PubMed · 7031928
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T V Ballantine. 1981. Appendicitis.. https://doi.org/10.1016/s0039-6109(16)42535-1
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The value of exposed to vertical central ray supine (dorsal decubitus or pregnancy standard) plain films was determined in this retrospective study in diagnosing pneumoperitoneum based on comparing of exposed to horizontal X-ray beam abdominal radiographs in 54 patients associated with perforation of hollow viscus (48 stomachs or duodenums of them). Until the anteroposterior erect or sitting and semi-recumbent positioning views moreover laterolateal supine and posteroanterior left lateral projections were negative in all cases, then in 24 of 54 subjects free intraperitoneal gas collections as spotted radiolucencies were detected inside the right upper quadrant of abdomen on pregnancy standard dorsal aspects. The orientation of gas to left upper abdominal quadrant was noted in additional 2 cases. The 18 of 26 perforations were not proceeded to free intraperitoneal space. The pregnancy standard plain film is a sensitive technique for visualisation of pneumoperitoneum after perforation of the hollow viscus between 3-6th penetration hours just as in unable to cooperation patients, particularly.
HISTORY AND CLINICAL FINDINGS: A 35-year-old woman was admitted because of cramp-like abdominal pain with nausea and vomiting since the previous evening. There was no history of previous abdominal symptoms of jaundice. Physical examination suggested atypical appendicitis with pain on palpation of the right mid-abdomen, localized paraumbilical guarding tension and diffuse pressure pain, more on the right, on rectal examination. Body temperature was 37.8 degrees C. EXAMINATIONS: There were leucocytosis (12000/microliters) and abnormally high liver function tests (GOT 95 U/l, GPT 110 U/l, LDH 368 U/l, alkaline phosphatase 335 U/l). Ultrasonography of the abdomen demonstrated free fluid in the Douglas pouch. TREATMENT AND COURSE: Laparotomy, performed because atypical appendicitis was suspected, revealed a torsioned pedicle of a severely bleeding accessory liver lobe positioned near the gall bladder bed. The accessory lobe was removed and the patient became symptom-free. This is the 15th reported case of clinical manifestations of an accessory liver lobe.