Popliteal Echinococcosis: A Long Journey from the Liver.

INTRODUCTION: Intra-abdominal and pelvic seeding of hepatic cystic echinococcosis to various organs is a known feature of the disease. Dissemination into distal extremities is uncommon and in this report, we present a case of disseminated cystic echinococcosis extending toward the right popliteal fossa. CASE PRESENTATION: A 68-year-old male presented with swelling in the right upper leg and discomfort in the right popliteal region. Work-up revealed various cystic mass lesions of different sizes within the liver, intra-abdominal cavity, right inguinal region, right femoral region, and right popliteal fossa. Diagnosis of hepatic cystic echinococcosis was made and the patient was started on medical therapy. DISCUSSION: Hepatic cysts can be easily observed with ultrasonography and the WHO-Informal Working Group on Echinococcosis (WHO-IWGE) classification system is commonly used to further classify cysts. The work-up of the disseminated disease involves further radiological modalities such as computerized tomography and magnetic resonance imaging. Management includes medical therapy, percutaneous drainage, or surgery depending on hepatic cyst localization and the presence of dissemination. CONCLUSION: Extrahepatic dissemination of cystic echinococcosis is commonly encountered in endemic areas. Rarely, hepatic cysts can spread beyond the abdomen towards the distal extremities. Therefore, cystic echinococcosis should be included in the differential diagnosis in endemic areas where patients present with cystic masses.

Effectiveness of pre-operative routine blood tests in predicting complicated acute appendicitis.

BACKGROUND: Early prediction and diagnosis of perforation in acute appendicitis allow surgeons to choose the most appropriate treatment. The purpose of this study is to evaluate whether pre-operative routine laboratory examinations have a role in predicting complicated acute appendicitis. METHODS: In the study, 783 patients operated with the diagnosis of acute appendicitis between the years 2014 and 2019 were analyzed retrospectively. Among the patients with non-perforated and perforated acute appendicitis, pre-operative laboratory tests include leukocyte (WBC), neutrophil, lymphocyte, platelet (PLT), mean platelet volume (MPV), platelet distribution width (PDW), C-reactive protein (CRP), and neutrophil-to-lymphocyte rate (NLR) parameters were compared. RESULTS: Appendicitis was not detected histopathologically in 81 cases. In the study, 89.9% (n=631) of the 702 patients were non-perforated and 10.1% (n=71) were perforated acute appendicitis cases. Perforation rate was higher in elderly patients (p<0.01). It was seen that lymphocyte count was significantly lower in the perforated group, and CRP and NLR were significantly higher (p=0.048, p=0.001, p=0.028, respectively). In the diagnosis of perforated acute appendicitis, cutoff values were 44.0 mg/dL for CRP, 7.65 for NLR and 1.7/mm3 for lymphocytes. There was no statistical difference between the groups in terms of WBC, neutrophil, PLT, MPV, and PDW values. CONCLUSION: Low lymphocyte count, high CRP, and high NLR were found to be reliable and strong predictive parameters in the diagnosis of complicated acute appendicitis.