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Ganesan G, Ramachandran R, Raji VBR, Nandhakumar S, Rangasami R, Sai PV. A Radiological Review of the Unusual Contents of Inguinal Region. Indian J Radiol Imaging 2023; 33:373-381. [PMID: 37362368 PMCID: PMC10289859 DOI: 10.1055/s-0043-1764404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Background The inguinal region is an area of complex anatomy that could contain diverse uncommon contents in routine clinical practice. Although inguinal hernia repair is one of the commonest surgeries done routinely, thorough preoperative imaging has a significant impact on the outcome of the surgery, by revealing the presence of unusual contents in the inguinal region. Aim The aim of this article is to review the differential diagnosis of the uncommon inguinal pathologies, which can simulate an inguinal hernia, to determine, and to simplify the treatment approach. Conclusions A profound understanding of the imaging characteristics of uncommon inguinal pathologies is crucial for both the radiologists (to prevent misdiagnosis) and the treating physicians (to avoid surgical complications) and ensure optimal management.
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Affiliation(s)
- Gunalan Ganesan
- Centre of Excellence in Radiology and Imaging Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Rajoo Ramachandran
- Centre of Excellence in Radiology and Imaging Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Venkatesh Bala Raghu Raji
- Centre of Excellence in Radiology and Imaging Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Subhashini Nandhakumar
- Centre of Excellence in Radiology and Imaging Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Rajeswaran Rangasami
- Centre of Excellence in Radiology and Imaging Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - P.M. Venkata Sai
- Centre of Excellence in Radiology and Imaging Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Montuori M, Famularo S, Santurro L, Lo Bianco G, Giani A, Uggeri F, Gianotti LV. Retroperitoneal abscess from perforated acute appendicitis: a diagnostic challenge. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.18.04939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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van Hulsteijn LT, Mieog JSD, Zwartbol MH, Merkus JW, van Nieuwkoop C. Appendicitis Presenting As Cellulitis of the Right Leg. J Emerg Med 2017; 52:e1-e3. [PMID: 27658552 DOI: 10.1016/j.jemermed.2016.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022]
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Mallia AJ, Ashwood N, Arealis G, Galanopoulos I. Retroperitoneal abscess: an extra-abdominal manifestation. BMJ Case Rep 2015; 2015:bcr-2014-207437. [PMID: 25576509 DOI: 10.1136/bcr-2014-207437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Retroperitoneal abscesses are unusual occurrences with occult and insidious presentations. There is often a lack of abdominal signs, leading to delays in drainage and high mortality rates. We report a case of thigh emphysema in an 88-year-old patient with diabetes. Prior to admission the patient reported a vague 4-week history of left thigh pain and an inability to fully weight bear. She presented to our emergency department with sepsis and acute kidney impairment. An X-ray of her left femur revealed widespread gas between muscular planes. A retroperitoneal abscess involving the left renal fossa, psoas, iliacus and upper thigh muscles was revealed on an urgent CT scan. The patient was transferred to intensive care unit (ICU) and underwent an emergency drainage. Despite ICU the patient died 2 days after admission.
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Affiliation(s)
- Alvin James Mallia
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
| | - Neil Ashwood
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
| | - George Arealis
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
| | - Ilias Galanopoulos
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
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McDonald LS, Shupe PG, Raiszadeh K, Singh A. Misdiagnosed pneumothorax interpreted as necrotizing fasciitis of the chest wall: case report of a potentially preventable death. Patient Saf Surg 2014; 8:20. [PMID: 24834125 PMCID: PMC4022431 DOI: 10.1186/1754-9493-8-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/25/2014] [Indexed: 11/30/2022] Open
Abstract
Background Subcutaneous emphysema is an uncommon clinical finding associated both with benign sources and potentially deadly necrotizing infections. Wide ranges of causes exist including trauma, iatrogenic injuries, factitious disorders and necrotizing infections. Case presentation A 49-year old male presented to the emergency room with extensive subcutaneous emphysema following blunt trauma. The orthopaedic surgery service was consulted for treatment of suspected necrotizing fasciitis due to his subcutaneous emphysema. A careful patient history and physical examination correlated with laboratory and radiographic findings revealed rib fractures and a long-standing, undiagnosed pneumothorax as the cause for emphysema. Treatment of the underlying condition with chest tubes led to eventual resolution of the emphysema, though multisystem organ failure ultimately resulted in patient death. Conclusion This case illustrates the importance of rapidly and appropriately evaluating trauma patients, and in this case specifically diagnosing and treating the underlying cause of subcutaneous emphysema. The late diagnosis of pneumothorax resulted in delayed definitive treatment, which may have contributed to the patient’s ultimate demise. In acute and sub-acute trauma situations a high level of suspicion for life threatening injuries must be maintained. Decision making for initial treatment should be based on the basic tenants of Advanced Trauma Life Support to primarily address these injuries and help prevent further disability or death.
