candidates during a one-year period from October 2013 through September 2014 in the Department of Cardiac Surgery at Mashhad University of Medical Sciences. Eighty-seven patients voluntarily underwent EVH, and another 86 patients matched for age, gender, and other cardiovascular risk factors were selected for OVH. They were followed up for six weeks, and the main outcome measures were infections of the wound, pain, duration of hospital stay, and the costs of hospitalization. Paired sample t-test, independent t-test, or their non-parametric equivalents and the chi-squared test were used by SPSS version 17.0 for data analysis. RESULTS: The mean duration of time for vein harvesting was shorter in the EVH group (p < 0.001), and the pain score was lower (p = 0.04). No infections occurred at the site of the wound. The length of hospital stay was not significantly different for the two groups (OVH versus EVH: 8.5 ± 3.3 versus 8.4 ± 3.2 days; p-value: 0.08). Hospitalization costs were significantly higher in the EVH group (OVH versus EVH: 5.8 ± 4.7 versus 7.3 ± 2.0 million Tomman; p-value: 0.008), yet no difference was diagnosed with respect to endothelial damage in the vein grafts harvested by the EVH and OVH techniques. CONCLUSION: EVH is considered as a minimally invasive and safe vein harvesting technique in our Center, and it can reduce the harvesting time and post-operative pain. In addition, its efficiency was similar to that of OVH.

The comparison of saline enema and bisacodyl in rectal preparation before anorectal surgery.

BACKGROUND: Given the limited data on the need of mechanical bowel preparation application before anorectal surgeries and the preferred method for bowel preparation, we aimed to compare saline enema and bisacodyl in rectal preparation before anorectal surgery. MATERIALS AND METHODS: This is a randomized clinical trial study. Seventy-nine hospitalized patients for anorectal surgery (hemorrhoid, fissure, and fistula) were recruited by convenient sampling and then randomly allocated to receive 500 cc Saline by rectal enema or six bisacodyl tablets (Sobhan company) beginning from a day before the operation in order to prepare the bowel. After surgery, surgeons' satisfaction of the surgery and patients' satisfaction of the preparation process were evaluated in the ward using Likert score by a nurse blind to the study. Also, the patients were interviewed for pain after the first defecation, using numeric rating scale based on a 0-10 scores. All patients were actively followed-up after discharge for 1 mo concerning postoperative complications. The obtained data were analyzed by SPSS software (version 16), Mann-Whitney, chi-squared, and Fisher exact tests at the significant level of P < 0/0.5. RESULTS: A total of 79 patients participated in the study, 38 received 500-cc saline by rectal enema and 41 bisacodyl tablets. No significant differences were observed between the two groups in most variables except for pain after the first defecation (P = 0.032). CONCLUSIONS: According to the results, the bisacodyl approach results in less pain in the first postoperative defecation and fewer complications than the rectal enema. Thus, bisacodyl can be suggested as a superior counterpart for enema.

The Best Anticoagulation Therapy in Multiple-Trauma Patients with Mechanical Heart Valves: Evaluation of Latest Guidelines and Studies.

BACKGROUND: It is common practice for patients with prosthetic cardiac devices, especially heart valve prosthesis, arterial stents, defibrillators, and pacemaker devices, to use anticoagulation treatment. When these patients suffer from multiple trauma after motor vehicle accidents, the best medical management for this challenging position is mandatory. This strategy should include a rapid diagnosis of all possible multiple organ injuries, with special attention to anticoagulation therapy so as to minimize the risk of thromboembolism complication in prosthetic devices. In this review, we describe the best medical management for patients with multiple trauma who use anticoagulants after heart valve replacement. METHODS: We searched electronic databases PubMed/Medline, Scopus, Embase, and Google Scholar using the following terms: anticoagulant, warfarin, heparin, and multiple trauma. Also, similar studies suggested by the databases were included. Non-English articles were excluded from the review. RESULTS: For patients who use anticoagulation therapy, teamwork between cardiac surgeons, general surgeons, anesthesiologists, and cardiologists is essential. For optimal medical management, multiple consults between members of this team is mandatory for rapid diagnosis of all possible damaged organs, with special attention to the central nervous system, chest, and abdominal traumas. With this strategy, it is important to take note of anticoagulation drugs to minimize the risk of thromboembolism complications in cardiac devices. CONCLUSION: The best anticoagulant agents for emergency operations in patients with multiple trauma who are using an anticoagulant after heart valve replacement are fresh frozen plasma (FFP) and prothrombin complex concentrates (PCC).

