Atypically located incidental appendicitis during laparoscopic cholecystectomy
DOI:
https://doi.org/10.6016/ZdravVestn.3333Keywords:
appendicitis, laparoscopic cholecystectomyAbstract
Appendicitis is the most common surgical emergency. It classically presents with periumbilical pain that localizes to the right lower quadrant and nausea, vomiting, anorexia, and fever. Acute appendicitis may result from an obstructing faecolith or some other mechanical blockage. However, appendicitis presenting with rare and misleading right upper quadrant pain may result in an initial false-negative diagnosis by the physician and even result in negative findings on computed tomography (CT) or ultrasound, increasing the risk of perforation/abscess formation and prolonged hospital stay. This report presents a case of atypical appendicitis during laparoscopic cholecystectomy where the correct diagnosis was not initially considered. Unusual localization was documented several times, otherwise known as classical localization of the appendix. Findings of acute appendicitis varied according to the localization of the appendix. The most common position was the retrocaecal region (65-70%). Other localizations were paraileal, postileal, promontoric, pelvic, subcaecal, paracolic and retrocaecal. These conditions were important to recognise, given that they may need additional specific management. This case report study showed atypical located incidental appendicitis during laparoscopic cholecystectomy.
Downloads
References
1. Jaschinski T, Mosch C, Eikermann M, Neugebauer EA. Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. BMC Gastroenterol. 2015;15(1):48.
DOI: 10.1186/s12876-015-0277-3
PMID: 25884671
2. Gorter RR, Eker HH, Gorter-Stam MAW, Abis GSA, et al. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc. 2016;30(11):4668-90.
DOI: 10.1007/s00464-016-5245-7
PMID: 27660247
3. Ferris M, Quan S, Kaplan BS, Molodecky N, Ball CG, Chernoff GW, et al. The global incidence of appendicitis: a systemic review of population based studies. Ann Surg. 2017;266(2):237-41.
DOI: 10.1097/SLA.0000000000002188
PMID: 28288060
4. Victory J, Meytes V, Parizh D, Ferzli G, Nemr R. Co-existent appendicitis and cholecystitis. Ann Laparosc Endosc Surg. 2017;2:54.
DOI: 10.21037/ales.2017.02.30
5. Sedik A, Makhdoomi M, El Dakak A, El Houshy S. Simultaneous acute acalculous cholecystitis and acute appendicitis: a case report and literature review. Saudi Surg J. 2018;6(1):22.
DOI: 10.4103/ssj.ssj_8_17
6. Auh YH, Pardes JG, Chung KB, Rubenstein WA, Kazam E. Posterior hepatodiaphragmatic interposition of the colon: ultrasonographic and computed tomographic appearance. J Ultrasound Med. 1985;4(3):113-7.
DOI: 10.7863/jum.1985.4.3.113
PMID: 3884830
7. Helling TS, Soltys DF, Seals S. Operative versus non-operative management in the care of patients with complicated appendicitis. Am J Surg. 2017;214(6):1195-200.
DOI: 10.1016/j.amjsurg.2017.07.039
PMID: 28941724
8. Woodwell DA, Cherry DK. National Ambulatory Medical Care Survey: 2002 summary. Adv Data. 2004(346):1-44.
PMID: 15460863
9. Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin North Am. 2003;21(1):61-72.
DOI: 10.1016/S0733-8627(02)00080-9
PMID: 12630731
10. Shweiki E, Price TP, Patel PH, Koenig GJ, Beekley AC, Rittenhouse DW, et al. Synchronous acute appendicitis and acute cholecystitis: a discussion of a century’s worth of epidemiologic, basic science, and clinical research, explicating the pathophysiology of a likely underrecognized historical condition. Am Surg. 2016;82(11):1140-2.
DOI: 10.1177/000313481608201133
PMID: 28206945
11. Akbulut S, Caliskan A, Ekin A, Yagmur Y. Left-sided acute appendicitis with situs inversus totalis: review of 63 published cases and report of two cases. J Gastrointest Surg. 2010;14(9):1422-8.
DOI: 10.1007/s11605-010-1210-2
PMID: 20567931
12. Hou SK, Chern CH, How CK, Kao WF, Chen JD, Wang LM, et al. Diagnosis of appendicitis with left lower quadrant pain. J Chin Med Assoc. 2005;68(12):599-603.
DOI: 10.1016/S1726-4901(09)70101-7
PMID: 16379346
13. Buhamed F, Edward M, Shuaib A. Synchronous acute appendicitis and acute cholecystitis, is it a myth or reality? A literature review. Open Access Emerg Med. 2019;11:201-3.
DOI: 10.2147/OAEM.S214161
PMID: 31496842
Published
Issue
Section
License
The Author transfers to the Publisher (Slovenian Medical Association) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Slovenian Medical Association) has the right to transfer the rights of acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
