Torsion hematosalpinx concurrent with acute appendicitis

Isolated fallopian tube torsion is an uncommon cause of acute low abdominal pain in women. We present a case of 18-year-old virgin girl with isolated right fallopian tube torsion. She was admitted to the Emergency Department of our hospital with abdominal pain. Pelvic ultrasound revealed bilateral enlarged ovaries containig 4 cm and 3 cm cystic masses and some free fluid in the pouch of Douglas. An urgent laparoscopy was performed by a general surgeon. They revealed a dusky blue twisted right hydrosalpinx with a twist of the long axis of a necrotic right fallopian tube. Laparotomy was performed due to restrictions of laparoscopy in detorsion of the pelvic mass. A right salpingectomy was performed subsequently. In conclusion; surgical treatment should not be delayed for salvage the tube and preserve fertility in suspicion of tubal torsion. Keywords: Abdominal pain, fallopian tube, laparoscopy, salpingectomy

Evaluation of the Adolescent Female With Acute Lower Abdominal Pain

Background: Acute Appendicitis (AA) remains the most frequent abdominal surgical emergency in the developed world. Failure to make an early diagnosis is a primary reason for the persistent rate of morbidity and mortality. Decision making in cases of acute appendicitis may be a problematic experience in developing countries where the facilities for investigations lack, especially in rural and semi-rural areas. Alvarado Score (AS) may be used as a guide. Aim of Study: To evaluate the effectiveness of Alvarado Score in diagnosing acute appendicitis by correlating it with the operative findings, and the pathologic findings if it is feasible. Also, to know the specificity and sensitivity of Alvarado Score as a diagnostic tool of acute appendicitis in both genders and all age groups, so we can apply it to all patients suspected to have acute appendicitis. To save time and money by diagnosing Acute Appendicitis with the help of Alvarado Score and using it as a guide in requesting a CT Abdomen for suspicious appendicitis. So, we can eventually reduce the number of negative appendices or complications of undiagnosed appendicitis. Patients and Methods: The study was conducted on 50 patients complaining of lower abdominal pain with a provi-sional diagnosis of acute appendicitis, selected non-randomly, in the Emergency Department of Harpur Memorial Hospital in Menof City, Menofeya Governorate-Egypt. Patients were assessed pre-operatively by the Alvarado scale. Post-operative histological examination of removed specimens was done. Results: The results showed that 60% of the patients were males. The mean age was 27.54, range (9-62) years old. 100% of cases had Right Lower Quadrant tenderness (RLQ) as well as Rebound tenderness, followed by; anorexia in (96%) of cases. The migration of pain to the right lower quadrant was present in (68%) of cases. Conclusion: We concluded that in our local setting, efficacy (sensitivity, specificity, and diagnostic odds ratio) of Alvarado Score, using a conventional cut off value of 7 for high-risk group, in the diagnosis of Acute Appendicitis is a good initial evaluation of patients with acute lower abdominal pain. Also, it is a cheap and quick tool to apply in Emergency Departments to rule our acute appendicitis.

Acute right lower quadrant abdominal pain in adolescent women commonly raises suspicion for appendicitis; however, the differential diagnosis must also include gynecologic causes. Rare congenital anomalies can complicate the clinical picture and lead to unexpected intraoperative findings. We report the case of a 13-year-old girl presenting with right iliac fossa pain and minimal clinical signs. Laboratory and imaging studies supported a diagnosis of acute appendicitis. During an appendectomy, a duplicated right ovary was incidentally identified - an extremely rare anatomical anomaly with fewer than 30 cases documented in the literature. The appendectomy was completed, the internal genitalia were evaluated and repositioned anatomically, and the patient had an uneventful postoperative course, being discharged within 48 hours. Ovarian duplication is a rare embryologic anomaly that is usually asymptomatic and discovered incidentally. This case highlights the importance of maintaining a broad differential diagnosis in adolescent women presenting with acute abdominal pain and demonstrates the value of systematic intraoperative exploration. It also emphasizes the need for collaboration between pediatric surgeons and gynecologists when such anomalies are encountered. The discovery of rare congenital anomalies during routine surgical procedures underscores the importance of thorough intraoperative assessment and the limitations of preoperative imaging in pediatric emergencies. Documenting such cases adds to the medical literature, enhances awareness of uncommon anomalies, and informs future clinical management.

