1
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Avci MA, Akgün C, Uyanik MS. The relationship between abnormal urinalysis findings and appendicitis location. Int J Colorectal Dis 2023; 38:232. [PMID: 37713118 DOI: 10.1007/s00384-023-04527-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
AIMS Acute appendicitis is a common cause of acute abdomen in general surgery and early diagnosis is crucial for prognosis. Abnormal urinalysis results have been associated with appendicitis in some studies, with reports of microscopic hematuria or pyuria in laboratory tests. The aim of this article is to evaluate the relationship between laboratory findings of hematuria, pyuria, and the location of acute appendicitis. METHODS This retrospective study included 577 patients who underwent appendectomy for suspected acute appendicitis between January 1, 2018, and December 31, 2022, at the general surgery clinic of Samsun Training and Research Hospital. RESULTS Among the 577 patients, 247 were female and 330 were male, with a median age of 34 years. A statistically significant difference was observed between appendicitis location and erythrocyte values (p = 0.009), specifically in paraileal and retrocecal locations. There was a statistically significant difference between appendicitis location and leukocyte values (p < 0.001), with significant differences found in paraileal, promontoric, and retrocecal locations. A statistically significant difference was observed between appendicitis location and leukocyte esterase values (p = 0.002), specifically in paraileal and retrocecal locations. DISCUSSION/CONCLUSION Abnormal urinalysis findings are not uncommon in patients with acute appendicitis. Our study demonstrated a significant correlation between tit erythrocyte, tit leukocyte, and tit leukocyte esterase positivity with appendicitis locations. Therefore, we believe that pathological findings in urine tests of patients undergoing surgery with a preliminary diagnosis of appendicitis can provide valuable information to surgeons regarding the location of the appendix, ultimately aiding in optimizing the timing and cost of the operation.
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Affiliation(s)
| | - Can Akgün
- Samsun University General Surgery, Samsun, Turkey
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2
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Ozkan B, Ustun C, Coskuner ER. Acute appendicitis coexisting with acute pyelonephritis causing diagnostic dilemma: a case report. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00171-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Acute appendicitis and acute pyelonephritis are the most common diseases admitted to emergency departments. Both conditions have common symptoms such as flank pain, abdominal pain, and fever. Patients’ history, physical examination, laboratory evaluation, and imaging methods are used to differentiate these two conditions. Diverticulitis, colitis, gynecological pathologies, and ureteral stones that mimic acute appendicitis should be kept in mind as differential diagnoses. Cases of pyelonephritis mimicking acute appendicitis have been reported in the literature, but there has not been a reported case in which acute appendicitis occurs during management of acute pyelonephritis. In this article, a case report which can cause such a diagnostic dilemma has been presented.
Case presentation
A 42-year-old female patient presented with clinical features suggestive of acute appendicitis that developed after a diagnosis of acute pyelonephritis. She underwent laparoscopic appendectomy on account of acute appendicitis during medical treatment for acute pyelonephritis. Physical examination showed only right costovertebral tenderness without any rebound tenderness at McBurney’s point at the first admission, but during treatment rebound tenderness at McBurney’s point was also detected. The Alvarado score of the patient was 5 at the first admission and 7 when acute appendicitis was diagnosed. The patient fully recovered and was discharged after both diseases were completely treated.
Conclusions
As seen in this case, it should be remembered that both diseases can be seen together which causes a diagnostic dilemma. If clinical or biochemical progression is detected in a patient under treatment, imaging methods should be repeated and additional ones with higher resolutions should be used.
