Saleh Aysha, Alrashid Maryam, Al Hindi Saeed
Arabian Gulf University, College of Medicine, P.O. Box 26671, Manama, Bahrain.
Arabian Gulf University, College of Medicine, P.O. Box 26671, Manama, Bahrain.
Int J Surg Case Rep. 2021 May;82:105911. doi: 10.1016/j.ijscr.2021.105911. Epub 2021 Apr 27.
The presentation of an acute abdomen has a wide range of differentials. Developmental anomalies are rarely considered as part of the clinical reasoning process due to it being a mimicker of other commoner diseases. The importance of considering such anomalies and recognizing them early is essential in order to prevent complications, such as infertility.
Our case report presents an approach to a female of pediatric age complaining of right lower abdominal pain mimicking appendicitis. The physical examination and clinical findings were also in line with appendicitis. Thus, the initial work-up focused on that as the top differential. Due to the patient being female, other work-ups were conducted in order to rule out gynecological conditions such as a pelvic ultrasound. The ultrasound findings changed the approach, warranting a CT and MRI. The subsequent diagnosis was Herlyn-Werner-Wunderlich Syndrome. Intervention involved incision and dilation of the vaginal septum as it is the most effective and least traumatic method. On follow-up, the patient's symptoms resolved.
Rare diseases can mimic common diseases. Clinically, findings of other work-ups indicated a completely different diagnosis than originally suspected. Clinical reasoning thus shifted the focus to another approach and intervention.
Clinical features of appendicitis, a clinical diagnosis, were most evident. An inappropriate management may have ensued if investigations were not conducted. Ultimately, the case report illustrated the importance of radiological investigations in an acute abdomen.
急腹症的表现有多种不同的鉴别诊断。发育异常很少被视为临床推理过程的一部分，因为它常被误诊为其他更常见的疾病。考虑此类异常并尽早识别它们对于预防并发症（如不孕症）至关重要。
我们的病例报告展示了对一名主诉右下腹痛、疑似阑尾炎的儿科女性患者的诊疗过程。体格检查和临床发现也与阑尾炎相符。因此，初始检查主要针对这一最有可能的鉴别诊断。由于患者为女性，还进行了其他检查以排除妇科疾病，如盆腔超声检查。超声检查结果改变了诊疗方向，进而进行了CT和MRI检查。最终诊断为赫林-韦纳-温德利希综合征。干预措施包括切开并扩张阴道隔，因为这是最有效且创伤最小的方法。随访时，患者症状消失。
罕见疾病可能会模仿常见疾病。临床上，其他检查结果显示的诊断与最初怀疑的完全不同。因此，临床推理将重点转向了另一种诊疗方法和干预措施。
阑尾炎的临床特征最为明显，这是一种临床诊断。如果不进行检查，可能会导致不恰当的治疗。最终，该病例报告说明了影像学检查在急腹症中的重要性。