Objective: to analyze the results of treatment of children with acute appendicitis and improve the algorithm of care. Materials and methods. The study is based on the results of treatment of 269 children with acute appendicitis and its complications, who were treated in the period 2019-2020; the microbiological part of the work was analyzed on 2334 bacteriological cultures in patients with HA in the period 1997-2019; 239 pathohistological examinations of removed appendages in the period 2019-2020. Results. The groups had different appendectomy techniques: 122 children underwent laparoscopic surgery, 147 children underwent laparotomy. In the group of children who underwent laparoscopic surgery in the structure of diagnoses: acute phlegmonous appendicitis – 51 (41.8%) children; primary peritonitis – 28 (22.9%) children; acute gangrenous-perforated appendicitis, abscess, purulent peritonitis – 24 (19.7%) children, acute gangrenous appendicitis – 16 (13.1%) children, catarrhal – 3 (2.5%) children. In 21 (17.2%) cases there was a conversion: the main reason for which was the lack of visualization of the tailbone, which led the surgeon to switch to laparotomy. Visualization of pathological changes during the ultrasound examination of the abdominal cavity occurred in 27 (31.4%) cases out of 86 performed. Intraoperative diagnosis and histopathological conclusion coincided in 65 (69%) cases. Of these: 74.5% with phlegmonous appendicitis; 68.5% with gangrenous appendicitis; 67% with gangrenous-perforated appendicitis, abscess, purulent peritonitis. In the group of children operated laparotomically in the structure of diagnoses: acute phlegmonous appendicitis – 60 (40.8%) children; acute gangrenous appendicitis – 66 (38%) children; gangrenous-perforative appendicitis, abscess, purulent peritonitis – 26 (17.7%) children. In 35 (44.3%) cases out of 79 in the preoperative ultrasound examination of the abdominal cavity, the tail was not visualized. Intraoperative diagnosis and histopathological conclusion coincided in 115 (78.2%) cases with 147. Comparing the results of treatment of both groups of children, it should be noted that in the group of children operated laparoscopically in 68.4% of cases during the ultrasound examination visualization of the tailbone was impossible. Due to the atypical location of the appendix in 17.2% of cases, which was not visualized during laparoscopy, conversion was performed. In the group of children operated laparotomically in 44.3% of cases, the tail, during the ultrasound examination, was not visualized due to the presence of destructive changes and complications in the abdominal cavity. Conclusions. Diagnosis of acute appendicitis with an atypical location and the presence of anatomical abnormalities can be complicated and affect the choice of treatment, requires a full arsenal of diagnostic capabilities of the clinic. When performing laparoscopic surgery, it is necessary to control its duration, pressure in the abdominal cavity, to conduct visual inspection of the abdominal cavity, to determine the feasibility and timeliness of conversion, which ultimately affects the safety of the patient. According to our studies, in 43% of cases of examined children in the preoperative period, the appendix was not visualized sonographically, during diagnostic laparoscopy in 11.5% (according to our studies) failed to visualize the tailbone, which required the surgeon to convert. According to the research results, the sensitivity of the Alvarado scale was 89.8%, and the specificity was 75.9%, which indicates the expediency and necessity of using the scale when examining children with suspected acute appendicitis. The informed consent of the patient was obtained for conducting the studies. Key words: children, appendicitis, acute appendicitis, laparoscopy, laparotomy.

Torsion of the fallopian tube without ovarian involvement is an extremely rare event and often difficult to diagnose, but noteworthy, cause of lower abdominal pain. The authors describe a case related to a 14- year-old adolescent with acute lower abdominal pain and vomiting presented to the gynaecological emergency department. Blood tests exhibited modest biochemical parameters of inflammation and a transvaginal ultrasound showed a left adnexal tubular cystic mass with normal ovarian appearance. A diagnostic laparoscopy revealed an isolated fallopian tube torsion. The tube was able to be untwisted with restoration of pelvic anatomy and the follow-up was uneventful. The authors describe a challenging diagnosis in an adolescent in which delayed intervention could compromise her reproductive future. Tubal torsion should however be kept in mind in the differential diagnosis of lower abdominal pain in women of all ages.

