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Chronic Appendicitis—From Ambiguous Clinical Image to Inconclusive Imaging Studies

A six-year-old boy visits a general practitioner due to diarrhea and abdominal pain with a moderate fever of up to 39 °C for 2 days. Treatment is initiated; however, the recurrence of abdominal pain is observed. Physical examination of the child at the emergency department reveals abdominal guarding...

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Autores principales: Brodzisz, Agnieszka, Kuczyńska, Maryla, Zbroja, Monika, Cyranka, Weronika, Cielecki, Czesław, Woźniak, Magdalena Maria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9028538/
https://www.ncbi.nlm.nih.gov/pubmed/35453865
http://dx.doi.org/10.3390/diagnostics12040818
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author Brodzisz, Agnieszka
Kuczyńska, Maryla
Zbroja, Monika
Cyranka, Weronika
Cielecki, Czesław
Woźniak, Magdalena Maria
author_facet Brodzisz, Agnieszka
Kuczyńska, Maryla
Zbroja, Monika
Cyranka, Weronika
Cielecki, Czesław
Woźniak, Magdalena Maria
author_sort Brodzisz, Agnieszka
collection PubMed
description A six-year-old boy visits a general practitioner due to diarrhea and abdominal pain with a moderate fever of up to 39 °C for 2 days. Treatment is initiated; however, the recurrence of abdominal pain is observed. Physical examination of the child at the emergency department reveals abdominal guarding and visible, palpable, painful intestinal loops in the left iliac and hypogastric regions—this is referred to as an ‘acute abdomen’. An X-ray shows single levels of air and fluid indicative of bowel obstruction. Ultrasound reveals distended, fluid-filled intestinal loops with diminished motility. The intestinal wall is swollen. Laboratory tests indicate increased inflammatory indices. Contrast-enhanced computed tomography examination of the abdominal cavity and lesser pelvis shows intestinal dilation. The loops were filled with liquid content and numerous collections of gas. The patient is qualified for a laparotomy. An intraoperative diagnosis of perforated gangrenous appendicitis with autoamputation was made. In addition, numerous interloop and pelvic abscesses, excessive adhesions, signs of small intestine micro-perforation, and diffuse peritonitis are found. The patient’s condition and laboratory parameters significantly improve during the following days of hospitalization. Despite the implementation of multidirectional, specialized diagnostics in the case of acute abdomen, in everyday practice we still encounter situations where the final diagnosis is made intraoperatively only.
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spelling pubmed-90285382022-04-23 Chronic Appendicitis—From Ambiguous Clinical Image to Inconclusive Imaging Studies Brodzisz, Agnieszka Kuczyńska, Maryla Zbroja, Monika Cyranka, Weronika Cielecki, Czesław Woźniak, Magdalena Maria Diagnostics (Basel) Case Report A six-year-old boy visits a general practitioner due to diarrhea and abdominal pain with a moderate fever of up to 39 °C for 2 days. Treatment is initiated; however, the recurrence of abdominal pain is observed. Physical examination of the child at the emergency department reveals abdominal guarding and visible, palpable, painful intestinal loops in the left iliac and hypogastric regions—this is referred to as an ‘acute abdomen’. An X-ray shows single levels of air and fluid indicative of bowel obstruction. Ultrasound reveals distended, fluid-filled intestinal loops with diminished motility. The intestinal wall is swollen. Laboratory tests indicate increased inflammatory indices. Contrast-enhanced computed tomography examination of the abdominal cavity and lesser pelvis shows intestinal dilation. The loops were filled with liquid content and numerous collections of gas. The patient is qualified for a laparotomy. An intraoperative diagnosis of perforated gangrenous appendicitis with autoamputation was made. In addition, numerous interloop and pelvic abscesses, excessive adhesions, signs of small intestine micro-perforation, and diffuse peritonitis are found. The patient’s condition and laboratory parameters significantly improve during the following days of hospitalization. Despite the implementation of multidirectional, specialized diagnostics in the case of acute abdomen, in everyday practice we still encounter situations where the final diagnosis is made intraoperatively only. MDPI 2022-03-26 /pmc/articles/PMC9028538/ /pubmed/35453865 http://dx.doi.org/10.3390/diagnostics12040818 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Brodzisz, Agnieszka
Kuczyńska, Maryla
Zbroja, Monika
Cyranka, Weronika
Cielecki, Czesław
Woźniak, Magdalena Maria
Chronic Appendicitis—From Ambiguous Clinical Image to Inconclusive Imaging Studies
title Chronic Appendicitis—From Ambiguous Clinical Image to Inconclusive Imaging Studies
title_full Chronic Appendicitis—From Ambiguous Clinical Image to Inconclusive Imaging Studies
title_fullStr Chronic Appendicitis—From Ambiguous Clinical Image to Inconclusive Imaging Studies
title_full_unstemmed Chronic Appendicitis—From Ambiguous Clinical Image to Inconclusive Imaging Studies
title_short Chronic Appendicitis—From Ambiguous Clinical Image to Inconclusive Imaging Studies
title_sort chronic appendicitis—from ambiguous clinical image to inconclusive imaging studies
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9028538/
https://www.ncbi.nlm.nih.gov/pubmed/35453865
http://dx.doi.org/10.3390/diagnostics12040818
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