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19 January 2019 : Case report  Lebanon

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

Management of emergency care, Rare disease

Christian Saliba1ABDFG, Samer H. Diab1ABCDEF, Gregory Nicolas1CDEF*, Julien S. El Sayegh2ACD, Dani Osman2ACD, Jean Michel Azzo3ACD, Ali Dabbous2EG, Hussein Hmadeh2DEG, Ali Wehbe1BCF, Houssein Haidar Ahmad1ABCEFG

DOI: 10.12659/AJCR.912226

Am J Case Rep 2019; 20:78-82

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.

Keywords: Abdominal Pain, Appendectomy, appendicitis, Diagnostic Errors, Gastroenteritis, Mucocele, Situs Inversus

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923