The authors review the color Doppler ultrasonographic (US) features of appendicitis and other diseases that can manifest with acute lower abdominal pain. Causes of acute abdominal pain, other than appendicitis, include gynecologic abnormalities (ovarian cyst, ovarian torsion, pelvic inflammatory disease), gastrointestinal abnormalities (infectious enteritis, Crohn disease, mesenteric lymphadenitis, intussusception), and urinary tract diseases. On color Doppler images, inflammatory and infectious processes usually show locally increased blood flow, whereas cysts and twisted masses have absent blood flow. Enlarged lymph nodes also are avascular. Color Doppler US is a useful adjunct to gray-scale US in evaluating acute lower abdominal pain in children and can aid in defining and clarifying gray-scale abnormalities.

Diagnosing acute appendicitis in children with equivocal signs and symptoms may be difficult. The usual approach is hospital observation and frequent re-examination. However, many surgeons are reluctant to delay surgery because of the risk of perforation and a negative laparotomy. To assess and compare the value of the technetium-99m hexamethylpropylene amine oxime ((99m)Tc-HMPAO)-labelled white-blood-cell (WBC) abdomen scan in the diagnosis of acute appendicitis in children with atypical clinical presentation. Fifty children with acute right lower quadrant abdominal pain and possible acute appendicitis, but atypical findings were included. After IV injection of (99m)Tc-HMPAO-labelled WBCs, serial anterior abdomen scans were obtained using a gamma camera. Thirty-three children underwent surgery, while 17 children were managed conservatively and were followed up for at least 1 month. Four children had false-positive results and one child had a false-negative scan result. The overall sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the scan to diagnose acute appendicitis in children with atypical findings was 96.7, 80.0, 90.0, 87.8 and 94.1%, respectively. The (99m)Tc-HMPAO WBC abdomen scan is a potential tool for diagnosing acute appendicitis in children with atypical clinical findings. The high sensitivity and negative predictive value allows early discharge from the emergency department to avoid costly observation in hospital and potentially unnecessary surgery in those patients with negative scans.

The differential diagnosis of right lower quadrant abdominal pain includes both ureterolithiasis and acute appendicitis. Surgical treatment can be undergone without confirmatory imaging studies after a clinical diagnosis is made. For this reason, an occult, second abdominal process may be present.A 47-year-old male presented with a three-day history of acute right lower quadrant abdominal pain. A contrast CT revealed both a 6 mm calculus obstructing the right ureter and acute appendicitis. The patient underwent appendectomy and ureteroscopy with stent placement at the same time.Simultaneous appendicitis and ureterolithiasis may present with similar clinical findings. Due to the potential risks associated with missing either diagnosis, imaging studies may be an appropriate as a step in the management of the patient with right lower quadrant pain.

Acute appendicitis is the commonest surgical emergency, but its diagnosis can be elusive with a negative appendicectomy rate of 20%. The aims of this study were to investigate the potential value of the markers of acute inflammation, serum amyloid A (SAA), and serum procalcitonin (ProCT), in the diagnosis of acute appendicitis in adults and to compare that with the commonly used serum C-reactive protein (CRP). Adult patients presenting with acute right lower abdominal pain and a clinical suspicion of acute appendicitis were included. Blood samples were obtained within 6 hours of admission for rapid serum CRP assay and for end-of-recruitment batch analysis of SAA and serum ProCT concentrations. A total of 147 patients (81 males) with a mean (±SD) age of 36 (±17) years were recruited. Appendicitis was confirmed histologically in 61 of 72 patients (84.7%) who underwent appendicectomy. A post hoc analysis revealed a diagnostic sensitivity and specificity for SAA of 92% and 72%, ProCT of 85% and 74%, and CRP of 75% and 72%, respectively. The receiver operator characteristics for the area under the curves showed that SAA (P=0.011) and ProCT (P=0.037) significantly exceeded CRP in the prediction of acute appendicitis on admission. The measurement of SAA and serum ProCT on admission in patients with clinically suspected acute appendicitis seems to outperform serum CRP in aiding that diagnosis.

