This journal is
indexed in Scopus
Year 2017 Vol. 25 No 2
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
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.
- Schein Ì, Rogers PN, Leppaniemi A, Rosin D, Efron JE. Schein's Common Sense Emergency Abdominal Surgery. 4th ed. Harley, UK: TFM Publishing Ltd; 2015. 772 p.
- Kriger AG, Fedorov AV, Voskresenskii PK, Dronov AF. Ostryi appenditsit [Acute appendicitis]. Moscow, RF: Medpraktika-M; 2002. 244 p.
- Toshovskii V. Appenditsit u detei [Appendicitis in children]: monografiia. Moscow, RF: Meditsina, 1988. 208 p.
- Pronin VA, Boiko VV. Patologiia cherveobraznogo otrostka i appendektomiia [The pathology of the appendix and appendectomy]. Khar'kov, Ukraina: SIM; 2007. 271 p.
- Astaf'ev VI, Grigor'ev EG, Sandakov PI, Agryzkov AL, Veniaminov LK. Kishechnye svishchi posle appendektomii [Intestinal fistula after appendectomy]. Vestn Khirurgii im II Grekova. 1988;119(7):122-25.
- Grigor'ev EG, Shumov AV, Sandakov PI, Veniaminov LK. Planovye relaparotomii pri appendikuliarnom peritonite u detei [Planned relaparotomy in appendicular peritonitis in children]. Khirurgiia Zhurn im NI Pirogova. 1989; (11):20-23.
- Rotkov IL. Diagnosticheskie i takticheskie oshibki pri ostrom appenditsite [Diagnostic and tactical errors in acute appendicitis]. Moscow, RF: Meditsina; 1980. 208 p.
664049, Russian Federation,
Irkutsk, Yubileyniy, 100, a /b 15,
FGBNU «Irkutsk Scientific Center
of Surgery and Traumatology»,
Tel.: 7 (3952) 40-78-09,
Evgeniy G. Grigoryev
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».