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A Case of Intussusception with Acute Appendicitis.

Kee HM, Park JY, Yi DY, Lim IS - Pediatr Gastroenterol Hepatol Nutr (2015)

Bottom Line: His vital signs were stable and laboratory test findings showed no specific alterations.We detected tenderness in the right lower quadrant.A computed tomography scan showed an ileocolic intussusception with no strangulation and diffuse wall thickening of the appendix trapped within the intussusception.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea.

ABSTRACT
In children presenting to hospital with gastrointestinal symptoms, diseases such as intussusception and acute appendicitis require particular attention and careful examination. Early diagnosis and proper treatment are important because of possible severe complications such as peritonitis and death. Intussusception and appendicitis share similar clinical manifestations. More importantly, the presence of acute appendicitis together with intussusception in children is very rare. We describe an interesting case of a 38-month-old boy who presented with abdominal pain in the right lower quadrant. His vital signs were stable and laboratory test findings showed no specific alterations. We detected tenderness in the right lower quadrant. A computed tomography scan showed an ileocolic intussusception with no strangulation and diffuse wall thickening of the appendix trapped within the intussusception. The patient underwent an appendectomy and manual reduction.

No MeSH data available.


Related in: MedlinePlus

Abdominal pelvic computed tomography. (A) Intussusceptions: ileocolic type intussusception without strangulation and significant obstruction (axial view, arrow). (B, C) Appendicitis: diffuse and mild wall thickening of the appendix partially trapped in the intussusception (B: axial view, C: coronal view; arrows).
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Figure 2: Abdominal pelvic computed tomography. (A) Intussusceptions: ileocolic type intussusception without strangulation and significant obstruction (axial view, arrow). (B, C) Appendicitis: diffuse and mild wall thickening of the appendix partially trapped in the intussusception (B: axial view, C: coronal view; arrows).

Mentions: In the emergency room, his vital signs were stable (body temperature, 37.2℃; pulse rate, 98 beats/min; respiration rate, 20 breaths/min). He did not report vomiting or diarrhea. On physical examination, we found tenderness in the right lower quadrant and auscultation indicated a hypoactive bowel. We did not find any rebound tenderness or palpable mass in the abdomen. He complained of increased pain in the right lower quadrant with coughing (Dunphy's sign). Abdominal radiography and laboratory tests were performed. Abdominal radiography showed a mild generalized ileus (Fig. 1), and laboratory investigations revealed the following: hemoglobin, 11.0 g/dL; hematocrit, 39.5%; platelets, 229,000/mm3; white blood cell (WBC) count, 8,540/mm3 (WBC differential: neutrophils, 56.9%; monocytes, 2.7%; lymphocytes, 36.4%). Atypical lymphocytes were absent on peripheral blood smear. Liver function test results were normal, and high-sensitivity C-reactive protein was mildly elevated (1.95 mg/L, normal range: 0-1 mg/L). We suspected acute appendicitis and performed an abdominal and pelvic computed tomography (CT) that showed an ileocolic intussusception with no strangulation and diffuse wall thickening of the appendix trapped within the intussusceptions (Fig. 2).


A Case of Intussusception with Acute Appendicitis.

Kee HM, Park JY, Yi DY, Lim IS - Pediatr Gastroenterol Hepatol Nutr (2015)

Abdominal pelvic computed tomography. (A) Intussusceptions: ileocolic type intussusception without strangulation and significant obstruction (axial view, arrow). (B, C) Appendicitis: diffuse and mild wall thickening of the appendix partially trapped in the intussusception (B: axial view, C: coronal view; arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493247&req=5

Figure 2: Abdominal pelvic computed tomography. (A) Intussusceptions: ileocolic type intussusception without strangulation and significant obstruction (axial view, arrow). (B, C) Appendicitis: diffuse and mild wall thickening of the appendix partially trapped in the intussusception (B: axial view, C: coronal view; arrows).
Mentions: In the emergency room, his vital signs were stable (body temperature, 37.2℃; pulse rate, 98 beats/min; respiration rate, 20 breaths/min). He did not report vomiting or diarrhea. On physical examination, we found tenderness in the right lower quadrant and auscultation indicated a hypoactive bowel. We did not find any rebound tenderness or palpable mass in the abdomen. He complained of increased pain in the right lower quadrant with coughing (Dunphy's sign). Abdominal radiography and laboratory tests were performed. Abdominal radiography showed a mild generalized ileus (Fig. 1), and laboratory investigations revealed the following: hemoglobin, 11.0 g/dL; hematocrit, 39.5%; platelets, 229,000/mm3; white blood cell (WBC) count, 8,540/mm3 (WBC differential: neutrophils, 56.9%; monocytes, 2.7%; lymphocytes, 36.4%). Atypical lymphocytes were absent on peripheral blood smear. Liver function test results were normal, and high-sensitivity C-reactive protein was mildly elevated (1.95 mg/L, normal range: 0-1 mg/L). We suspected acute appendicitis and performed an abdominal and pelvic computed tomography (CT) that showed an ileocolic intussusception with no strangulation and diffuse wall thickening of the appendix trapped within the intussusceptions (Fig. 2).

Bottom Line: His vital signs were stable and laboratory test findings showed no specific alterations.We detected tenderness in the right lower quadrant.A computed tomography scan showed an ileocolic intussusception with no strangulation and diffuse wall thickening of the appendix trapped within the intussusception.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea.

ABSTRACT
In children presenting to hospital with gastrointestinal symptoms, diseases such as intussusception and acute appendicitis require particular attention and careful examination. Early diagnosis and proper treatment are important because of possible severe complications such as peritonitis and death. Intussusception and appendicitis share similar clinical manifestations. More importantly, the presence of acute appendicitis together with intussusception in children is very rare. We describe an interesting case of a 38-month-old boy who presented with abdominal pain in the right lower quadrant. His vital signs were stable and laboratory test findings showed no specific alterations. We detected tenderness in the right lower quadrant. A computed tomography scan showed an ileocolic intussusception with no strangulation and diffuse wall thickening of the appendix trapped within the intussusception. The patient underwent an appendectomy and manual reduction.

No MeSH data available.


Related in: MedlinePlus