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Affiliation(s)
- Lucas S McDonald
- Department of Orthopaedics, Naval Medical Center, 34800 Bob Wilson Drive, Suite 112, San Diego, CA 92134-1112, USA
| | - Paul G Shupe
- Department of Orthopaedics, Naval Hospital Jacksonville, 2080 Child Street, Jacksonville, FL 32214, USA
| | - Kian Raiszadeh
- Department of Orthopaedics, Kaiser Permanente Hospital, 4647 Zion Avenue 92120 San Diego, CA, USA
| | - Anshuman Singh
- Department of Orthopaedics, Kaiser Permanente Hospital, 4647 Zion Avenue 92120 San Diego, CA, USA
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Coulier B, Gogoase M, Ramboux A, Pierard F. Extra-abdominal lumbar abscesses caused by retroperitoneal gastrointestinal perforations through the lumbar triangle of Petit: report of two cases diagnosed by CT. ACTA ACUST UNITED AC 2013; 37:1122-8. [PMID: 22270582 DOI: 10.1007/s00261-012-9847-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Extra-abdominal abscesses of gastrointestinal origin developing within the lumbar subcutaneous tissues are extremely rare. We report two cases of retroperitoneal bowel perforation presenting spontaneously at admission with a lumbar abscess trespassing the lumbar triangle of Petit, a classical "locus of minus resistencia" of the posterior abdominal wall. The first case was caused by perforation of a retrocecal appendicitis--being concomitantly responsible of a necrotizing fasciitis of the thigh--and in the second case perforation was caused by left colonic diverticulitis. In both cases, the full diagnosis was made with abdominal CT. The patients were threatened by a two-step surgical approach comprising a direct posterior percutaneous drainage of the abscess followed by classical laparotomy.
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Affiliation(s)
- Bruno Coulier
- Department of Diagnostic Radiology, Clinique St Luc, Rue St Luc 8, 5004 Bouge, Namur, Belgium.
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Hsu WH, Lee CY, Lai LJ, Huang TY, Peng KT. The role of cross sectional imaging in the management of acute pyogenic inguinal abscess - extrapelvic versus intrapelvic origin. BMC Infect Dis 2013; 13:155. [PMID: 23537455 PMCID: PMC3639101 DOI: 10.1186/1471-2334-13-155] [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] [Received: 05/02/2012] [Accepted: 03/22/2013] [Indexed: 11/16/2022] Open
Abstract
Background Abscesses involving the inguinal region as manifestations of complex soft-tissue infections are rare, and the infectious route is usually unclear. The purpose of this study was to ascertain the importance of imaging study and whether the clinical presentations differ between the extrapelvic and intrapelvic origin. Methods Patients who presented with inguinal abscess between January 2003 and December 2010 were evaluated retrospectively. All patients received broad-spectrum antibiotic therapy and debridement. Imaging studies, including computed tomography or magnetic resonance imaging, were performed in all patients to elucidate the origin and extent of infectious disease, and the results were reviewed. Clinical data, laboratory examination findings, and culture results were analyzed. Results Twenty-eight patients were enrolled in the study: 13 patients whose infections were of extrapelvic origin (Group 1) and 15 patients of intrapelvic origin (Group 2). Imaging studies yielded information that helped guiding the treatment. Gram-positive coccus infection was more frequent in Group 1 (p < 0.001), while mixed pathogen and anaerobic bacterial infection were more frequent in Group 2 (p = 0.002 and p = 0.006, respectively). Group 2 had a higher incidence of history of malignancy and chronic renal failure (p = 0.044 and p = 0.038, respectively). Conclusions Computed tomography and magnetic resonance imaging are helpful in diagnosing cases of inguinal abscess and determining the extent of infection. In patients presenting with acute pyogenic inguinal abscess, a higher prevalence of chronic renal failure and history of malignancy were found in those with an intrapelvic, as compared with an extrapelvic, origin of infection.
