Cases reported • Appendicitis

11/69. appendicitis-like syndrome owing to mesenteric adenitis caused by salmonella typhi.

We report a 14-year-old girl who presented with signs of appendicitis and had her appendix removed. She subsequently proved to have mesenteric adenitis owing to salmonella typhi which responded to treatment with ceftriaxone.

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12/69. rupture of coliform pyosalpinx in a nine-year old girl.

The authors report on an atypical clinical picture of an acute abdomen syndrome caused by the rupture of an atypically located pyosalpinx in a 9-year old girl.A perforated right-sided pyosalpinx was found at two locations, firmly adhering to a vesicouterine excavation. Right-sided salpingectomy, appendectomy, pelvic cavity lavage and drainage of the Douglas cavity were performed. The pathohistology indicated a perforated pyosalpinx and catarrhal appendicitis. On bacteriological analysis, escherichia coli was isolated from the vaginal discharge and from the pus collected from the small pelvis.

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13/69. Concurrent appendicitis and ectopic pregnancy. A case report.

BACKGROUND: Ectopic pregnancy is infrequently encountered together with appendicitis. Since 1960, 21 such cases have been reported. CASE: A 32-year-old, Hispanic woman presented with signs and symptoms of an acute surgical abdomen. Preoperatively, the diagnoses of both ectopic pregnancy and acute appendicitis were entertained. On surgical exploration, a ruptured appendix and an unruptured left-sided ectopic pregnancy were found. CONCLUSION: The possibility of multiple pathologic disorders should always be considered in a patient with an acute surgical abdomen, especially during pregnancy. Evidence exists of a possible association between ectopic pregnancy and appendicitis in terms of a common pathogenic mechanism.

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14/69. Human monocytic ehrlichiosis presenting as acute appendicitis during pregnancy.

Human monocytic ehrlichiosis (HME) is caused by ehrlichia chaffeensis, an obligate intracellular bacterium that infects mononuclear phagocytic cells. We report a unique case of HME diagnosed in a woman who presented with abdominal pain and acute appendicitis during early pregnancy and whose condition progressively deteriorated to adult respiratory distress syndrome.

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15/69. dientamoeba fragilis infection presenting to the emergency department as acute appendicitis.

dientamoeba fragilis is a non-enteroinvasive, protozoan parasite of the human large intestine with a worldwide prevalence. Considered for years to be a non-pathogenic organism, more recent studies suggest that up to 25% of adult hosts and up to 90% of infested children may manifest clinical disease. D. fragilis infestation has been implicated in chronic gastrointestinal syndromes characterized by protean complaints such as post-prandial abdominal pain, chronic diarrhea, flatulence, fatigue, anorexia, and weight loss. Rarely, D. fragilis infestation is the etiology of acute abdominal pain, mimicking a surgical abdomen. A case report is presented that details a patient with a 1-month history of vague abdominal complaints who presented to the Emergency Department with an apparent episode of acute appendicitis.

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16/69. Anaesthetic implications of the child with Robinow syndrome.

Robinow syndrome, originally described in 1969, consists of mesomelic brachymelia, short stature, genital hypoplasia and characteristic facies. Associated organ system involvement may include developmental delay, congenital heart disease, obstructive disorders of the urinary tract and renal cysts. As there is a potential for airway problems related to the facial features, such as midface hypoplasia and micrognathia, perioperative management of these patients is important. The authors present an 8-year-old boy, previously diagnosed with Robinow syndrome, who was admitted for an emergency surgical procedure. The perioperative implications of this disorder are reviewed.

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17/69. Eosinophilic gastroenteritis: report of two cases and comment on the literature.

Two cases of eosinophilic gastroenteritis (EGE) are reported. One recovered spontaneously, the other relapsed after bowel resection. Comments outline the immunological processes. They relate EGE to the hypereosinophilic syndrome (HES) and other collagenous diseases. Bowel resection is discouraged in favor of more conservative treatment.

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18/69. 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.

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19/69. Behcet's disease and surgical intervention.

Behcet's disease (BD) is a systemic disorder with an unknown etiopathogenesis. The need for clinical criteria in the establishment of diagnosis is of great importance. We present the case of a 27-year-old man with BD, who had a surgical operation during the active period of his disease and experienced subsequent complications. Cutaneous hyper-reactivity response to minor cutaneous trauma--the pathergy phenomenon--is found in most patients with BD. Theoretically, major traumas may lead to major reactions in the skin or any of the organs. In practice, we observed that while there was a severe inflammatory reaction--histopathologically a superficial perivascular dermatitis--which developed at the incision site, the systemic symptoms of the disease increased in spite of intensive treatment of the condition.

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20/69. Acute presentation of infected urachal cysts: case report and review of diagnosis and therapeutic interventions.

Urachal remnants, although relatively rare, masquerade as a large number of diverse disorders leading to a high rate of misdiagnosis. A typical case is reported in which a 10-year-old boy presented to the Emergency Department twice before being incorrectly diagnosed with a pelvic or lower abdominal periappendiceal abscess. Definitive diagnosis and treatment of an infected urachal cyst were made intraoperatively. A review and discussion of urachal remnants is presented, and a diagnostic algorithm and treatment plan is offered for this entity.

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