medigraphic.com

2015, Number 1-4

Rev Mex Cir Endoscop 2015; 16 (1-4)

Inconclusive diagnostic evaluation in perforated appendicitis. Report of two cases

Granados-Romero JJ, Valderrama-Treviño AI, Mendoza-Barrera GE, Ceballos-Villalva JC, Flores-Ceballos M, Estrada-Mata AG, Graniel-Palafox LE

Language: Spanish
References: 27
Page: 40-46
PDF size: 1116.67 Kb.


ABSTRACT

Introduction: Acute appendicitis is one of the most common causes of acute abdominal pain and is the most common abdominal surgical emergency. Nowadays we face cases with atypical clinical features and nonspecific clinical findings, where the evaluation with abdominal ultrasound and computed tomography helps to confirm the clinical suspicion. Two cases are reported. Case 1 is a 54 year-old women diagnosed by imaging tests with Hinchey 1A diverticulitis. In the presence of clinical deterioration was performed exploratory laparoscopy finding a retrocecal phase 4 appendicitis. Case 2 is an 84 year-old women with diffuse abdominal pain in both iliac fossae. Abdominal ultrasound and CT scan were negative for appendicitis. In the presence of clinical deterioration a diagnostic laparoscopy was performed, finding a phase 4 perforated appendix. Discussion: The diagnostic accuracy of both combined imaging techniques (abdominal ultrasound and computed tomography) is close to 100%, thus decreasing the negative appendectomy rate. In this case, the non-conclusive diagnostic evaluation was despite having a perforated appendix in both cases. Conclusions: The diagnosis of acute appendicitis is mainly clinical, but in the presence of atypical symptoms should use imaging techniques such as ultrasound and computed tomography of the abdomen, reducing the uncertainty of diagnosis, which in many cases like this, cannot be determined to a 100% accuracy using auxiliary diagnostic tools.


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