Sağ Üst Kadran Ağrısı ile Prezente Olan Pararenal Yerleşimli Retroçekal Apandisit: Bilgisayarlı Tomografi ile Demonstrasyonu

Yıl 2014, Cilt: 14 Sayı: 3, 128 - 130, 25.09.2014

İşıl Başara Yiğit Akın

https://doi.org/10.17098/amj.72055

Öz

Özet:

Akut apandisit, erken cerrahi müdahale ile tedavi edilen, düşük mortalite ve morbiditeye sahip, sık ğörülen cerrahi bir durumdur. Ancak, bazı hastalarda tanıda ğecikmelere ve artmış komplikasyonlara neden olan atipik semptomlar ve fıziksel bulgular bulunabilir. Atipik prezantasyon, apendiksin atipik yerleşimi ile ilgili olabilir. Sağ üst kadran ağrısı ile prezente olan asendan retroçekal apandisit, klinik olarak akut safra kesesi, karaciğer, safra yolları, sağ böbrek ve sağ üriner sistem yollarına ait akut patolojilerle karışabilir. Biz, ilk etapta klinik tanısı sağ üreter taşı olan akut sağ üst kadran ağrısı ile prezante olan retroçekal apandisit olğusunu sunuyoruz. Ultrason ve bilğisayarlı tomoğrafı incelemeleri sonrası, pararenal yerleşimli retroçekal apandisit ve retroperitonda inflamasyon tanısı konuldu. Cerrahi bulğular apandisitin varlığını ve retroperitoneal uzanımını doğruladı.

Anahtar Kelimeler

Bilgisayarlı tomografi, retroçekal apandisit, üst kadran ağrısı

Pararenally Located Ascending Retrocecal Appendicitis Presenting with Upper Abdominal Pain: Demonstration with Computed Tomography

Öz

Acute appendicitis is a common surgical condition that is usually managed with early surgery, and is associated with low morbidity and mortality. However, some patients may have atypical symptoms and physical findings that may lead to a delay in diagnosis and increased complications. Atypical presentation may be related to the position of the appendix. Ascending retrocecal appendicitis presenting with right upper abdominal pain may be clinically indistinguishable from acute pathologies in the gallbladder, liver, biliary tree, right kidney and right urinary tract. We here report a case of retrocecal appendicitis presented with acute right upper abdominal pain of which the clinical diagnosis at presentation was right ureteric colic. After the application of ultrasound and computed tomography examinations, pararenal located retrocecal appendicitis and inflammation in the retroperitoneum was diagnosed. Surgical findings confirmed the presence of appendicitis and its retroperitoneal extensions.

Anahtar Kelimeler

Computed tomography, retrocecal appendicitis, upper abdominal pain

Kaynakça

• Collins DC. Acute retrocecal appendicitis: based on seven hundred and fifty-one instances. Arch Surg. 1938;36(5):729–743.
• Wakeley CP. The Position of the Vermiform Appendix as Ascertained by an Analysis of 10,000 Cases. J Anat. 1933;67(2):277–283.
• Meyers MA, Oliphant M. Ascending retrocecal appendicitis. Radiology. 1974;110(2):295–299.
• Lee SL, Ho HS. Acute appendicitis: is there a difference between children and adults? Am Surg. 2006;72(5):409–413.
• El-Masry NS, Theodorou NA. Retroperitoneal proliferation of the appendix presenting as right thigh abscess. Int Surg 2002;87(2):61-64.
• Kim S, Lim HK, Lee JY, Lee J, Kim MJ, Lee AS. Ascending retrocecal appendicitis: clinical and computed tomographic findings. J Comput Assist Tomogr. 2006;30(5):772–776.
• Dimofte G, Dubei L, Lozneanu LG, Ursulescu C, Grigora Scedil M. Right adrenal abscess -- an unusual complication of acute apendicitis. Rom J Gastroenterol. 2004;13(3):241–244.
• Hsieh CH, Wang YC, Yang HR, Chung PK, Jeng LB, Chen RJ. Extensive retroperitoneal and right thigh abscess in a patient with ruptured retrocecal appendicitis: an extremely fulminant form of a common disease. World J Gastroenterol. 2006;12(3):496–499.
• Omundsen M, Dennett E. Delay to appendicectomy and associated morbidity: a retrospective review. ANZ J Surg. 2006;76(3):153–155.
• Bickell NA, Aufses AH Jr, Rojas M, Bodian C. How time affects the risk of rupture in appendicitis. J Am Coll Surg. 2006;202(3):401–406.