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Subhepatic appendicitis: a diagnostic dilemma
William Robert Ball1, Antonio Privitera
1Department of Surgery, University Hospital North Staffordshire, Stoke-on-Trent, UK. ballwilliam@doctors.org.uk
BMJ Case Reports
|April 23, 2013
Summary
A woman experienced persistent abdominal pain after gallbladder removal. Doctors discovered an inflamed appendix in an unusual location, requiring surgery and leading to a full recovery.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Recurrent abdominal pain can present diagnostic challenges, especially post-cholecystectomy.
- Unusual presentations of common conditions like appendicitis can mimic other pathologies.
Observation:
- Despite cholecystectomy, the patient experienced persistent, worsening abdominal pain, leading to readmission.
- Elevated inflammatory markers and ultrasound revealed a tubular hypoechoic structure in the subhepatic region.
Findings:
- Diagnostic laparoscopy identified an inflammatory mass of appendicular origin in the subhepatic space.
- The mass necessitated a right colon mobilization and appendicectomy.
- Histological examination confirmed acute appendicitis with mucosal ulceration.
Implications:
- This case highlights appendicitis as a rare but significant cause of post-cholecystectomy abdominal pain.
- It underscores the importance of considering atypical diagnoses in persistent post-operative symptoms.
- Accurate diagnosis and surgical management are crucial for resolving such complex presentations.
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01:19Appendicitis
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01:22Appendicitis-I: Introduction
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Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
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Diagnosing and managing appendicitis requires a structured and comprehensive approach that spans from initial assessment to postoperative care. Here is an overview of the process:
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It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
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