A Case of Right Upper Abdominal Pain Misdiagnosed on Computerized Tomography
Journal name: The Malaysian Journal of Medical Sciences
Original article title: A Case of Right Upper Abdominal Pain Misdiagnosed on Computerized Tomography
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Seema SINGH, Ashesh Kumar JHA, Naveen SHARMA, Tushar Subhadarshan MISHRA
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: A Case of Right Upper Abdominal Pain Misdiagnosed on Computerized Tomography
Year: 2014
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Right upper abdominal pain is a frequent symptom presented in emergency surgical cases, where accurate diagnosis is typically achieved through clinical evaluation or imaging techniques. However, there are occasions where the true cause of the pain remains elusive. This report discusses a rare case of right upper abdominal pain attributed to a perforated subhepatic appendix, which was initially misdiagnosed as gall bladder perforation despite the use of various imaging methods, including contrast-enhanced computerized tomography (CECT).
Diagnostic Challenges of Subhepatic Appendicitis
The clinical presentation of acute appendicitis can vary significantly based on the position of the appendix, and subhepatic appendicitis is a particularly rare variant. The case presented involved a 55-year-old woman who exhibited symptoms consistent with acute cholecystitis, leading to initial misdiagnosis. Ultrasound and CT scans identified gallstones and associated collections but failed to reveal the underlying appendicitis. The surgical intervention ultimately confirmed that the patient had a gangrenous, perforated subhepatic appendix, emphasizing the diagnostic challenges posed by atypical presentations of appendicitis. The literature has documented similar occurrences where appendicitis mimicked other conditions, highlighting the potential for misdiagnosis and the necessity for awareness among clinicians regarding variations in appendix positioning.
Conclusion
This case underscores the importance of considering less common diagnoses like subhepatic appendicitis when evaluating right upper abdominal pain, particularly when conventional imaging studies do not yield clear results. The challenges associated with diagnosing appendicitis in atypical positions call for a high degree of clinical suspicion and may necessitate exploratory surgical procedures to ensure appropriate treatment. Improved diagnostic strategies, such as the use of laparoscopy or advanced imaging techniques, may enhance the accuracy of diagnosis in similar cases, reducing the likelihood of mismanagement and its associated complications.
FAQ section (important questions/answers):
What is a common symptom leading to surgical emergencies?
Right upper abdominal pain is a common symptom that patients often present with in surgical emergency departments. The cause can often be diagnosed through clinical evaluations or imaging studies.
What condition was misdiagnosed in the reported case study?
In the reported case, a perforated subhepatic appendix was misdiagnosed as gall bladder perforation, despite utilizing various imaging modalities, including contrast-enhanced computerized tomography (CECT).
Why can appendicitis in subhepatic positions be challenging to diagnose?
Subhepatic appendicitis can mimic conditions like acute cholecystitis or liver abscess due to its atypical presentation, often leading to misdiagnosis even with imaging techniques like ultrasound and CT scans.
What surgical procedure was performed after misdiagnosis in the patient?
The surgical procedure performed was an exploratory laparotomy, which revealed a gangrenous, perforated subhepatic appendix, leading to an appendicectomy and cholecystectomy for effective treatment.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “A Case of Right Upper Abdominal Pain Misdiagnosed on Computerized Tomography”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Pain:
Pain refers to the localized discomfort that is a primary symptom in the context of the case discussed, where a 55-year-old woman presented with right upper abdominal pain due to a perforated subhepatic appendix. It often serves as a crucial indicator for diagnosis in medical evaluations, influencing subsequent imaging and treatment decisions.
2) Patel:
Patel is likely a reference to an author or researcher who contributed to medical literature concerning appendicitis or related abdominal conditions. One cited case was from Patel et al., emphasizing the potential for misdiagnosis when appendicitis presents atypically, underlining the importance of correct identification for effective treatment.
3) Chang:
Chang refers to a researcher who studied the role of colonoscopy in diagnosing appendicitis, particularly in atypical presentations. Their work provides insights into alternate diagnostic approaches when imaging techniques yield inconclusive results, thereby improving diagnostic accuracy and patient outcomes in cases of unusual abdominal pain.