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3
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Gammon BR, Alloy AC, Herres JP. Ultrasound in Emergency MedicinePoint-of-Care Ultrasound (POCUS) for Isolated Pediatric Dysuria: An Unusual Presentation of Acute Appendicitis. J Emerg Med 2021; 61:e64-e66. [PMID: 34253397 DOI: 10.1016/j.jemermed.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 04/29/2021] [Accepted: 05/30/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Isolated complaint of dysuria in an adolescent is a rare presentation for acute perforated appendicitis. Acute appendicitis typically involves vague periumbical pain that migrates to the right lower quadrant, associated with pain, nausea, and loss of appetite. There have been case reports of associated pyuria and dysuria in addition to classical symptoms, but to our knowledge, this is the first case with isolated dysuria presenting to an emergency department (ED). CASE REPORT A 14-year-old boy presented to the ED with 3 days of dysuria and subsequent sensation of urinary retention. Urine dip showed occult blood without white cells or nitrites. A bedside renal/bladder point-of-care ultrasound (POCUS) did not show evidence of obstruction. However, it did reveal a retrovesicular fluid collection with an echogenic foci inside suspicious for abscess, likely secondary to ruptured appendicitis. This diagnosis was confirmed with a dedicated right lower quadrant ultrasound, with resultant treatment with i.v. antibiotics and eventual surgical resection of the appendix. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pediatric and adolescent patients may present with extremely atypical symptoms of a common disease process. In this case, early use of POCUS in the ED helped to quickly identify an acute surgical process and focus diagnostic and therapeutic interventions.
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Affiliation(s)
| | - Alyssa C Alloy
- Albert Einstein Medical Center, Philadelphia, Pennsylvania
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4
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Tan MO, Yam WL, Tan YK, Chia SJ, Ng KS. A Rare Case of Acute Urinary Bladder Diverticulitis Mimicking Acute Appendicitis. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925236. [PMID: 32780730 PMCID: PMC7440753 DOI: 10.12659/ajcr.925236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient: Male, 52-year-old Final Diagnosis: Urinary bladder diverticulitis Symptoms: Right iliac fossa pain Medication: — Clinical Procedure: Computed tomography • cystoscopy Specialty: Urology
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Affiliation(s)
- Min-On Tan
- Department of Radiology, Changi General Hospital, Singapore, Singapore
| | - Wai Loon Yam
- Department of Urology, Changi General Hospital, Singapore, Singapore
| | - Yung Khan Tan
- Urohealth Medical Clinic, Mount Elizabeth Novena Specialist Centre, Singapore, Singapore
| | - Sing Joo Chia
- ML've Urocare Center, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Keng Sin Ng
- Department of Radiology, Mount Alvernia Hospital, Singapore, Singapore
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5
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Assessment of ureteric diameter using contrast-enhanced helical abdominal computed tomography. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00021-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Assessment of ureteric size is imperative for diagnosis of urinary tract abnormalities especially with regard to obstructive pathologies. The ureteric opacification and distension obtained from contrast-enhanced computed tomography allows for differentiation from surrounding soft tissue and better assessment of ureteric diameter. Abdominal computed tomographic scans are commonly requested for the evaluation of the urinary tract, and we therefore aim to establish a normal reference value of the ureteral diameter using contrast-enhanced computed tomographic scans of the abdomen.
Method
With the purpose of establishing our local normogram of ureteric diameter, we did a retrospective study of archived images of 170 patients referred to the radiology department of a tertiary hospital for contrast-enhanced abdominal CT from January 2016 to June 2018. The largest transverse dimension along the course of the ureter beginning 1–2 cm below the ureteropelvic junction was measured at the delayed phase and obtained data subjected to analysis using SAS software version 9.3 with statistical level of significance set at 0.05.
Result
A total number of 340 ureters in 170 patients were analyzed with the mean age of 47.9 years (range 1.0–94.0 years) and male-to-female ratio of 1.2:1. The mean left ureteric diameter of all patients was 4.3 mm (range 1.7–8.0 mm) while the mean right ureteric diameter of all patients was 4.4 mm (range 1.5–8.0 mm). Ninety-five percent of ureters in our study measured 6.9 mm and less with no significant difference in ureteric sizes across gender and ages.
Conclusion
The mean CT normogram for ureteric caliber is 4.3–4.4 mm with no significant age and gender difference and 7 mm proposed as upper limit of normal.
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6
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Nayyar R, Kumar P. Spontaneous appendico-renal fistula: clinical presentation and management of a previously unreported entity. BMJ Case Rep 2019; 12:12/3/e228278. [PMID: 30904895 DOI: 10.1136/bcr-2018-228278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Entero-urinary fistulas are uncommon in urological practice and may have widely varying aetiologies ranging from benign to malignant or iatrogenic in nature. All permutations of entero-urinary fistulas have been reported in the literature except an appendico-renal fistula. Here, we present one such case, presenting with urinary tract infections and perineal urethrocutaneous fistulae. He was ultimately diagnosed to have a spontaneous appendico-renal fistula as underlying pathology behind the symptoms.
