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Chronic appendicitis "syndrome" manifested by an appendicolith and thickened appendix presenting as chronic right lower abdominal pain in adults.

In this short report, we describe a small series of adult patients with chronic appendicitis presenting with chronic right lower quadrant abdominal pain. The clinical presentation was unusual and atypical for classic appendicitis because of the absence of fever, peritoneal tenderness on focused graded compression of the abdomen, and leukocytosis. Computed tomography (CT) findings included the presence of an appendicolith and appendiceal thickening, without mesenteric infiltration, abscess, or collection. In this series, the appendicolith appeared to represent a marker rather than an actual cause of appendicitis. Focused CT scans with additional lung and bone windows proved optimal in detecting appendicoliths, which were not visible on the scout localizer scans, despite windowing modifications. Our findings suggest that chronic appendicitis may be a phenomenon unique to adults and should be included in the differential diagnosis of chronic right lower quadrant pain in patients seen in the emergency room setting. Surgery is curative in such patients, although expectant management is an alternative when tolerated by the patient.

Abdominal Pain↗

Appendicular intussusception into a polyp.

Intussusception of the appendix is a rare condition. We present the case of a 72-year-old woman with multiple polyps in the colon with an appendix completely intussuscepted into a polyp within the caecum. The clinical features, preoperative diagnosis, classification and treatment of this condition are discussed with reference to literature.

Aged↗

Perforated diverticulum of the caecum. A difficult preoperative diagnosis. Report of 2 cases and review of the literature.

BACKGROUND: Perforation of a solitary caecal diverticulum is a rare cause of acute abdomen and an uncommon differential diagnosis for acute appendicitis. Nine hundred cases have been described since Potiers' first description of perforated caecal diverticulum in 1912. METHODS: We describe 2 cases of perforated diverticulum of the caecum. The first patient was a 50-year-old man diagnosed by subsequent histology, and the second a 77-year-old woman diagnosed intra-operatively. Radiography, ultrasound and CT scan of the abdomen pointed at the diagnosis in the second case. A right hemicolectomy was performed. RESULTS: There were no complications, apart from a transient faecal fistula in the first patient managed conservatively. In both patients histology revealed a perforated caecal diverticulum. CONCLUSIONS: The surgeon must be familiar with the diagnosis and management of this rare, inflammatory benign caecal entity.

Aged↗

Perforated colon secondary to virtual colonoscopy: report of a case.

We describe a case of a perforated colon secondary to a virtual colonoscopy in an 81-year-old female with ulcerative colitis. She underwent an emergent right hemicolectomy. The pathologic findings were described as ulcerative colitis with full-thickness perforation. To the best of our knowledge, this is the first complication from a virtual colonoscopy reported in the literature.

Aged↗

The management of cecal volvulus.

Cecal volvulus is second only to sigmoid volvulus in its frequency of occurrence. Diagnostic doubt is not uncommon in cecal volvulus; nonoperative decompression is rarely achievable; and if gangrene supervenes, mortality rises appreciably. Resection is mandatory for gangrene and a grossly distended, thin-walled cecum. Cecopexy and cecostomy seem less-effective and more morbid options than resection and anastomosis for viable bowel. However, their role needs reappraisal in the light of advances in minimally invasive techniques.

Cecal Diseases↗

Intramural hematoma of the cecum: report of two cases.

Intramural hematoma of the cecum is a rare complication of blunt abdominal trauma. We report two patients who presented with cecal hematoma after a fall and a traffic accident, respectively. Diagnosis was by abdominal computed tomographic scan. Patients were operated on 24 and 36 hours after the injury because of sudden clinical deterioration and hemoperitoneum, respectively. The patients had a large cecal intramural hematoma that progressed to the ascending colon by dissection of the teniae coli. Emergency right hemicolectomy was followed by uneventful recovery in both patients. Only six previously reported cases of cecal intramural hematoma were found, and in all cases a right hemicolectomy was performed. In conclusion, in contrast to hematomas located in other sections of the gastrointestinal tract, early surgical treatment for intramural hematoma of the cecum is recommended.

Abdominal Injuries↗

Post-cesarean section cecal volvulus.

Cecal volvulus after cesarean section is rare. Symptoms include abdominal pain, nausea, vomiting, constipation, cystic abdominal mass, and high-pitched bowel sounds. Abdominal x-ray photography is often diagnostic, revealing a dilated cecum with a single fluid level and distended loops of small bowel. The main differentiating factors in post-cesarean large bowel distention are sigmoid volvulus and pseudo-obstruction of the colon. Treatment should accomplish derotation, decompression, and anchoring to prevent recurrence.

Adult↗

The appendix as the cause of chronic lower abdominal pain.

The records of 63 patients who had appendectomy for chronic lower abdominal pain were reviewed. Histologically 92% of the removed appendices revealed abnormality, and 95% of these patients were completely cured. It is concluded that appendicopathy does exist and could be the cause of chronic lower abdominal pain.

Abdominal Pain↗