4) Thomas:
Thomas appears as a co-author in the reference concerning subhepatic appendicitis mimicking acute cholecystitis. As part of a collaborative study, Thomas's contributions highlight the complexity and rarity of such conditions, stressing the necessity for a comprehensive understanding among medical practitioners to avoid diagnostic errors in abdominal pain cases.
5) Table:
In this context, 'Table' may reference figures or illustrations showing diagnostic imaging results, such as CT scans. Visual aids like tables or figures are vital for communicating complex data, providing clearer insight into diagnostic findings, guiding clinical decision-making, and illustrating the unusual presentations of abdominal conditions.
6) Fever:
Fever is a common accompanying symptom in various medical conditions, including the case of appendicitis described. It indicates the body's response to infection or inflammation. In this case, the presence of fever alongside abdominal pain raised suspicion for an underlying issue, aiding in the urgency of surgical evaluation.
7) Study (Studying):
Study refers to the research or case reports mentioned throughout the text, highlighting various instances of misdiagnoses. These studies contribute to the medical community's understanding of abnormal presentations of appendicitis and stress the importance of comprehensive evaluations to avoid critical delays in treatment for patients with abdominal pain.
8) Post:
Post typically indicates the phase after a procedure or action. In the article, references to the 'post-operative' condition of the patient emphasize the recovery period after surgical interventions. This term is significant as it examines patient outcomes and outlines the effectiveness and challenges of management strategies undertaken post-surgery.
9) Inflammation:
Inflammation is a biological response to harmful stimuli and plays a crucial role in the case of appendicitis. The report highlights that the misdiagnosis of inflammation around the appendix can lead to significant clinical errors. Understanding inflammation is essential for effective management and recognizing when surgical intervention is necessary.
10) Discussion:
Discussion is an important section in academic articles where the authors analyze their findings, relate them to existing knowledge, and contemplate implications for practice. In this report, the discussion highlights the diagnostic challenges presented by atypical cases of appendicitis, underscoring the necessity for continued medical education and refined imaging protocols.
11) Vomiting:
Vomiting is another symptom that can accompany abdominal pain and fever, further indicating a gastrointestinal issue. In the case described, it contributed to the overall clinical picture and urgency for assessment. This symptom can signal serious underlying conditions, thus it is integral in evaluating patients presenting with such complaints.
12) Account:
Account refers to the narrative or report of the clinical case presented in the article. This term underscores the significance of documenting patient experiences, especially in rare medical scenarios. Such accounts enhance medical knowledge about unusual presentations, informing and guiding future clinical practices and academic investigations.
13) Wall:
Wall can refer to the anatomical structures involved in the case study, such as the abdominal wall. The mention of the wall emphasizes the complexities of diagnosing conditions like appendicitis, particularly when internal structures encroach upon or affect external areas, complicating the clinical picture and treatment strategies.
Other Health Sciences Concepts:
Discover the significance of concepts within the article: ‘A Case of Right Upper Abdominal Pain Misdiagnosed on Computerized Tomography’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:
Chill, Vomiting, Fever, Abdominal pain, Surgical management, Abscess, Embryonic development, Peritonitis, Appendicitis, Clinical evaluation, Ultrasonography, Ultrasound, Cholecystectomy, Colonoscopy, Ultrasonography (USG), Magnetic resonance imaging, Noninvasive method, Appendicectomy, Laparoscopic surgery, Acute appendicitis, Diagnostic laparoscopy, Gall Stones, Computerized tomography, Clinical finding, Imaging modalities, Laparoscopic cholecystectomy, Surgical emergency, Atypical Presentation, Pyelonephritis, Gall Bladder, Diagnostic Dilemma, Acute cholecystitis, Laparotomy, Exploratory laparotomy, Liver abscess, Leucocytosis, Gall bladder perforation, Pericholecystic fluid, Emergency general surgery, Post-Operative Day, Hepatic parenchyma, New York (NY).