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Affiliation(s)
- Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Prashant Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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7
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Lam JSY, Hui JWY, Siu DYW, Hung EHY. Ultrasound Quiz: An Elderly Lady with Flank Pain. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790701400312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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8
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Simson N, Stonier T, Coscione A, Qteishat A. A rare urological presentation of appendicitis. BMJ Case Rep 2017; 2017:bcr-2017-220546. [PMID: 28798242 DOI: 10.1136/bcr-2017-220546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 17-year-old boy with no medical comorbidities, but a significant family history of malignancy, presented to Accident and Emergency following 3 days of increasing rectal pain, symptoms of bladder outflow obstruction (poor flow, intermittent stream and hesitancy) and dysuria. Notably he had no abdominal pain. Digital rectal examination revealed a tender, enlarged prostate. Inflammatory markers were significantly raised (white cell count 17.7, C reactive protein 191). He was diagnosed clinically as prostatitis and commenced on intravenous antibiotics. Despite this his pain and inflammatory markers deteriorated, necessitating a CT of his abdomen and pelvis. This demonstrated multiloculated large thick-walled abscesses in the pelvis closely related to the rectum, prostate and seminal vesicles with some bowel wall thickening. Laparoscopy demonstrated a large colonic mass adherent to surrounding structures. The procedure was converted to laparotomy to enable resection of the mass via a limited right haemicolectomy. He recovered well and was discharged. Histopathological analysis of the specimen revealed appendicitis.
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Affiliation(s)
- Nick Simson
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Thomas Stonier
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Alberto Coscione
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Ahmed Qteishat
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
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9
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Dalpiaz A, Gandhi J, Smith NL, Dagur G, Schwamb R, Weissbart SJ, Khan SA. Mimicry of Appendicitis Symptomatology in Congenital Anomalies and Diseases of the Genitourinary System and Pregnancy. Curr Urol 2017; 9:169-178. [PMID: 28413377 DOI: 10.1159/000447136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/24/2015] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Appendicitis is a prevailing cause of acute abdomen, but is often difficult to diagnose due to its wide range of symptoms, anatomical variations, and developmental abnormalities. Urological disorders of the genitourinary tract may be closely related to appendicitis due to the close proximity of the appendix to the genitourinary tract. This review provides a summary of the urological complications and simulations of appendicitis. Both typical and urological symptoms of appendicitis are discussed, as well as recommended diagnostic and treatment methods. METHODS Medline searches were conducted via PubMed in order to incorporate data from the recent and early literature. RESULTS Urological manifestations of appendicitis affect the adrenal glands, kidney, retroperitoneum, ureter, bladder, prostate, scrotum, and penis. Appendicitis in pregnancy is difficult to diagnose due to variations in appendiceal position and trimester-specific symptoms. Ultrasound, CT, and MRI are used in diagnosis of appendicitis and its complications. Treatment of appendicitis may be done via open appendectomy or laparoscopic appendectomy. In some cases, other surgeries are required to treat urological complications, though surgery may be avoided completely in other cases. CONCLUSION Clinical presentation and complications of appendicitis vary among patients, especially when the genitourinary tract is involved. Appendicitis may mimic urological disorders and vice versa. Awareness of differential diagnosis and proper diagnostic techniques is important in preventing delayed diagnosis and possible complications. MRI is recommended for diagnosis of pregnant patients. Ultrasound is preferred in patients exhibiting typical symptoms.
