Diagnostic accuracy of pediatric atypical appendicitis: Three case reports
Rationale: Acute appendicitis is one of the most common causes of acute abdomen in children, yet it is difficult to diagnose in young children because its clinical manifestations may be atypical. Here, 3 atypical clinical cases associated with appendicitis in children are reported. Patient concern: The 1st case corresponds to a 5-year-old male patient who presented with abdominal discomfort, intermittent fevers, and vomiting, have increased white blood cell (WBC) count and C-reactive protein (CRP). The second case is a 7-year-old male patient who began with intermittent fevers and lower quadrant abdominal pain, showing increased WBC count and CRP. The 3rd case corresponds to a 7-year-old female patient who presented with intermittent fevers, abdominal pain, and forebreast discomfort, demonstrating increased WBC count and CRP. Diagnoses: Abdominal computed tomography (CT) scan presented data suggestive of enlarged appendix in diameter, and stercolith, corroborated through surgery. Intervention: Two patients were treated by appendectomy, and 1 patient was treated conservatively with antibiotics. Outcomes: Three patients were treated successfully. At 3-month follow-up, the patients had no complaints of discomfort with no relapse of appendicitis. Lessons: Due to atypical symptoms of children, the diagnosis of appendicitis is often delayed, suggesting that the clinicians should be aware of this disease when encountering gastroenteritis patients with elevated WBC a...
Discussion Peritoneal fluid is normal. It decreases the friction of the peritoneum covering abdominal and pelvic organs and helps to protect them and allow their movement. A normal amount of peritoneal fluid is expected on radiological evaluation. Increased peritoneal fluid is a continuum and is concerning as a wide variety of pathological causes are associated with it such as abdominal trauma and appendicitis. At the far end of the scale is ascites that is the accumulation of free fluid more than 25 ml. It is usually associated with abdominal distension but fluid must accumulate before distension can occur and therefore i...
ConclusionOur case report illustrates the significance in identifying atypical features of appendicitis, broadening the differential of non-specific abdominal pain in pediatric patients, and depending on the clinical situation, ruling out other potential intra-abdominal infections even in the presence of a true urinary tract infection.
CONCLUSION: ACUTE ABDOMEN sonographic approach in acute abdomen can play an important role in ruling out critical diagnosis, and can guide emergency physician or any critical care physician in patient management. PMID: 31544223 [PubMed]
ConclusionACUTE ABDOMEN sonographic approach in acute abdomen can play an important role in ruling out critical diagnosis, and can guide emergency physician or any critical care physician in patient management.
Ovarian torsion is a rare cause of acute abdomen. It is very uncommon in the pediatric age group with an incidence of 2.7% of all children with acute pain abdomen . Diagnosis in children is extremely difficult due to the overlapping presentation of commoner diseases i.e. gastroenteritis, urinary tract infection, appendicitis and intestinal obstruction
Ovarian torsion is a rare cause of acute abdomen. It is very uncommon in the pediatric age group, with an incidence of 2.7% of all children with acute pain abdomen . Diagnosis in children is extremely difficult because of the overlapping presentation of commoner diseases (i.e., gastroenteritis, urinary tract infection, appendicitis, and intestinal obstruction).
BY JEFFREY LOMBARDO, MD, &MARK SUPINO, MDThe progressive suprapubic pain was a cunning symptom.The 38-year-old man had had five days of that pain and dysuria. By the time he presented to our ED, his pain had spread to the right lower quadrant as well. He had a history of diverticulitis after a laparoscopic left hemicolectomy four years earlier.He reported no fevers, but complained of nausea and diarrhea. He was afebrile at 36.8°C with a pulse of 76 bpm. All other vital signs were normal. Physical exam was significant for suprapubic pain and right lower quadrant tenderness to palpation without rebound, guarding, ...
ConclusionMore than 90% children presenting in pediatric ED with complaints of abdominal pain are non-surgical. Constipation was the most common diagnosis in these children, followed by acute gastroenteritis. Only in 8% children cause of pain is surgical and acute appendicitis is the most common surgical cause.
ConclusionAppendiceal masses should be considered in the differential diagnosis of a presumed pelvic mass. For low-grade appendiceal mucinous neoplasms that are diagnosed intraoperatively, laparoscopic resection without spillage or rupture is a feasible and appropriate approach for treatment 1, 2, 3.
ConclusionAppendiceal masses should be considered in the differential diagnosis of a presumed pelvic mass. For low-grade appendiceal mucinous neoplasms that are diagnosed intra-operatively, laparoscopic resection without spillage or rupture is a feasible and appropriate approach for treatment (1,2,3).