Ovarian torsion is an uncommon but critical surgical emergency in adolescent girls, often presenting as acute lower abdominal pain that can mimic other abdominal conditions. Prompt diagnosis and timely surgical intervention are essential to prevent irreversible adnexal damage and preserve fertility. Objective was to analyse the clinical presentation, diagnostic findings, surgical management, and histopathological outcomes of ultrasound-defined adnexal masses in adolescent girls. This retrospective study was conducted on 18 adolescent girls aged 11–19 years diagnosed with adnexal masses at Vijaya Hospital, Chennai, from 2019 to 2025. Data regarding demographic details, symptoms, imaging findings, intraoperative observations, management procedures, and histopathological diagnoses were reviewed. The mean age of presentation was 17 years. Most patients presented with acute-onset right-sided lower abdominal pain of less than 48 hours’ duration, often associated with vomiting. Ultrasound was the primary diagnostic modality, though the presence of vascular flow did not exclude torsion. Laparoscopic detorsion with cystectomy was the most frequent management approach. Histopathological evaluation predominantly showed benign lesions such as serous, mucinous, and para-ovarian cysts. Follow-up imaging revealed either normal or polycystic ovaries in most cases. Ovarian torsion should be considered in all adolescent girls presenting with sudden lower abdominal pain. Ultrasound remains the initial diagnostic tool, but surgical exploration confirms the diagnosis. Conservative management with detorsion is recommended to preserve ovarian function and future fertility.

Acute abdomen is a common emergency condition affecting young adults, and the first consideration is usually aimed to rule out acute appendicitis in this age group. Omental fat torsion has emerged as one of the rare etiologies of acute abdomen in the younger population. It warrants serious consideration as it closely mimics acute appendicitis in its clinical presentation. Herein we report a case of omental fat torsion in a 22-year-old male patient who presented with an acute right-sided lower abdominal pain which was highly suggestive of acute appendicitis. However, the diagnostic laparoscopy revealed a normally looking appendix and terminal ileum with an infarcted omental segment on the right side of the greater omentum. A laparoscopic omentectomy and an appendectomy were performed with an uneventful postoperative recovery. The pathology report confirmed omental fat infarction and a normal appendix. This case highlights omental fat infarction as a rare etiology of acute abdomen in a young male patient.

Isolated fallopian tube torsion (IFTT) is a rare cause of acute abdominal pain. This article reports a case of isolated torsion of the right fallopian tube associated with a paraovarian cyst (POC) in a pre-menarchal 12-year-old girl. The patient presented with 18hours of progressively worsening right iliac fossa pain and nausea. Laboratory tests showed mild leukocytosis. Ultrasound showed a cystic mass adjacent to a normal right ovary with a thickened tubular structure, while computed tomography confirmed a right POC with features suggestive of torsion. Laparoscopy revealed a markedly edematous fallopian tube twisted twice around its axis with areas of necrosis. The tube was detorsed and the POC was removed. Salpingectomy was declined by the family and the tube was preserved. The postoperative course was uncomplicated. This case highlights the importance of considering IFTT in young patients with acute abdominal pain and a POC.

Acute appendicitis is one of the most common diagnoses in the emergency department. As with other surgical procedures, post-appendectomy complications are numerous and can be either immediate or delayed. Stump appendicitis is an underreported and underrecognized complication that is often diagnosed radiologically while ruling out other diagnoses. We report a case of a 26-year-old male presenting with acute right lower quadrant abdominal pain. Although he initially denied any surgical history, a focused abdominal exam revealed an incisional scar which turned out to be the result of an appendectomy nine years ago. The patient was worked up for alternate causes of right lower quadrant pain. Investigations revealed high inflammatory markers and hematuria. We proceeded with a non-contrast CT scan to rule out vesicoureteric junction stone. Instead, the scan was suggestive of stump appendicitis. The patient was admitted and treated conservatively. Maintaining a high index of suspicion for stump appendicitis, especially in patients with a clinical picture typical of appendicitis but a history of appendectomy, is key to making an early diagnosis and avoiding further complications.

BackgroundIsolated twisted fallopian tube is an uncommon event, isolated twisted fallopian tube in pregnancy is also very rare. The diagnosis is often difficult and established during the operation. The right fallopian tube is most common affected.Case presentationWe report an uncommon twisted left fallopian tube in pregnancy. A 34-year-old G3P2 28 weeks pregnant woman presented with acute left lower abdominal pain. The clinical and ultrasonographic findings led to diagnosis of twisted left ovarian cyst. Emergency exploratory laparotomy was performed. A twisted left fallopian tube and paratubal cyst was noted and left salpingectomy was performed. The postoperative course was uneventful and the pregnancy continued until term without complication.ConclusionsAlthough isolated twisted fallopian tube during pregnancy is very rare, it should be included in the differential diagnosis of acute abdomen in pregnancy. Early surgical intervention will decrease obstetric morbidity and may allow preservation of the fallopian tube.