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Affiliation(s)
- Amanda Dalpiaz
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | | | - Gautam Dagur
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Richard Schwamb
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Steven J Weissbart
- Department of Urology, Stony Brook University School of Medicine, Stony Brook, N.Y., USA.,Women's Pelvic Health & Continence Center, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA.,Department of Urology, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
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10
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Bair MJ, Lee PH, Chan YJ. Urologic manifestations of acute appendicitis secondary to metastatic cervical cancer. J Formos Med Assoc 2007; 106:784-7. [PMID: 17908669 DOI: 10.1016/s0929-6646(08)60041-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Acute abdominal pain may be attributed to a variety of medical or surgical conditions. Acute appendicitis, a common entity in differential diagnosis, may present with diverse clinical manifestations. It may occasionally mimic urogenital disorders and be particularly challenging to diagnose in women. We report a 34-year-old woman who had undergone radical hysterectomy 2 years previously for stage Ib cervical cancer. She presented with lower abdominal pain, dysuria, and fever of 2 days duration, unrelieved by 5 days of antibiotics. Computed tomography revealed an enlarged appendix surrounded by an abscess, and appendectomy was performed. Pathologic examination of the surgical specimen revealed metastatic cervical cancer in the appendix. Patients with acute appendicitis may manifest with urologic disorders that can be caused by metastatic tumor.
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Affiliation(s)
- Ming-Jong Bair
- Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung, Taiwan
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11
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Mammen A, Ponnambathayil S, Varma KK, Kumar EKS. A rare complication of appendicitis: appendiculorenal sinus with renal cellulitis. Pediatr Surg Int 2005; 21:582-4. [PMID: 16012839 DOI: 10.1007/s00383-005-1450-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2004] [Indexed: 10/25/2022]
Abstract
This report describes a rare complication of appendicitis, renal cellulitis, which led to a diagnostic dilemma in a 2-year-old girl who presented with fever of long duration.
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Affiliation(s)
- Abraham Mammen
- Department of Paediatric Surgery, Malabar Institute of Medical Sciences, Govindapuram, Calicut, Kerala, 673016, India.
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12
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Burck I, Yeh BM, Joe BN, Qayyum A, Coakley FV. Pyelonephritis mimicking colitis on CT: case report. ACTA ACUST UNITED AC 2004; 30:105-7. [PMID: 15647879 DOI: 10.1007/s00261-004-0221-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Accepted: 03/10/2004] [Indexed: 10/26/2022]
Abstract
We report a patient with acute pyelonephritis in whom the dominant computed tomographic findings were ascending colon and cecal wall thickening and pericolonic fat stranding, likely related to contiguous inflammation from the right kidney. To our knowledge, this is the first report of acute pyelonephritis affecting the right colon mimicking colitis on computed tomography.
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Affiliation(s)
- I Burck
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA
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13
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Zelenko N, Coll D, Rosenfeld AT, Smith RC. Normal ureter size on unenhanced helical CT. AJR Am J Roentgenol 2004; 182:1039-41. [PMID: 15039184 DOI: 10.2214/ajr.182.4.1821039] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Unenhanced helical CT is the imaging method of choice when evaluating patients with acute flank pain and suspected ureterolithiasis. In addition to directly identifying stones in the lumen of the ureter, CT secondary signs of obstruction such as ureteral dilatation are frequently present and can be helpful in establishing a diagnosis. The purposes of this study were to define ureteral dilatation on unenhanced helical CT and determine the range of normal ureter size. MATERIALS AND METHODS We retrospectively reviewed the unenhanced helical CT studies of 212 consecutive patients with acute flank pain whose CT scans showed acute ureterolithiasis. The size of the ureter was determined on the asymptomatic side as well as on the obstructed side. Mean ureteral diameter was determined as the largest transverse dimension along the course of the ureter beginning 1-2 cm below the ureteropelvic junction. RESULTS The mean size of ureters on the asymptomatic side was 1.8 mm with a standard deviation (SD) of 0.9 mm. The mean size of ureters on the obstructed side was 7 mm with an SD of 3.2 mm. In 96% of patients, the ureter diameter on the asymptomatic side was 3 mm or smaller. CONCLUSION Three millimeters should be considered the upper limit of normal size for nonobstructed ureters on unenhanced helical CT.
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Affiliation(s)
- Natalie Zelenko
- Weill Medical College of Cornell University, 420 E 70th St., New York, NY 10021, USA.
