Pediatric subhepatic appendicitis with elevated lipase
| Autor: | Austin Essenburg, Scott A. McAninch |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Abdominal pain Delayed Diagnosis Delayed diagnosis 03 medical and health sciences 0302 clinical medicine medicine Appendectomy Humans Surgical emergency Child Pelvis business.industry 030208 emergency & critical care medicine Lipase General Medicine Appendicitis medicine.disease Normal limit Abdominal Pain medicine.anatomical_structure Elevated Lipase Emergency Medicine Pancreatitis Female Radiology medicine.symptom Emergency Service Hospital Tomography X-Ray Computed business |
| Zdroj: | The American Journal of Emergency Medicine. 37:174.e1-174.e3 |
| ISSN: | 0735-6757 |
| DOI: | 10.1016/j.ajem.2018.09.039 |
| Popis: | Appendicitis is the most common surgical emergency in children, of which most are located in the retrocecal space or pelvis. Appendicitis occurring in the subhepatic space is uncommon and may present with atypical features such as right upper quadrant pain, leading to delayed diagnosis and complications. We present a rare case of subhepatic appendicitis in an 11-year-old female, who presented with a three-day history of both right upper quadrant (RUQ) and right lower quadrant (RLQ) abdominal pain and serum lipase elevated four times the upper normal limit. The abdominal ultrasound was normal, except for prominent RLQ abdominal lymph nodes. Hours later, a computed tomography scan revealed a non-ruptured subhepatic appendicitis and normal pancreas. Our patient encounter demonstrates the need to be aware of the atypical presentations of pediatric appendicitis in general and subhepatic appendicitis in particular. Moreover, to our knowledge, this is the first reported case of elevated lipase (with a radiographically normal pancreas) in association with subhepatic appendicitis. Providers should be aware elevated serum lipase levels may be due to conditions other than pancreatitis and further evaluation should be considered if the elements of the clinical picture are incongruent. |
| Databáze: | OpenAIRE |
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