Study of treatment results and early complications of tube drainage versus capitonnage after the unroofing and aspiration of hydatid cysts.

OBJECTIVE: There is controversy concerning the management of the remaining cavity after the evacuation of a cyst in patients who have undergone surgical operation for liver hydatidosis. This study compares the results of capitonnage and tube drainage of the remaining cavity. METHODS: In this retrospective study, participants were selected from two groups of patients with a liver hydatid cyst who underwent capitonnage or tube drainage from 2004 to 2012. The patients were followed for 6-24 months. The data of age, sex, involved liver lobe, size of the cyst, complications, drain duration, and hospital stay were analyzed. RESULTS: Participants included 155 patients consisting of 96 (61.94%) females and 59 (38.06%) males. Most cysts were in the right lobe, and the most common diameter of the cysts was greater than 10 cm. Capitonnage was performed on 90 (58.06%) patients and the tube drainage procedure was performed on the remaining 65 (41.94%) patients. In the tube drainage group and the capitonnage group, the operative times were 2.21 ± 0.65 hours and 2.53 ± 0.35 hours, respectively; the hospital stays were 5.695 ± 3.37 days and 4.43 ± 2.96 days, respectively; the drain duration was 9.2 ± 1.7 days and 2.1 ± 0.4 days, respectively; and the time to return to work was 14.7 ± 2.3 days and 8.3 ± 10.4 days, respectively. All variables were statistically significant, except for the operative time. Cavity infection and biliary fistula were identified in three patients and six patients, respectively, in the tube drainage group and identified in two patients and three patients, respectively, in the capitonnage group. This difference was not statistically significant. CONCLUSION: This study demonstrated that capitonnage versus the tube drainage method may result in a shorter hospital stay, decreased time to return to work, and low rate of morbidity and complications.

A rare central venous catheter malposition: a case report.

INTRODUCTION: Central venous catheter placement is a routine procedure for the management of critically ill patients; however, it is important to ensure its proper placement. A central venous catheter malposition may cause various complications, some of which can be fatal. CASE PRESENTATION: We report an unexpected malposition of a catheter in the left internal jugular vein, where it entered into the left internal mammary vein. CONCLUSIONS: We think one of the influential factors for leading a guidewire and catheter into a nominated vein may be the left sided bevel of the needle at the time of internal jugular vein needle and catheter insertion. We were required to continue going towards the subclavian vein and accidentally turned into the left internal mammary vein.

Successful treatment of cardiogenic shock with an intraaortic balloon pump following aluminium phosphide poisoning.

Aluminium phosphide (AlP) is a highly toxic pesticide that inhibits cytochrome oxidase c and causes oxidative stress. Death results from refractory cardiogenic shock due to myocardial dysfunction. There is very little information regarding extracorporeal life support in severe AlP poisoning. Although several therapies are available, none are curative. We report on the use of an intra-aortic balloon pump (IABP) in a 24-year-old woman brought to our hospital after an intentional ingestion of a tablet of AlP (3 g), which caused refractory AlP-induced cardiogenic shock and acute respiratory distress syndrome (ARDS). The patient underwent gastric lavage with potassium permanganate, received sodium bicarbonate intravenously, and was admitted to the intensive care unit. Echocardiography at 36 h post ingestion showed a left ventricular ejection fraction (LVEF) of <20 %. An IABP was inserted and the patient's vital signs stabilised. After eight days, the IABP was removed and on day 20, the patient's LVEF increased to 50 %. IABP was successfully used and may improve future prognoses for severely poisoned AlP patients with refractory cardiogenic shock. We encourage clinical toxicologists to examine this new treatment.

