General

CaseDiscussion-301016

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30 Oct 2016 - General
 

A middle aged lady, with background history of depression/anxiety disorder, hypertension, migraine (taking NSAIDs in a regular basic for migraine for many years), increased in body mass index, and smoker of 20 pack years history, admitted due to increasing in the severity of right iliac fossa pain for the last 3 days. Her right iliac fossa pain, started gradually 3 days ago, but the intensity of the pain was gradually increase to a rate of 8-9/10. She denied any changed of bowel habbit, with no diarrhoea or constipation, no fever or rigore. She never experienced the same pain before. On examination of her abdomen, there was tenderness over her right iliac fossa, with some rebound tendernss. Her inflmmatory marker (CRP), was elevated. Her pregnancy test was negative. An urgent CT-ABD was done, which showed no evidence of bowel perforation, with normal appendix. But, the CT-ABD scan did commented about thickening with some fat stranding around the terminal ileum and caecum area. What will be your differential diagnosis or diagnosis ??? What is the next investigation for her ??

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I think this case is most probably acute appendicitis or meckel's diverticulitis. The increasing unprecedented pain in the right iliac fossa pain for the last 3 days and her normal bowel habits are suggestive for an acute non obstructive event. Her negative pregnancy test rules out pregnancy related complications such as ectopic pregnancy. The rebound tenderness over her right iliac fossa and the elevated inflammatory marker (CRP) along with the thickening found aroun...
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Very interesting case. I think this is a case of Meckel diverticulitis.
Pain and tenderness in right iliac fossa have multiple differential diagnosis like appendicitis, crohn's disease, intestinal TB,PID, oophoritis etc. But, all of those are excluded by the history you presented. The patient takes regular NSAID and we know Meckel diverticulum may contain peptic or pancreatic type of tissue. This patient is probably suffering from a peptic ulcer in the diverticulum. As she is a patient o...
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