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14
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Gardikis S, Touloupidis S, Dimitriadis G, Limas C, Antypas S, Dolatzas T, Polychronidis A, Simopoulos C. Urological symptoms of acute appendicitis in childhood and early adolescence. Int Urol Nephrol 2003; 34:189-92. [PMID: 12775091 DOI: 10.1023/a:1023226631364] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We present 15 cases of acute appendicitis in ten boys and five girls (age 3-15 years) with cardinal symptomatology coming from the urogenital tract, who were treated in our departments. All the patients presented with right renal colic, dysuria, frequency and urinary retention. The symptoms were attributed to an ongoing appendix inflammatory process in close proximity to the right distal ureter and urinary bladder. All the patients were successfully operated, and postoperative courses were uneventful. As the present patient group is the largest reported to date, a classification of the pathophysiology in relation to the clinical presentation is proposed.
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Affiliation(s)
- Stefanos Gardikis
- Department of Pediatric Surgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece.
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15
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Cicco A, de la Taille A, Saint F, Salomon L, Chopin DK, Abbou CC. Appendicular abscess presenting as an infiltrating bladder tumour. BJU Int 2002; 89:462-3. [PMID: 11872044 DOI: 10.1046/j.1464-4096.2001.01444.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- A Cicco
- Service d'Urologie, Hôpital Henri Mondor, Créteil, France.
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16
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Abstract
An unusual complication of appendicitis, perforation of pelvic appendicitis into the uterinal cavity in a 3-year-old girl, is presented in this report.
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Affiliation(s)
- S Sander
- Section of Pediatric Surgery, SSK Bakirköy Maternity and Childrens' Hospital, Istanbul, Turkey
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17
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Galinkin D, Katz S, Greenwald M, Fagelman D. Pseudotumor of the bladder as a manifestation of uncomplicated appendicitis. J Clin Gastroenterol 2001; 32:367-8. [PMID: 11276289 DOI: 10.1097/00004836-200104000-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
We report the case of a 67-year-old woman who presented with an apparent bladder tumor and complaints of increased urinary frequency and postvoiding pain. Her diagnostic work-up revealed conflicting findings regarding the source of her bladder disease, and laparoscopy was required to make the final diagnosis of appendicitis. The presentation of appendicitis can be disguised and is often a difficult diagnosis.
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Affiliation(s)
- D Galinkin
- Department of Medicine, North Shore University Hospital, Manhasset, New York, USA
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18
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Alkhuja S, Alkhalil C, Menkel R. Acute renal failure: expect the unexpected. Ren Fail 2001; 23:265-7. [PMID: 11417958 DOI: 10.1081/jdi-100103498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- S Alkhuja
- Department of Medicine, St. Barnabas Hospital, Cornell University Medical College, Bronx, New York 10457, USA.
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19
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Bove P, Kaplan D, Dalrymple N, Rosenfield AT, Verga M, Anderson K, Smith RC. Reexamining the value of hematuria testing in patients with acute flank pain. J Urol 1999; 162:685-7. [PMID: 10458342 DOI: 10.1097/00005392-199909010-00013] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Hematuria testing is routinely performed in patients with acute flank pain to screen for ureterolithiasis and to help determine the need for excretory urography. Unenhanced helical computerized tomography (CT) has recently been shown to be superior to excretory urography in diagnosing ureteral obstruction and can evaluate many other causes of flank pain. Given the speed, accuracy and safety of CT the value of hematuria testing for acute flank pain should be reexamined. MATERIALS AND METHODS We reviewed the medical records of 267 consecutive patients with acute flank pain referred for unenhanced helical CT. Microscopic and dipstick urinalysis data were obtained in 195 patients. Using helical CT as the gold standard, we calculated the sensitivity, specificity, predictive value and accuracy of hematuria for diagnosing ureterolithiasis. RESULTS Of the patients with ureterolithiasis 33% had 5 or less, 19% had 1 or less and 11% had no red blood cells (RBCs) per high power field. Of the patients without ureterolithiasis 24% had greater than 5 and 51% had greater than 1 RBC per high power field. Of the patients with ureterolithiasis 14% had a negative dipstick test and 1 RBC or less per high power field. There were 25 patients without ureterolithiasis who had CT abnormalities unrelated to the urinary tract, of whom 8 had greater than 1 RBC per high power field. CONCLUSIONS Absence of hematuria in the setting of acute flank pain cannot exclude a diagnosis of ureterolithiasis and should not obviate other diagnostic testing. Even when strongly positive on microscopy, hematuria has insufficient positive predictive value for diagnosing ureterolithiasis and may be misleading as other serious conditions resulting in acute flank pain may yield a positive test.
