Perinephric abscess due to acute appendicitis
A 17-year-old boy presented with a 6-day history of abdominal pain and fever. Physical examination revealed an ill-looking patient with right lumbar/flank abdominal pain and minimal tenderness. Laboratory results showed leukocytosis (C-reactive protein, 236 mg/L). Urinalysis had no abnormalities. Ultrasound demonstrated a 4-cm collection contiguous to the upper pole of the right kidney. Computed tomography (Fig 1) revealed an air-fluid collection in the perinephric space (arrows) with 2 calcified images (appendicoliths, arrowheads), the upper one within the renal fascia; the kidney exhibited normal parenchyma.
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...
We report a case of an 80-year-old woman admitted to our emergency department complaining of pain in the right groin. This symptomatology, present for 2 days, increased in the following 1 2 h. Ultrasonography (US) and contrast-enhanced computed tomography (CECT) were performed, which showed the herniation of the vermiform appendix in the femoral hernia sac. Doppler ultrasonography (DUS) and CECT were the fundamental imaging investigations for this diagnosis. The management of De Gar engeot’s hernia is surgical through herniorrhaphy, which makes it possible to repair the femoral hernia and perform an appendicecto...
The objective of this study was to evaluate whether early administration of ORC in children with abdominal pain receiving abdominal CT for possible appendicitis obscures subsequent abdominal US image quality.Methods: We designed a prospective observational study of children
CONCLUSION: The strategy of repeating limited focused US followed by CT scan in cases that remain inconclusive has good diagnostic accuracy and reasonable NAR and decreases the number of CT scans. PMID: 31913249 [PubMed - as supplied by publisher]
Authors: Altomare M, Cimbanassi S, Chiara O, Salvi PF Abstract OBJECTIVES: Evaluate Alvarado Score's (AS) accuracy related with C-reactive protein (CRP). Evaluate the accuracy rate of ultrasonography (US). MATERIALS AND METHODS: We analyzed data on 290 patients admitted to Emergency Department (ED) of Sant'Andrea Hospital (Rome - Italy) presenting abdominal pain in lower quadrants between Jan2009-Apr2015. AS, laboratory tests, images and report from CT-scan and US were collected. Histological examination is considered as Gold Standard. We calculated Specificity(Sp), Sensitivity(Se), Accuracy(Ac), positive predi...
ConclusionsWe recommend laparoscopic appendectomy and totally extraperitoneal hernia repair with mesh after laparoscopic reduction for Amyand ’s hernia.
CONCLUSION: A large randomised trial to evaluate the use of unenhanced computed tomography in atypical right iliac fossa pain appears feasible and justified. PMID: 31219315 [PubMed - as supplied by publisher]
ConclusionsDespite its rarity, it is feasible to diagnose SA using PoCUS, as patients presenting with right lower quadrant pain and history of appendectomy are at risk for delayed diagnosis, perforation, and poor outcome. PoCUS may reduce time to diagnosis, time to definitive operative or non-operative management, and minimize morbidity.
ConclusionsYoung women are particularly at risk for NA. Increasing the use of preoperative CT and incorporating imaging into the overall assessment of a patient seems to be actually the only way to reduce the incidence of NA without increasing the rates of perforation. Considering the relatively high morbidity after an NA procedure, every surgeon must carefully consider the risk –benefit balance prior to performing an appendectomy during diagnostic laparoscopy for suspected acute appendicitis showing a macroscopically noninflamed appendix.
Conclusions In contrast to the earlier dramatic increase in CT use for pediatric patients with abdominal pain, CT remained constant between 2008 and 2011. There was no associated change in the rate of diagnosis of appendicitis or hospitalization; however, ultrasound is increasing.