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...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

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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]
Source: Pain Physician - Category: Anesthesiology Authors: Tags: Ultrasound J Source Type: research
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.
Source: Critical Ultrasound Journal - Category: Radiology Source Type: research
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 [1]. Diagnosis in children is extremely difficult due to the overlapping presentation of commoner diseases i.e. gastroenteritis, urinary tract infection, appendicitis and intestinal obstruction
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: IMAGES IN Gynecological Surgery Source Type: research
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 [1]. Diagnosis in children is extremely difficult because of the overlapping presentation of commoner diseases (i.e., gastroenteritis, urinary tract infection, appendicitis, and intestinal obstruction).
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: Images in Gynecologic Surgery Source Type: research
​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, ...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
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.
Source: Current Medicine Research and Practice - Category: General Medicine Source Type: research
ConclusionsThis report adds to the limited stock of available literature on this unusual issue and strengthens the evidence base on the best approach to support informed clinical decision making. The significant clinical implication of such case reports is increased identification rate of rare clinical conditions which otherwise often go unnoticed.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
AbstractWhile endometriosis typically affects the ovaries, deep infiltrating endometriosis can affect the gastrointestinal tract, urinary tract, and deep pelvis, awareness of which is important for radiologists. Symptoms are nonspecific and can range from chronic abdominal and deep pelvic pain to nausea, vomiting, diarrhea, constipation, hematuria, and rectal bleeding. Ultrasound and computed tomography may show nonspecific soft-tissue density masses causing bowel obstruction and hydronephrosis. This constellation of presenting symptoms and imaging evidence is easily mistaken for other pathologies including infectious gast...
Source: Abdominal Imaging - Category: Radiology Source Type: research
Abstract Acute abdominal pain accounts for approximately 9% of childhood primary care office visits. Symptoms and signs that increase the likelihood of a surgical cause for pain include fever, bilious vomiting, bloody diarrhea, absent bowel sounds, voluntary guarding, rigidity, and rebound tenderness. The age of the child can help focus the differential diagnosis. In infants and toddlers, clinicians should consider congenital anomalies and other causes, including malrotation, hernias, Meckel diverticulum, or intussusception. In school-aged children, constipation and infectious causes of pain, such as gastroenterit...
Source: American Family Physician - Category: Primary Care Authors: Tags: Am Fam Physician Source Type: research
Abdominal pain is very common in the pediatric population (
Source: Journal of Ultrasound in Medicine - Category: Radiology Authors: Tags: Pictorial Essays Source Type: research
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