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Affiliation(s)
- P Bove
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
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20
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Smith RC, Levine J, Rosenfeld AT. Helical CT of urinary tract stones. Epidemiology, origin, pathophysiology, diagnosis, and management. Radiol Clin North Am 1999; 37:911-52, v. [PMID: 10494278 DOI: 10.1016/s0033-8389(05)70138-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Urolithiasis is a common medical problem. The diagnosis of this entity in the setting of acute flank pain presents an interesting challenge to the radiologist. Unenhanced helical CT has recently entered the fray and has quickly become the imaging study of choice when evaluating patients with acute flank pain and suspected ureterolithiasis. The nature and origin of ureteral stones and the pathophysiology of ureteral obstruction provide a basis for understanding the imaging findings in these patients.
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Affiliation(s)
- R C Smith
- Department of Diagnostic Imaging, Yale University School of Medicine, New Haven, Connecticut, USA.
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21
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Smith RC, Levine J, Dalrymple NC, Barish M, Rosenfield AT. Acute flank pain: a modern approach to diagnosis and management. Semin Ultrasound CT MR 1999; 20:108-35. [PMID: 10222519 DOI: 10.1016/s0887-2171(99)90042-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acute flank pain is a common and complex clinical problem. In addition to flank pain caused by ureterolithiasis, other urinary and extraurinary abnormalities can result in a similar clinical picture. Unenhanced CT can rapidly, accurately, and safely determine the presence or absence of ureteral obstruction. When obstruction is caused by ureterolithiasis, CT allows precise determination of stone size and location. These are the two most important factors used for patient management. In addition to direct stone visualization, there are many secondary CT signs of ureteral obstruction that are direct manifestations of the underlying pathophysiology. On the other hand, when obstruction is absent, CT can diagnose or exclude most other abnormalities that result in flank pain. As a result of its many advantages, unenhanced helical CT should become the dominant imaging modality for evaluation of all patients with acute flank pain in whom a clinical diagnosis is uncertain.
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Affiliation(s)
- R C Smith
- Yale University School of Medicine, New Haven, CT 06520, USA
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22
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Acute Appendicitis Presenting as a Perinephric Abscess. J Urol 1996. [DOI: 10.1097/00005392-199611000-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Paajanen H, Tainio H, Laato M. A chance of misdiagnosis between acute appendicitis and renal colic. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1996; 30:363-6. [PMID: 8936624 DOI: 10.3109/00365599609181311] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The symptoms of right-sided renal colic mimic sometimes acute appendicitis. A prospective comparative study of 188 patients with ureteral stone and 188 patients with acute appendicitis was performed to evaluate the features of differential diagnosis. Appendicitis caused more often nausea (81 vs 11%), fever and localized pain in the McBurney (97 vs 59%) than renal colic. The patients with ureteral stone had tenderness in 16% in the right lower quadrant. The mean values of C-reactive protein (41 mg/l) and blood leukocytes (14 x 10(9)/l) were elevated in appendicitis, but not in renal colic (14 mg/l and 10 x 10(9)/ l). Urinanalysis revealed red cells in 92% of ureteral stones compared with 26% in appendicitis. Only one of 188 patients with appendicitis was first misdiagnosed to have renal colic. A mistake of appendicitis for ureteral stone is clinically rare occurring only once or twice per year in the hospital where 700-800 emergency appendectomies are annually performed.
