Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2017 Vol. 25 No 2

CASE REPORTS

DOI: https://dx.doi.org/10.18484/2305-0047.2017.2.202   |  

A.I. PANASYUK 1,3, E.G. GRIGORYEV 1,2

PECULIARITIES OF CLINICAL SIGNS AND DIAGNOSTIC DIFFICULTIES OF ACUTE APPENDICITIS IN INTRAMESENTERIC MESOGASTRAL (MESOCELIAC) LOCATION OF THE VERMIFORM APPENDIX

SBEE HE "Irkutsk State Medical University"1
FSBSE "Irkutsk Scientific Center of Surgery and Traumatology"2
SBME "Irkutsk Regional Clinical Hospital"3
Irkutsk
The Russian Federation

Atypical variants of the acute appendicitis course occur in 20-30% of patients. Indistinctive clinical picture is explained by the location variety of the vermiform appendix in the abdomen.
The paper presents the peculiarities of clinical manifestations of acute appendicitis. Particular attention is given to the atypical clinical signs depending on the localization of the vermiform appendix in the abdominal cavity. Posibilities of diagnostic visualization methods (ultrasound, multislice computed tomography) for the differential diagnosis of the acute abdomen syndrome are under discussion, as well as the reasons of possible misdiagnosis.
This case report demonstrates one of the multiple masks of acute appendicitis the chameleon of the abdominal cavity and the difficulties of clinical diagnosis in case of mesoceliac appendix. Atypical onset of the disease, which the patient associated with a large meal, intolerable pains, frequen vomiting, not typical for acute appendicitis forced position, physical findings served as a basis for working diagnosis acute intestinal obstruction. This version of small bowel invagination was supported by means of diagnostic visualization. The erroneous conclusion was obviously associated with the location of the vermiform appendix, its size (D=1,2 cm) and severe inflammatory changes. Videolaparoscopy turned out to be a comprehensive method of diagnosis and treatment.

Keywords: acute appendicitis, atypical onset, vermiform appendix location, acute intestinal olstruction, chameleon of the aldominal cavity, differential diagnosis, videolaparoscopic appendectomy
p. 202-205 of the original issue
References
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Address for correspondence:
664049, Russian Federation,
Irkutsk, Yubileyniy, 100, a /b 15,
FGBNU Irkutsk Scientific Center
of Surgery and Traumatology,
Tel.: 7 (3952) 40-78-09,
e-mail: egg@iokb.ru,
Evgeniy G. Grigoryev
Information about the authors:
Panasyuk A.I. Surgeon of emergency department, SBME Irkutsk Regional Clinical Hospital.
Grigoryev E.G. Corresponding member of RAS, MD, Professor, Scientific Supervisor, FSBSE Irkutsk Scientific Center of Surgery and Traumatology, Head of department of hospital surgery, SBEE HE Irkutsk State Medical University.
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