Apendicitis Aguda
Femenina 36 años, sin antecedentes personales de interés, viene vía emergencia por presentar dolor abdominal de varias horas de evolución que comenzó en epigastrio y se ha focalizado en fosa iliaca derecha. Le indican analítica que muestra leucocitosis de 10.300 blancos con desviación izquierda de la formula leucocitaria ( 82,3 de neutrofilos ). El examen físico muestra dolor mas acentuado en el área de la fosa iliaca derecha. Le piden sonografia abdominal y pelvica. El examen sonografico de abdomen superior es normal,lo mismo ocurre con el examen pelvico. Cuando se explora la fosa iliaca derecha con transductor linear nos encontramos con imagen típica de ¨ojo de buey¨ la cual no se deforma con la presión ejercida con el transductor, el diámetro del apéndice es de 7,9 mm ( normal hasta 6 mm ). El Doppler Color muestra aumento del flujo local y la Elastografia patrón de Color con Score 1 de Ueno típico de los procesos inflamatorios. En el interior del apéndice que visualiza imagen hiper-ecogenica con sombra posterior que corresponde con la presencia de apendicolito en la luz apendicular No se detecta la presencia de liquido peri-apendicular. Se concluye con el diagnostico de Apendicitis Aguda.Se convoca a dos cirujanos, uno de ellos, esta de acuerdo con nuestro diagnostico, el otro tiene dudas y prefiere esperar y enviar a hacer Tomografía . En los resultados de la Tomografía no se llega a una conclusión definitiva y la paciente fue llevada a quirofano. En la cirugía se extirpa un apéndice claramente inflamado ( Apendicitis Supurativa es el termino que usan en su descripción ) con presencia de liquido supurativo en fondo de saco posterior ( extrajeron 50 c.c.de este liquido). Téngase en cuenta que transcurrieron muchas horas desde nuestro examen hasta el acto quirúrgico.
Feminine 36 years, with no personal history of interest, comes via emergency due to abdominal pain of several hours of evolution that began in the epigastrium and has focused on the right iliac fossa. It is indicated by an analytical sample showing leukocytes of 10,300 targets with a left deviation of the leukocyte formula (82.3 neutrophils). The physical examination shows more accentuated pain in the area of the right iliac fossa. She is asked for abdominal and pelvic sonography. The sonographic examination of the upper abdomen is normal, the same happens with the pelvic examination. When the right iliac fossa is explored with a linear transducer, we find a typical "bull's-eye" image that does not deform with the pressure exerted by the transducer, the diameter of the appendix is 7.9 mm (normal up to 6 mm). Color Doppler shows the increased local flow and Color Pattern Elastography with Ueno Score 1 typical of inflammatory processes. Inside the appendix that shows a hyper-echogenic image with a posterior shadow that corresponds to the presence of appendicolith in the appendicular light. The presence of peri-appendicular liquid is not detected. It concludes with the diagnosis of acute appendicitis. Two surgeons are summoned, one of them agrees with our diagnosis, the other has doubts and prefers to wait and send to make a tomography. The results of the CT scan do not reach a definitive conclusion and the patient was taken to the operating room. In surgery, a clearly inflamed appendix is removed (suppurative appendicitis is the term used in its description) with the presence of suppurative fluid in the posterior cul-de-sac (50 cc of this liquid was removed). Keep in mind that many hours passed from our examination until the surgical act.
Acute Appendicitis
Feminine 36 years, with no personal history of interest, comes via emergency due to abdominal pain of several hours of evolution that began in the epigastrium and has focused on the right iliac fossa. It is indicated by an analytical sample showing leukocytes of 10,300 targets with a left deviation of the leukocyte formula (82.3 neutrophils). The physical examination shows more accentuated pain in the area of the right iliac fossa. She is asked for abdominal and pelvic sonography. The sonographic examination of the upper abdomen is normal, the same happens with the pelvic examination. When the right iliac fossa is explored with a linear transducer, we find a typical "bull's-eye" image that does not deform with the pressure exerted by the transducer, the diameter of the appendix is 7.9 mm (normal up to 6 mm). Color Doppler shows the increased local flow and Color Pattern Elastography with Ueno Score 1 typical of inflammatory processes. Inside the appendix that shows a hyper-echogenic image with a posterior shadow that corresponds to the presence of appendicolith in the appendicular light. The presence of peri-appendicular liquid is not detected. It concludes with the diagnosis of acute appendicitis. Two surgeons are summoned, one of them agrees with our diagnosis, the other has doubts and prefers to wait and send to make a tomography. The results of the CT scan do not reach a definitive conclusion and the patient was taken to the operating room. In surgery, a clearly inflamed appendix is removed (suppurative appendicitis is the term used in its description) with the presence of suppurative fluid in the posterior cul-de-sac (50 cc of this liquid was removed). Keep in mind that many hours passed from our examination until the surgical act.
