Acute Lower Abdominal Pain in a Young Female Patient
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Saudi Journal of Medicine & Medical Sciences | Vol. 2 | Issue 1 | Jan-Apr 2014 | 60-62 60 Acute Lower Abdominal Pain in a Young Female Patient A 24-year-old multipara women presented with right lower abdominal pain of 2-day duration. Initially, the pain was periumbilical then shifted to right iliac fossa (RIF). She finished her regular menstrual cycle 10 days ago. The rest of the clinical history was unremarkable. Physical examination, including the vital signs, was unremarkable apart from tenderness at RIF. A preliminary diagnosis of acute appendicitis versus ovarian pathology was made. The white blood count was normal. Abdominal ultrasound failed to visualize the appendix. Computed tomography (CT) scan with intravenous contrast was made. The coronal [Figure 1] and axial [Figure 2] cuts are shown. QUESTIONS What are the findings? What is the diagnosis? Access this article online Quick Response Code: Website: www.sjmms.net DOI: 10.4103/1658-631X.128458 Figure 1: Coronal CT with IV contrast Figure 2: Axial CT with IV contrast IMAGE QUIZ For answers, see page 62 [Downloaded free from http://www.sjmms.net on Tuesday, July 19, 2016, IP: 62.193.78.199]
Transcript of Acute Lower Abdominal Pain in a Young Female Patient
Saudi Journal of Medicine & Medical Sciences | Vol. 2 | Issue 1 | Jan-Apr 2014 | 60-6260
Acute Lower Abdominal Pain in a Young Female Patient
A 24-year-old multipara women presented with right lower abdominal pain of 2-day duration. Initially, the pain was periumbilical then shifted to right iliac fossa (RIF).Shefinishedherregularmenstrualcycle10daysago. The rest of the clinical history was unremarkable.
Physical examination, including the vital signs, was unremarkable apart from tenderness at RIF.
A preliminary diagnosis of acute appendicitis versus ovarian pathology was made.
The white blood count was normal.
Abdominal ultrasound failed to visualize the appendix.
Computed tomography (CT) scan with intravenous contrast was made. The coronal [Figure 1] and axial [Figure 2] cuts are shown.
QUESTIONS
Whatarethefindings?
What is the diagnosis?
Access this article onlineQuick Response Code:
Website:www.sjmms.net
DOI:10.4103/1658-631X.128458
Figure 1: Coronal CT with IV contrast
Figure 2: Axial CT with IV contrast
imAge Quiz
For answers, see page 62
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Al-Bisher, et al.: Image quiz
61Saudi Journal of Medicine & Medical Sciences | Vol. 2 | Issue 1 | Jan-Apr 2014
Departments of Surgery, and 1Department of Radiology. King Fahd Hospital of the University,
College of Medicine, University of Dammam, Dammam, Kingdom of Saudi Arabia
Correspondence: Dr. Abdulmohsen Al-Mulhim, Department of Surgery, King Fahd Hospital of the University, College of
Medicine, University of Dammam, Dammam, Kingdom of Saudi Arabia.
E-mail: [email protected]
REFERENCES1. Memon ZA, Irfan S, Fatima K, Iqbal MS, Sami W. Acute
appendicitis: Diagnostic accuracy of alvarado scoring system. AsianJSurg2013;36:144-9.
2. Choi D, Park H, Lee YR, Kook SH, Kim SK, Kwag HJ, et al. The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT. Acta Radiol 2003;44:574-82.
3. Rao PM, Rhea JT, Novelline RA. Helical CT of appendicitis and diverticulitis. Radiol Clin North Am 1999;37: 895-910.
COMMENTS
The patient underwent laparoscopy which revealed acute appendicitis. Laparoscopic appendectomy was performed and histology proved acute appendicitis.
The diagnosis of acute appendicitis in young women is a challenge. Based on the clinical findings, the rate ofnegative appendectomy, in these patients can reach up to 50%. According to Alvarado scoring system,[1] the diagnosis of acute appendicitis in our patient was unlikely; shehad3outof10scores.
Similar to others experience, the CT scans depicted herein showed classical signs of acute appendicitis.[2,3]
Hassan M. Al-Bisher, Hassan A. Al-Saleem, Ali M. Al-Saffar, Bander F. Aldhafery1,
Abdulmohsen A. Al-Mulhim
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Saudi Journal of Medicine & Medical Sciences | Vol. 2 | Issue 1 | Jan-Apr 2014 | 62-6262
Figure 4: Axial CT shows diluted thick-walled appendix (green arrow) and a large appendicolith obstructing the orifice of the appendix (red arrow)
Figure 3: Coronal CT shows diluted thick-walled appendix (green arrow) and a large appendicolith obstructing the orifice of the appendix (red arrow)
Findings [Figures 3 and 4]Dilated appendix 16 mm (normal diameter is less than 6 mm).Intense enhancement of the thickened wall of the appendix.
Answers OF Quiz
A large appendicolith obstructing the orifice of theappendix.
DiagnosisAcute appendicitis versus mucocele of the appendix.
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