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Affiliation(s)
- Wei-Hsiu Hsu
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia Yi, 6 West Section Chia Pu Road, Chia Yi Hsien 613, Taiwan.
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Parsons SR, Bennett JE, Kaloo P, Scott M. Appendicitis and uterine abscess: presentation of an unusual fistula between the gynaecological and gastrointestinal tracts. BMJ Case Rep 2012; 2012:bcr.09.2011.4795. [PMID: 22984000 DOI: 10.1136/bcr.09.2011.4795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors present the case of a 65-year-old woman with clinical and radiological evidence of pelvic sepsis and a medical history of endometrial ablation 20 years previously. She underwent laparotomy after failing to settle with a course of intravenous antibiotics and her appendix was found to have perforated into the uterus with abscess formation which had not discharged vaginally presumably due to widespread intrauterine synechia following her endometrial ablation. She underwent appendectomy and hysterectomy and made a full recovery with no complications. Macroscopic and microscopic examination suggested the appearances are those of an abscess of the uterine fundus with part of the appendix incorporating into the abscess mass.
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Affiliation(s)
- Sian Ruth Parsons
- Colorectal Surgery Department, Gloucester Royal Hospital, Gloucester, UK
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Kadic L, Driessen JJ, van der Pluijm M, Veth RPH, Schreuder HWB. Subcutaneous emphysema after cryosurgery of a lesion of the femur during femoral nerve block. J Clin Anesth 2011; 23:255-7. [PMID: 21570624 DOI: 10.1016/j.jclinane.2010.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 09/15/2010] [Accepted: 09/20/2010] [Indexed: 11/26/2022]
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Mekhail P, Saklani A, Philobos M, Masoud A. Thigh subcutaneous emphysema: is that a clear indication for thigh exploration? J Surg Case Rep 2011; 2011:1. [PMID: 24950556 PMCID: PMC3649209 DOI: 10.1093/jscr/2011.2.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Thigh subcutaneous emphysema is an usual orthopaedic presentation normally associated with musculoskeletal problems or penetrating wounds. But, sometimes it can be related to abdominal pathology. We present a case of subcutaneous emphysema of the thigh secondary to para-caecal abscess.
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Affiliation(s)
- P Mekhail
- Prince Charles Hospital, Merthyr Tydfil, UK
| | - A Saklani
- Prince Charles Hospital, Merthyr Tydfil, UK
| | - M Philobos
- Prince Charles Hospital, Merthyr Tydfil, UK
| | - Ag Masoud
- Prince Charles Hospital, Merthyr Tydfil, UK
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Retroperitoneal abscess cured by percutaneous drainage with ultrasonography. J Med Ultrason (2001) 2010; 37:63-5. [PMID: 27277715 DOI: 10.1007/s10396-009-0251-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 11/08/2009] [Indexed: 10/20/2022]
Abstract
This report presents an unusual case of an extensive retroperitoneal abscess caused by appendicitis in a child. A 3-year-old boy who presented with right lower abdominal pain and a high fever was found, by abdominal ultrasonography (US) and computed tomography (CT), to have a retroperitoneal abscess. Percutaneous drainage of the abscess under US guidance was successfully performed. There was no sign of recurrence of appendicitis or the abscess 12 months after the drainage.
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Saldua NS, Fellars TA, Covey DC. Case report: Bowel perforation presenting as subcutaneous emphysema of the thigh. Clin Orthop Relat Res 2010; 468:619-23. [PMID: 19653051 PMCID: PMC2806974 DOI: 10.1007/s11999-009-1015-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 07/21/2009] [Indexed: 01/31/2023]
Abstract
Necrotizing fasciitis is recognized as a surgical emergency. Early detection and aggressive surgical débridement are crucial to reduce patient mortality and morbidity. There are, however, other causes of subcutaneous emphysema. We present the case of a 64 year-old patient with a history of postsurgical radiation for rectal carcinoma with subcutaneous emphysema of the thigh in the presence of urinary sepsis. Surgical exploration revealed the source of the emphysema to be an enterocutaneous fistula. The patient had an unstable and prolonged hospitalization after débridements of the thigh and abdominal surgery and was readmitted for recurrence of thigh drainage, but eventually was discharged; nine months after the initial diagnosis all wounds had healed and he was walking with a walker. Despite an otherwise benign clinical appearance, the radiographic finding of subcutaneous emphysema in the absence of penetrating trauma must be considered a case of a necrotizing soft tissue infection until proven otherwise.
