Rebekah S Wood, BS1, Michael D Sarap, MD, FACS2. 1Wright State Boonshoft School of Medicine, 2South Eastern Ohio Regional Medical Center
Introduction: Three rare surgical cases in a rural setting over the course of three weeks of right lower quadrant abdominal pain. Resulting diagnoses of infarcted cecal diverticulum, cecal perforation due to actinomycosis infection, and low grade appendiceal mucinous neoplasm
Case Presentation, Management, and Outcome: 55-year-old male presented to emergency department with sudden onset right lower quadrant abdominal pain and nausea without fever or vomiting. CT scan with contrast showed no intestinal obstruction or inflammation, normal appendix, no abnormal fluid or gas collection, present diverticulosis without associated inflammation, and no kidney stones. He was admitted and given pain medicine and IV hydration without any improvement of symptoms. Decision was made to take patient to the operating room due to concerns for an ongoing acute process from no improvement of symptoms, peritoneal signs on exam, and white count of 16,000. Patient underwent laparoscopy and was found to have an infarcted cecal diverticulum. Pathology reported transmural necrosis and acute suppurative inflammation of cecal diverticulum. On post operative day 1 he was eating, walking and feeling well.
14-year-old male presented for intermittent right lower quadrant abdominal pain for 5 months after a negative appendicitis workup. Upon presentation, CT and ultrasound showed large phlegmon in right lower quadrant. Patient was taken to surgery for laparoscopy, conversion to laparotomy with ileocecectomy and primary small bowel-colon anastomosis. Pathology returned as perforation at base of cecum as primary event leading to abscess formation with possible cause being an Actinomycoses infection due to presence of sulfur granules. Pathology specimen sent to Children’s infectious disease also indicated Actinomycoses as cause of perforation.
59-year-old male with mild right lower quadrant pain was referred after colonoscopy showed inverted large appendix and benign biopsies of the base of the appendix. Patient underwent outpatient laparoscopic appendectomy with removal of cuff of cecum due to concern for malignant etiology. Pathologic diagnosis of low-grade appendiceal mucinous neoplasm. Patient followed-up in office with complete resolution of symptoms.
Discussion: Appendicitis is a common etiology of right lower quadrant pain. However, there are many causes of right lower quadrant pain that mimic appendicitis. These other causes may differ from an appendicitis presentation in only one aspect. Full appendicitis workup if possible or exploratory laparoscopy with surgical abdomen while keeping in mind other etiologies of right lower quadrant pain, allowed for tremendous improvement post operatively for all three cases.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95111
Program Number: P271
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster