Manglik Ayant, Tomar Lakhsit, Akash Akash
Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital New Delhi, India.
Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital New Delhi, India.
Int J Surg Case Rep. 2022 Sep;98:107490. doi: 10.1016/j.ijscr.2022.107490. Epub 2022 Aug 12.
Acute appendicitis is a common condition presenting in emergency department. A patient presenting with pain associated with fever, and tenderness in the right iliac fossa will be suspected to have Acute Appendicitis. However a variety of other clinical conditions may have similar features and may be required to be excluded. Acute pyelonephritis in an ectopic right kidney is a rare clinical condition which may mimic Acute Appendicitis.
We present a middle-age male with complaints of pain in the right lower quadrant of the abdomen with high grade fever for one week. Clinical suspicion and initial ultrasonography (USG) of abdomen supported the diagnosis of acute appendicitis. The patient was initially managed conservatively and later non-contrast computed tomography (NCCT) scan was done that revealed right ectopic kidney with acute pyelonephritis. The appendix was within normal limits on NCCT scan.
Ectopic kidneys result from anomalies of ascend which can result in several complications depending upon its position. Acute appendicitis can also cause pyuria and may mimic urosepsis amounting to its close anatomical proximity to urinary bladder. An un-ascended ectopic kidney with pyelonephritis mimicking acute appendicitis is a rare occurrence. USG and CT scan are important tools in the differential diagnosis but however, USG is greatly operator dependent; CT scan provides excellent diagnostic accuracy.
This case report signifies importance of NCCT abdomen in accurate diagnosis of conditions featuring as right lower abdominal pain and fever. Also emphasizing significance of NCCT prior to any surgical intervention, if any conflict of diagnosis occurs.
急性阑尾炎是急诊科常见的病症。出现伴有发热的疼痛以及右下腹压痛的患者会被怀疑患有急性阑尾炎。然而，多种其他临床病症可能有相似特征，需要排除。异位右肾的急性肾盂肾炎是一种罕见的临床病症，可能会酷似急性阑尾炎。
我们报告一名中年男性，主诉右下腹疼痛并伴有高热一周。临床怀疑及腹部初步超声检查（USG）支持急性阑尾炎的诊断。患者最初接受保守治疗，后来进行了非增强计算机断层扫描（NCCT），结果显示为右异位肾伴急性肾盂肾炎。NCCT扫描显示阑尾正常。
异位肾是由于上升异常导致的，根据其位置可能会引发多种并发症。急性阑尾炎也可导致脓尿，并且由于其与膀胱在解剖位置上接近，可能酷似尿脓毒症。未上升的异位肾伴肾盂肾炎酷似急性阑尾炎的情况罕见。超声检查（USG）和CT扫描是鉴别诊断的重要工具，然而，超声检查很大程度上依赖操作人员；CT扫描具有出色的诊断准确性。
本病例报告表明NCCT腹部扫描对于准确诊断以下腹疼痛和发热为特征的病症具有重要意义。同时强调，如果诊断出现冲突，在任何手术干预之前进行NCCT扫描的重要性。