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Affiliation(s)
- Nelson S. Saldua
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 112, San Diego, CA 92134 USA
| | - Todd A. Fellars
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 112, San Diego, CA 92134 USA
| | - Dana C. Covey
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 112, San Diego, CA 92134 USA
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Lau MI, Foo FJ, Bury R, Guleri A, Kiruparan P. Osteomyelitis of the iliac crest: a rare complication following perforated appendicitis. Surg Infect (Larchmt) 2010; 11:397-402. [PMID: 20055574 DOI: 10.1089/sur.2009.020] [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] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Appendicitis is a common surgical emergency with numerous postoperative infective complications. We report an unusual case of iliac crest osteomyelitis as a late complication following emergency appendectomy for perforated gangrenous appendicitis. METHODS Review of the pertinent English language literature. RESULTS To the best of our knowledge, this is the first report in the English literature to describe iliac crest osteomyelitis as an infective complication of perforated gangrenous appendicitis. The diagnosis was made with the aid of magnetic resonance imaging and radioisotope bone scans. The complication was treated successfully with broad-spectrum intravenous antibiotics and physiotherapy. CONCLUSION Iliac crest osteomyelitis is indeed a rare complication of appendicitis. A heightened awareness and better understanding of this complication would necessitate early diagnosis and treatment.
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Affiliation(s)
- Michael I Lau
- Department of General Surgery, Victoria Hospital, Blackpool, Lancashire, United Kingdom
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Sookraj KA, Bowne WB, Ghosh BC. Perforated appendicitis presenting as a thigh abscess. J Am Coll Surg 2009; 208:1142. [PMID: 19476904 DOI: 10.1016/j.jamcollsurg.2008.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 10/13/2008] [Accepted: 10/23/2008] [Indexed: 11/26/2022]
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Subcutaneous emphysema: diagnostic clue in the emergency room. Emerg Radiol 2009; 16:343-8. [PMID: 19184143 DOI: 10.1007/s10140-009-0794-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 01/09/2009] [Indexed: 10/21/2022]
Abstract
The objective of this study was to illustrate the wide spectrum of subcutaneous emphysema in the emergency room; to show the key findings on computed tomography, plain radiographs, and echography; and to discuss the differential diagnoses. Subcutaneous emphysema is a common finding in emergency department imaging studies. It has a great importance due to its broad casualty, some of them totally benign, but others potentially lethal. We retrospectively reviewed our database of emergency pathology, analyzing its origins and associated features. SE was associated to traumatic, iatrogenic, or infectious causes (necrotizing fasciitis, Fournier gangrene). It also was found associated with thoracic (causing pneumothorax and pneumomediastinum) and abdominal pathology related to intraperitoneal and retroperitoneal gas. Diagnostic difficulties and differential diagnoses are emphasized. Radiologists must be aware of abnormal gas in soft tissue because it may be the main or unique sign leading to an underlying pathology, which can be lethal.
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Jones GH, Kalaher HR. Diverticular disease presenting as subcutaneous emphysema of the thigh. BMJ Case Rep 2009; 2009:bcr01.2009.1465. [PMID: 21687014 DOI: 10.1136/bcr.01.2009.1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A normally fit and well 79-year-old lady presented acutely confused and shocked after a few months history of atypical left-sided back and thigh pain. She was unable to tolerate movement of her left leg and soft tissue crepitus was palpable over her thigh. Emergency incision and drainage of the leg was performed with intraoperative swabs growing Streptococcusmilleri and coliforms. Postoperatively, in the Intensive Care Unit (ICU) deep faecal contamination of the wound was noted. Contrast imaging revealed severe diverticular disease and colocutaneous fistula. Abdominal examination was unremarkable throughout her admission and initial CT scan had not revealed the underlying pathology. A defunctioning colostomy was fashioned and after a prolonged period of rehabilitation the patient returned to being functionally independent.