Treatment of non-healing sternum wound after open-heart surgery with allogenic platelet-rich plasma and fibrin glue-preliminary outcomes.

INTRODUCTION: Non-healing wound in the sternal region after coronary arteries bypass graft surgery is a serious complication. For healing a chronic wound, several novel approaches have been proposed recently such as using bone marrow stem cells, platelets and fibrin glue (PFG); but a non-invasive method is highly desirable in the first approach for treatment. The current study was undertaken to evaluate the effect of the combination of PFG in one treatment. MATERIALS AND METHODS: We report on the treatment of six patients with life-threatening chronic sternum wounds, which caused septicemia with multi-drug resistant pathogens. The ulcers were extensively debrided initially and were measured and photographed at weekly intervals. The combination of PFG was applied topically on the wound after every 2 days. RESULTS: The wounds were completely closed in five patients and significantly reduced in size in one. There was no evidence of local or systemic complications and any abnormal tissue formation, keloid or hypertrophic scarring. CONCLUSIONS: Our study suggests, in the first approach, PFG can be used safely in order to heal a non healing sternum wound following coronary artery bypass surgery.

Wound infection incidence in patients with simple and gangrenous or perforated appendicitis.

BACKGROUND: Performing a delayed primary wound closure is often recommended in patients with gangrenous or perforated appendicitis who have undergone an appendectomy. It can result in increased pain as well as an extended hospital stay which, in turn, increases hospital costs. Delayed primary wound closure remains controversial. The general policy in our institution is to perform a primary wound closure. In this study, we have compared the incidence of wound infection in patients with simple appendicitis to those with gangrenous or perforated appendicitis whose wounds were primarily closed. METHODS: This is an observational study which was carried out on 400 patients with gangrenous or perforated (50%) and simple appendicitis (50%). Both groups underwent primary wound closure. Patients were followed for wound infection for at least one month after surgery. Data including age, sex, operating time, pathologic report and wound infection were collected. A comparison between the studied groups was made using Student's t-test for continuous variables and 2 test for categorical variables. RESULTS: The median age of the patients was 23 years. There were 141 (35.2%) females and 259 (64.8%) males. The median operating time was 30 minutes. Wound infections were observed in 15 patients (3.7%), including 6 cases of simple and 9 cases of gangrenous or perforated appendicitis which was not statistically significant. CONCLUSION: There was no statistically significant difference in wound infection between the simple and gangrenous or perforated appendicitis groups.

Gangrenous appendicitis in a child with Henoch-Schonlein purpura.

Abdominal pain is common feature of Henoch-Schonlein purpura, which may mimic appendicitis, leading to unnecessary laparotomy. Accordingly, the diagnosis must be confirmed by ultrasonography or computed tomography scan before laparotomy is performed. The authors report a case of simultaneous occurrence of Henoch-Schonlein Purpura and gangrenous appendicitis in an 18 year-old boy. The patient was admitted with abdominal pain, cramps, and mild dehydration. He also complained of small reddish purple on his lower limbs, bilateral knee pain, low-grade fever, as well as bloody stools. The symptoms subsided completely. Eight days later, he returned with nonbloody, nonbilious emesis, abdominal cramps, and right lower quadrant abdominal tenderness. Abdominal ultrasound evaluation was performed to rule out an intussusception but demonstrated appendiceal dilatation with a possible appendicolith without any evidence of intussusception. A laparotomy was undertaken, and appendectomy was performed for gangrenous appendicitis. Simultaneous occurrence of Henoch-Schonlein purpura and acute appendicitis is rarely observed. Clinical features of the patients may mislead the clinicians, resulting in delayed diagnosis or misdiagnosis. The use of ultrasonography and computed tomography scan would confirm the diagnosis before surgery.