1/25. Epiploic appendagitis: a new diagnosis for the emergency physician. Two case reports and a review.Two cases of epiploic appendagitis are presented. One was mistaken for acute appendicitis, the other for acute diverticulitis. In both cases, the correct diagnosis was made in the operating suite. With the aid of contemporary imaging modalities, however, the diagnosis of epiploic appendagitis need no longer hinge on the pathologic specimen but may be established by the emergency physician. As this disorder recently has been demonstrated to be predominantly self-limited, laparotomy no longer is considered necessary. Conservative management has been shown to be safe. The anatomy, pathophysiology, clinical presentation, radiologic evaluation, and emergency management of epiploic appendagitis are reviewed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/25. Telemedical experiences at an Antarctic station.Wintering-over in Antarctica represents a physician's most remote and inaccessible scenario, apart from a space station. Because of the harsh and unpredictable winter weather, Antarctic stations are typically inaccessible for over six months of the year. telephone and fax communication, and recently other forms of telemedicine, have provided vital links to specialists. The author was the sole physician for more than 250 people wintering-over during the 1995 austral winter at McMurdo Station. There were several instances of serious or life-threatening illness where the author relied on teleconsultation. These cases included new-onset coronary artery disease, posterior hip dislocation, complicated colles' fracture and acute appendicitis. There were also numerous consultations for non-emergency clinical presentations normally managed by specialists. telemedicine was a crucial link to specialists from the remote and inaccessible environment of Antarctica.- - - - - - - - - - ranking = 0.4keywords = physician (Clic here for more details about this article) |
3/25. Left lower quadrant pain of unusual cause.The differential diagnosis of left lower quadrant abdominal pain in an adult man includes, among others, sigmoid diverticulitis; leaking abdominal aortic aneurysm; renal colic; epididymitis; incarcerated hernia; bowel obstruction; regional enteritis; psoas abscess; and in this rare instance, situs inversus with acute appendicitis. We report a case of situs inversus totalis with left-sided appendicitis and a brief review of the literature. There were several subtle indicators of total situs inversus present that were missed by the physicians and surgeons who initially evaluated the patient prior to surgery. Computed tomography scan with contrast, however, revealed the diagnosis immediately, and treatment was successfully initiated.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
4/25. Appendicovesical fistula in childhood: a rare complication of ruptured appendix.The diagnosis of appendicovesical fistula is difficult and usually delayed. This is most unfortunate, since surgery is uniformly successful. The case we report reemphasizes the diagnostic value of the rectal examination, intravenous pyelogram, and foiding cystogram in a child with subacute or chronic abdominal pain. Only an awareness of this condition on the part of the attending physician will lead to prompt diagnosis and definitive therapy.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
5/25. Crohn's disease of the appendix presenting as acute appendicitis.A patient is reported who initially presented with findings simulating acute appendicitis and who was subsequently found to have Crohn's disease isolated to the appendix. Although the hazard of appendectomy in Crohn's disease is well known, it is interesting that none of the known patients with isolated appendiceal Crohn's disease has developed a fistula. Three of the 15 reported cases of Crohn's disease solely involving the appendix developed granulomatous changes involving other regions of the bowel as long as four years following the initial diagnosis. Because of the rarity of this condition, however, specific conclusions regarding the likehood of future recurrence cannot be drawn. We stress increased physician awareness of this entity in order to emphasize long-term follow-up for such patients.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
6/25. The clinical spectrum of chronic appendiceal abscess in cystic fibrosis.OBJECTIVE--To describe the varied characteristics seen in patients with cystic fibrosis who develop chronic abscess formation secondary to unrecognized appendicitis. DESIGN--Patient series. SETTING--cystic fibrosis Care Centers in Columbus, ohio, and Tucson, Ariz. PARTICIPANTS--Five patients with cystic fibrosis who developed chronic abdominal abscesses secondary to occult appendicitis are described. Two patients developed fistula formation with purulent fluid drainage before diagnosis. One patient developed an extensive psoas abscess. Another presented with prolonged fever of unknown origin. These patients were identified by retrospective review of the past 20-year experience at two cystic fibrosis Care Centers. CONCLUSIONS--Development of chronic abdominal abscess related to unrecognized appendicitis is a rare but important complication in patients with cystic fibrosis. Prompt diagnosis depends on physician familiarity with the varied presentations of this entity. Diagnostic abdominal computed tomography and/or ultrasonography should particularly be considered when patients with cystic fibrosis present with pain, mass, or drainage from the right flank; prolonged fever; a limp; or failure of suspected meconium ileus equivalent syndrome to respond promptly to cathartic measures.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
7/25. Peritoneal schistosomiasis: an unusual laparoscopic finding.Laparoscopic surgery is now a common procedure for the cure of appendicitis. Unexpected other laparoscopic findings can be a diagnostic challenge. The authors present a case in which, in addition to typical appendicitis, multiple whitish nodules were found diffusely on the peritoneal surfaces suggesting a differential diagnosis including miliary tuberculosis and carcinoma metastases. The final diagnosis of schistosomiasis, made by histology and serology, had not been suspected. This uncommon and rare presentation deserves to be reported, especially to physicians of nonendemic areas, in an era in which people travel extensively.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
8/25. Stump appendicitis: a rare but important entity.A case of right lower quadrant pain in a 35-year-old male who underwent an appendicectomy 14 years previously is presented. Recurrent appendicitis with perforation was noted in an appendiceal stump on exploratory laparotomy. Although rare, inlammation of the appendiceal stump can occur and is still an important clinical entity. It is difficult to diagnose pre-operatively. A wide spectrum of causes in the differential diagnosis of right lower quadrant pain of the abdomen and a previous appendicectomy in a patient's history may delay the diagnosis. knowledge of the condition should permit the physician to make an early diagnosis and, thus, limit the resultant morbidity.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
9/25. Two unusual presentations of acute rheumatic fever.patients with acute rheumatic fever sometimes present with atypical signs and symptoms. In these circumstances, the Jones criterions may not be sufficient to make a clinical diagnosis. We describe here two patients with unusual presentations, highlighting that, both in regions where the disease is endemic, or where it is seen only sporadically, physicians should be more alert and careful in making the diagnosis.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
10/25. Diagnosis of appendicitis with left lower quadrant pain.abdominal pain is one of the most common chief complaints of patients presenting to the emergency department and, among the diagnoses of abdominal pain, appendicitis is the most common surgical disorder. Traditionally, the diagnosis of appendicitis is based on well-established clinical criteria combined with physician experience. However, appendicitis presenting with rare and misleading left lower quadrant (LLQ) pain may result in an initial false-negative diagnosis by the physician and even result in failure to order the subsidiary examination of computed tomography (CT) or ultrasound, so increasing the risk of perforation/abscess formation and prolonged hospital stay. In this report, we present 2 cases of atypical appendicitis with LLQ pain where the correct diagnosis was not initially considered. One patient had right-sided appendicitis; the inflamed appendix was 12 cm in length and projected into the LLQ. Local peritonitis developed during observation. With the aid of CT, the diagnosis was established in time. The other patient had left-sided appendicitis with situs inversus totalis. Adverse outcomes with appendiceal rupture and abscess formation occurred due to inadvertent physical examinations and inadequate observation. Early clinical suspicion and adequate observation are indicated in patients with uncertain clinical features. However, in patients with unresolved clinical symptoms and/or local peritonitis that develop during observation, imaging studies play a significant role in preoperative diagnosis and determination of proper treatment.- - - - - - - - - - ranking = 0.4keywords = physician (Clic here for more details about this article) |
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