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Affiliation(s)
- Gareth Huw Jones
- Mersey Deanery, 7 Kenwick Close, Great Sutton, Ellesmere Port, Cheshire, CH66 2HY, UK
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Amitai A, Sinert R. Necrotizing Fasciitis as the Clinical Presentation of a Retroperitoneal Abscess. J Emerg Med 2008; 34:37-40. [DOI: 10.1016/j.jemermed.2007.03.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 07/25/2006] [Accepted: 11/16/2006] [Indexed: 10/22/2022]
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Hsieh CH, Wang YC, Yang HR, Chung PK, Jeng LB, Chen RJ. Retroperitoneal abscess resulting from perforated acute appendicitis: analysis of its management and outcome. Surg Today 2007; 37:762-7. [PMID: 17713730 DOI: 10.1007/s00595-006-3481-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 12/08/2006] [Indexed: 10/22/2022]
Abstract
BACKGROUND Acute appendicitis may become life threatening if it is complicated by retroperitoneal abscess. To the best of our knowledge, only case reports have been documented; thus, we analyzed the published experiences and reviewed this issue. MATERIALS AND METHODS In addition to two patients treated at our institution, a PubMed search identified 22 cases of acute appendicitis, complicated by retroperitoneal abscess, reported by 18 authors between 1955 and 2005. The patients' characteristics, onset of symptoms, timing and methods of diagnosis and management, and outcome are reviewed and analyzed. RESULTS Most of the patients were adults (21/24, 87.5%), of whom seven were older than 65 years. None of the patients presented with the classical symptoms of acute appendicitis at the onset of the disease, and less than half (9/24) reported abdominal pain. The average interval between the onset of symptoms and diagnosis was 16 days, and the most effective diagnostic tool was computed tomography. Pathogens were usually polymicrobial, and appendectomy followed by adequate drainage of the abscess was the best treatment. The mortality rate was 16.7% (4/24), and all deaths were caused by profound sepsis. According to the available data, the average hospital stay was 27.3 days for the survivors. CONCLUSION The formation of complicated retroperitoneal abscesses involving thigh, psoas muscle, perinephric space, or even the lateral abdominal wall is a serious complication of perforated acute appendicitis. An intra-abdominal pathological abnormality cannot be excluded in a patient presenting without abdominal symptoms. The mortality rate can only be reduced by a high index of suspicion, accurate diagnosis, and appropriate treatment.
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Affiliation(s)
- Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, China Medical University Hospitalz, No.2, Yuh-Der Road, Taichung 404, Taiwan
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Hsieh CH, Wang YC, Yang HR, Chung PK, Jeng LB, Chen RJ. Extensive retroperitoneal and right thigh abscess in a patient with ruptured retrocecal appendicitis: An extremely fulminant form of a common disease. World J Gastroenterol 2006; 12:496-9. [PMID: 16489659 PMCID: PMC4066078 DOI: 10.3748/wjg.v12.i3.496] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
As a disease commonly encountered in daily practice, acute appendicitis is usually diagnosed and managed easily with a low mortality and morbidity rate. However, acute appendicitis may occasionally become extraordinarily complicated and life threatening. A 56-year-old man, healthy prior to this admission, was brought to the hospital due to spiking high fever, poor appetite, dysuria, progressive right flank and painful swelling of the thigh for 3 d. Significant inflammatory change of soft tissue was noted, involving the entire right trunk from the subcostal margin to the knee joint. Painful disability of the right lower extremity and apparent signs of peritonitis at the right lower abdomen were disclosed. Laboratory results revealed leukocytosis and an elevated C-reactive protein level. Abdominal CT revealed several communicated gas-containing abscesses at the right retroperitoneal region with mass effect, pushing the duodenum and the pancreatic head upward, compressing and encasing inferior vena cava, destroying psoas muscle and dissecting downward into the right thigh. Laparotomy and right thigh exploration were performed immediately and about 500 mL of frank pus was drained. A ruptured retrocecal appendix was the cause of the abscess. The patient fully recovered at the end of the third post-operation week. This case reminds us that acute appendicitis should be treated carefully on an emergency basis to avoid serious complications. CT scan is the diagnostic tool of choice, with rapid evaluation followed by adequate drainage as the key to the survival of the patient.
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Affiliation(s)
- Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan, China
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