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Affiliation(s)
- H Paajanen
- Department of Surgery, Kuopio University Hospital, Finland
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25
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Tripp BM, Homsy YL, Kiruluta G. Bilateral Ureteral Obstruction Secondary to a Perforated Appendiceal Abscess. J Urol 1995. [DOI: 10.1016/s0022-5347(01)67018-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Benjamin M. Tripp
- Division of Urology, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Yves L. Homsy
- Division of Urology, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - George Kiruluta
- Division of Urology, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada
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Puskar D, Bedalov G, Fridrih S, Vucković I, Banek T, Pasini J. Urinalysis, ultrasound analysis, and renal dynamic scintigraphy in acute appendicitis. Urology 1995; 45:108-12. [PMID: 7817461 DOI: 10.1016/s0090-4295(95)97134-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The influence of acute appendicitis (AA) on the right kidney and urinalysis was investigated. Permanent damage of the urinary tract and abnormal urinalysis have been previously reported in AA. METHODS Appendectomy was performed in 84 patients with no previous urogenital, retroperitoneal, or pelvic disease, trauma, or operation. AA was confirmed in 66 of them. Control groups were the remaining 18 patients and 40 patients with varicocele repair. Renal sonography and urinalyses were done prior to operation, on days 1, 3, and 6 postoperatively. Pentetic acid renal scintigraphy was done on postoperative day 1 in patients with abnormal urinalysis. An obstructive radiographic curve indicated furosemide renography. RESULTS Abnormal urinalysis was found in 48% of patients with AA before appendectomy and in 12% on day 6 postoperatively. Sonography showed pyelocaliceal dilation of the right kidney in 38% of patients with AA prior to appendectomy and in none on day 6 postoperatively. Patients with AA had pyelocaliceal dilation of the right kidney more frequently than those in the control groups (P < 0.001). It was more frequent in patients having abnormal urinalysis (P < 0.01). Scintigraphy confirmed pyelocaliceal dilation of the right kidney in 38% of patients with abnormal urinalysis. Furosemide renography excluded an obstruction in all of them. CONCLUSIONS Inflammation is the major cause of abnormal urinalysis and transitory pyelocaliceal dilation in some patients with AA. Erythrocyturia, pyuria, proteinuria, and pyelocaliceal dilation detected by sonography or scintigraphy can frequently be found in patients with AA, but should not mislead the surgeon in the diagnosis of AA.
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Affiliation(s)
- D Puskar
- Department of Urology, New Hospital, Zagreb, Croatia
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27
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Abstract
Bilateral ureteral obstruction secondary to appendicitis is rare. We here report a case in which the obstruction caused anuria and renal failure.
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Affiliation(s)
- K Buckley
- Department of Radiology, Children's Hospital, Boston, MA 02115
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28
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Serretta V, Vasile P, Falletta V, Gange E, Piazza S, Piazza B. Appendiceal pathology simulating an advanced bladder cancer. Case report. Urologia 1992. [DOI: 10.1177/039156039205900418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A case of unusual appendiceal pathology presenting as an advanced bladder cancer is reported. The difficulties in clinical and radiological diagnosis are emphasized. Correct diagnosis was possible only upon surgical exploration.
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Affiliation(s)
- V. Serretta
- Divisione di Urologia - Ospedale Civico di Palermo
| | - P. Vasile
- Divisione di Urologia - Ospedale Civico di Palermo
| | - V. Falletta
- Divisione di Urologia - Ospedale Civico di Palermo
| | - E. Gange
- Divisione di Urologia - Ospedale Civico di Palermo
| | - S. Piazza
- Divisione di Urologia - Ospedale Civico di Palermo
| | - B. Piazza
- Divisione di Urologia - Ospedale Civico di Palermo
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Abstract
We report on 3 cases of unusual appendiceal pathology presenting as urologic disease: 2 cases were benign mucoceles and 1 a malignant mucocele or cystadenocarcinoma of the appendix. Two cases presented as pelvic masses causing urinary frequency and the third with fever and hydronephrosis. The appendix must remain in the differential diagnosis for both acute and chronic disease processes.
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Affiliation(s)
- L S Baskin
- Department of Urology, University of California, San Francisco
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30
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Bondavalli C, Visentini E, Pegoraro C, Schiavon L, Dall'Oglio B, Luciano M, Parma A. Alterazione Della via Escretrice Da Mucocele Appendicolare. Urologia 1991. [DOI: 10.1177/039156039105800121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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