Recurrent pain abdomen following appendectomy_ stump appendicitis, a surgeon’s dilemma – shah – 2017 – clinical case reports – wiley online library
Although there are many causes of pain right lower abdomen, stump appendicitis should always strike a clinician in postappendectomy patients even if it is a rare diagnosis. Chest ct scan price Here, we are discussing a 35-year female with stump appendicitis who underwent completion appendectomy.
Acute appendicitis is the commonest surgical operation, and appendectomy forms a major bulk of the emergency surgery performed in the emergency room. Does a head ct scan show sinuses Although stump appendicitis is a complication of appendectomy, it is rare, while wound infection, pelvic abscess, and adhesive bowel obstruction are more commonly seen among others.
Abdominal ct scan vs ultrasound We clinicians do not consider stump appendicitis as a differential diagnosis when evaluating a patient with right lower abdomen pain who has undergone appendectomy in the past. Ct scan for sinus cost Here, a 35-year female with stump appendicitis is described, with a previous history of appendectomy. Should i have a ct scan Case History/Examination
A 35-year female presented to our hospital with recurrent pain in right lower abdomen for 4 months which had increased in intensity in the last 24 h. Abdominal ct scan cancer She used to have on and off passage of altered blood in stool during previous attacks of pain but absent on this presentation. Ce ct scan She had undergone open appendectomy four-and-half months back at another center. Describe ct scan Her last pain episode was 1 month ago and was diagnosed as ileocolic intussusception and was managed conservatively, at another center without an adverse outcome.
On clinical examination, the patient was afebrile and her vital signs were otherwise normal. What is a ct scan for cancer Physical examination revealed a tender mass in right iliac fossa of 3 ? 2 cm 2 without evidence of guarding, rebound tenderness, or other peritoneal signs. Ct scan axial Routine laboratory studies were remarkable for a WBC count of 10,000/mm 3 with 88% neutrophils. 2 ct scans in one year Urinalysis was negative.
An ultrasound of the abdomen and pelvis was performed which showed invagination of one bowel loop into another bowel loop with characteristic target sign which suggested the preoperative diagnosis of ileocolic intussusception. Ct scan for sinus polyps Exploratory laparotomy with a lower midline incision was performed under general anesthesia. Ct cat scan The operative findings were adhered inflamed omentum forming a lump over the ileocecal junction with inflamed surrounding mesentery and acutely inflamed stump of appendix (~2 cm). Dye ct scan Rest of the bowel was normal. Ct scan sinus how long does it take As shown in Figures 1 and 2, completion appendectomy was performed and the postoperative period was uneventful, and on postoperative day 4, the patient was discharged. What is head ct scan Her histopathological report showed acutely inflamed appendix, and she is asymptomatic till date.
Acute appendicitis is the commonest abdominal surgical emergency encountered by a general surgeon [ 1]. Ct scan radiology It is a clinical diagnosis, and the patient usually presents with periumbilical pain that radiates to the right lower abdomen [ 2]. Ct or cat scan definition But then, it always poses a dilemma when a patient with a history of appendectomy presents with right iliac fossa pain.
The first appendectomy was performed in 1735 by Claudius Amyand, and in 1886, Reginald Fitz described the clinicopathological features, while Rose described stump appendicitis for the first time in 1945 [ 3]. Cost of ct scan abdomen and pelvis There is a whole list of complications following appendectomy, the common ones being wound infection and pelvic abscesses [ 4].
Stump appendicitis is defined as a rare complication following appendectomy caused by inflammation of the residual portion of the appendix left behind. Ct scan patient teaching The clinical presentation of stump appendicitis is similar to that of acute appendicitis [ 5]. Chest ct scan with contrast heart Stump appendicitis has an incidence of one in 50,000 cases [ 6]. Understanding ct scan Clinically, these patients have the symptoms and signs similar to appendicitis. How to perform ct scan Stump appendicitis poses a dilemma if the clinician is not aware of this uncommon presentation.
Stump appendicitis is associated with late diagnosis and therefore has higher rate of perforation with increased morbidity [ 7]. Ct scan method The factors leading to stump appendicitis can be either anatomical or surgical. What is a ct scan uk Anatomically, it can be retrocecal in position posing difficulty [ 8]. Introduction to ct scan While the surgical factors include inadequate identification of the base of appendix because of local inflammation, difficult dissection or leaving a long stump behind due to fear of injury to cecum [ 9]. Ct and cat scan the same thing This can be seen in either open or laparoscopic approach [ 10, 11].
Generally, adequate visualization of the appendix base and the ileocecal region and a stump of <5 mm reduces the risk of stump appendicitis [ 12, 13]. Frontal sinus ct scan Although stump appendicitis is thought to be a recent phenomenon that is mainly seen in laparoscopically performed appendectomies [ 14], the literature shows that 66% of stump appendicitis occurred after open appendectomy [ 15].
A preoperative diagnosis can be made by USG and CT scan [ 16]. What is a ct scanner However, USG is user dependent and a high suspicion for stump appendicitis is required. Ct scan of the heart While CT scan is said to be superior to USG [ 17], but in a developing country like Nepal, CT scan is not readily available and relatively expensive to be done routinely. Cost of ct scan with contrast Also, laparoscopy has an important role in the diagnosis and has therapeutic value [ 18].
However, in our patient, stump appendicitis was an intraoperative diagnosis. Ct scan sections We were misled by the previous history of appendectomy and USG finding of intussusception at this presentation. Explain ct scan But intraoperatively, on finding omental lump over the ileocecal junction with an inflamed appendicular stump clenched the diagnosis of stump appendectomy. What is an ct scan We then performed completion appendectomy, and the postoperative period was uneventful. Ct scan abdomen fasting The patient is asymptomatic since.
The treatment of choice is completion appendectomy, either open or laparoscopically [ 19]. Head ct scan radiation exposure Sometimes ileocolic resection may be required depending on the clinical presentation and inflammation around ileocecal region [ 20]. Ct scan abdomen and pelvis with contrast Conclusion
Although stump appendicitis is a rare complication after appendectomy, either open or laparoscopically, a clinician should keep in mind this possibility as the cause of right lower abdomen pain in a patient with previous history of appendectomy because of the increased risk of perforation and misdiagnosis. What does a ct scan with dye show Acknowledgment
The abstract titled: Recurrent pain abdomen following appendectomy: stump appendicitis, a surgeon’s dilemma by Tuhin Shah, Rakesh Gupta, Rikesh Jung Karkee, and Chandra Shekhar Agarwal has been published in the Abstract Journal for General Surgery, ANZ J. Does a chest ct scan show the esophagus Surg. Abdominal ct scan shows 2016; 86 (S1) 62. Ct scan of the head Authorship
TS and RKG: participated in study conception and design. Cost of brain ct scan TS: involved in acquisition of data. What does a ct scan of kidneys show TS and RJK: analyzed and interpreted the data. What is a ct scan for lungs TS, RKG, and CSA: drafted the manuscript. What is a ct heart scan with calcium scoring TS, RKG, and RJK: performed critical revision. Brain ct scan cost in chennai Conflict of Interest