Pitfalls of Diagnosing Left Lower Quadrant Pain Causes: Making the Uncommon Common Again.

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Pitfalls of Diagnosing Left Lower Quadrant Pain Causes: Making the Uncommon Common Again.

Am J Case Rep. 2019 Jan 19;20:78-82

Authors: Saliba C, Diab SH, Nicolas G, El Sayegh JS, Osman D, Azzo JM, Dabbous A, Hmadeh H, Wehbe A, Haidar Ahmad H

Abstract
BACKGROUND Left-sided acute appendicitis, although well described in the literature, is still an easily missed diagnosis. Midgut malrotation and situs inversus are 2 known leading conditions that contribute to misdiagnosis of appendicitis. CASE REPORT Here is the case of a 27-year-old male without any previous medical history, who presented with left lower quadrant tenderness and was misdiagnosed with gastroenteritis as an outpatient and sent home; the patient presented the next day to the emergency department where he was found to have acute appendicitis with situs inversus. He underwent laparoscopic appendectomy where a phlegmon was identified. Pathology came back as peri-appendiceal mucocele with no signs of malignancy. CONCLUSIONS This case report aimed to revisit the idea of left-sided acute appendicitis and discuss the management of a perforated appendiceal mucocele contained by a phlegmon.

PMID: 30659166 [PubMed - in process]

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