ABSTRACT
OBJECTIVES: This study aims to ascertain the prevalence of appendiceal endometriosis (AppE) in patients diagnosed with diaphragmatic endometriosis (DiaE), compare it with the prevalence in patients without DiaE, and delineate the anatomical distribution of endometriotic lesions within these cohorts. STUDY DESIGN: Comparison of the characteristics of patients with AppE and DiaE with the characteristics of patients with abdominal endometriosis without diaphragmatic involvement, in a prospective cohort study. SETTING: Tertiary referral center; endometriosis center. PATIENTS: A cohort of 1765 patients with histologically confirmed endometriosis INTERVENTIONS: Evaluation of correlations between demographic, clinical, and surgical variables of AppE patients with DiaE and without DiaE. We performed appendectomies selectively, in the presence of gross abnormalities of the appendix, such as endometriotic implants, edema, tortuosity, and discoloration of the organ. MEASUREMENTS: Patients' characteristics were evaluated using basic descriptive statistics (chi-square test or Fisher's exact test). A logistic regression analysis was performed to evaluate the relationship (hazard ratio) between patient characteristics and the presence of DiaE and AppE. MAIN RESULTS: Within a cohort of 1765 patients with histologically confirmed endometriosis, 31 were identified with AppE (1.8 %), and 83 with DiaE (4.7 %). The prevalence of DiaE was significantly elevated at 30.1 % (25/83), among patients with AppE compared to those without AppE, who showed a DiaE prevalence of 7.2 % (6/83). The calculated odds ratio for DiaE given the presence of AppE was 5.5, 95 % CI 2.1-14.4, p = 0.0004, and risk ratio was 4.2, 95 % CI 1.8-9.6, p = 0.0008, indicating a profound association. Surgical interventions did not lead to significant perioperative or postoperative complications. In the group with DiaE, the left ovary was affected in 96 % of cases (24/25), p < 0.05, the right ureter in 80 % of cases (20/25), p < 0.01 (in 19/25 only the serosa was affected, due to external compression of an endometriotic nodule of the parametrium). Concurrent AppE and right diaphragm was found in 92 % of cases (23/25 patients), p < 0.001. The concurrent presence of DiaE and AppE was often associated with severe endometriosis, rASRM IV 72 % OR = 3, 95 % CI (1.216-7.872). CONCLUSION: The investigation delineates a marked association between AppE and DiaE, with an odds ratio of 5.5 and risk ratio of 4.2, suggesting a markedly increased likelihood of DiaE in patients with AppE. These statistics significantly substantiate the notion that AppE can serve as a predictive marker for DiaE, underscoring the necessity for a meticulous intraoperative assessment of diaphragmatic regions in patients diagnosed with AppE. The absence of a significant correlation between the depth of DiaE infiltration and the presence of AppE implies that the detection of AppE should prompt a thorough search for DiaE, regardless of the perceived severity of the endometriosis or preoperative results of diaphragmatic MRI.
ABSTRACT
The appendix is a small, finger-sized tubular pouch that extends from your large intestine. Regardless, the physiology of the appendix is still unclear. There are several factors that cause appendicitis, such as infection, underlying tumor, constipation, and trauma. Symptoms of right lower quadrant abdominal pain, nausea, anorexia, and fever, as well as physical signs such as rebound tenderness and McBurney point/sign, are typical of non-traumatic acute appendicitis. On the other hand, a thorough history and physical examination are paramount for an accurate diagnosis of acute traumatic appendicitis. If the history and physical examination are inconclusive, further evaluation with ultrasonography or computed tomography (CT) is advised. Upon reaching an accurate diagnosis, the course of treatment involves an appendectomy and intravenous antibiotics. This case describes a patient who suffered blunt traumatic abdominal injury from a fall resulting in acute appendicitis. For pediatric patients who complain of abdominal pain and present to the emergency department (ED), appendicitis should be on the differential diagnosis list, even if the patient's symptoms started after blunt abdominal trauma. Due to the rarity of appendicitis after trauma, rapid identification necessitates a high index of suspicion.
ABSTRACT
INTRODUCTION: Idiopathic omental infraction is a rare cause of acute abdominal symptoms that has been known with growing recurrence in the past ten years. It presents as right iliac fossa pain, and it's sometimes misdiagnosed as acute appendicitis. In this study we present a case Report of idiopathic omental infraction as a cause of acute abdomen. PRESENTATION OF CASE: A 25â¯year old male, presented to the casualty complaing of intermittent worsening pain in the right side of the abdomen, this symptom which mimiced the other commoner causes of acute abdomen. On further investigations he had leukocytosis, high C-reactive protein and ESR levels, A contrast computed tomography suggested acute appendicitis, In due course patient was operated after taking his consent, inside the operation 70 % of the greater omentum was necrotic with a black colour, An omentectomy was performed and he was discharged after two days with good recovery. CONCLUSION: A right side abdominal pain is not only confined to appendeceal diseases, So other disease should be put in consideration.