Maqbool Nargis, Shafiq Khalid, Ali Syed Abid, Saeed Nida
Department of Surgery, Murshid Hospital and Health Care Centre, Karachi, Pakistan.
Department of Surgery, Fatima Jinnah Dental College, Karachi, SD, Pakistan.
SAGE Open Med Case Rep. 2024 May 21;12:2050313X241252352. doi: 10.1177/2050313X241252352. eCollection 2024.
This case presents a diagnostic challenge in a 28-year-old male initially evaluated for severe abdominal pain, vomiting, and constipation, leading to the presumption of post-appendectomy complications. Clinical examination revealed abdominal distension, tenderness, and signs of peritonism, along with a reducible inguinal hernia. On subsequent CT scan, a large, inflamed area of omentum localized to the right abdomen extending up to the defect in the inguinal region with mild ascites was revealed. Upon exploration, it was discovered that the patient's initial surgery had focused solely on an appendix deemed mildly inflamed by the operating surgeon, while a concurrent diagnosis of secondary omental torsion was missed. This oversight underscores the challenges in diagnosing abdominal pathologies, with the initial misdiagnosis leading to ongoing patient distress. Meticulous adhesiolysis and omentectomy were performed, resulting in the resolution of the patient's symptoms.
该病例为一名28岁男性,最初因严重腹痛、呕吐和便秘接受评估,这导致推测为阑尾切除术后并发症,诊断面临挑战。临床检查发现腹胀、压痛和腹膜炎体征,以及可复性腹股沟疝。随后的CT扫描显示,右腹部有一大片发炎的大网膜区域,向上延伸至腹股沟区缺损处,伴有轻度腹水。术中发现,患者最初的手术仅针对被手术医生认为轻度发炎的阑尾,而同时存在的继发性大网膜扭转诊断被漏诊。这一疏忽凸显了腹部疾病诊断的挑战,最初的误诊导致患者持续痛苦。进行了细致的粘连松解术和大网膜切除术,患者症状得以缓解。