A curious cause of appendicitis

Abstract

A previously healthy 10-year-old boy presented to the emergency department with central abdominal pain, loose stool and vomiting. He was diagnosed with gastroenteritis, but was well enough to be discharged. The next day he reattended with ongoing diarrhoea and vomiting, with the pain now localised to the right iliac fossa (RIF). Acute appendicitis was suspected, and he was taken for laparoscopic appendicectomy. At surgery, a gangrenous appendix was found, with pus extending from the pelvis up to the liver. The appendix was excised and thorough peritoneal washout performed. Postoperatively, he received 48 hours of intravenous antibiotics and was discharged home. Unfortunately the boy presented again 11 days later with right lower quadrant pain and fever. Ultrasound revealed a collection in the RIF, and he returned to theatre for washout. His recovery was slow until the peritoneal pus sent for bacterial culture grew Salmonella enteritidis, identification of which facilitated appropriate antibiotic treatment.

Typhoid Fever and Acute Appendicitis: A Rare Association Not Yet Fully Formed

“…This case adds to a small body of literature recognizing an association between enteric bacterial pathogens Salmonella sp. [ 4 , 5 , 6 , 7 , 8 ] and Campylobacter sp. [ 6 , 7 ] and acute appendicitis, thus serving as a rare example of a common surgical emergency.…”

Delay in the diagnosis of measles complicated by pneumonitis and appendicitis in a returning traveller

“…In the case of our patient S almonella bredeney was also isolated in his stool sample. Appendicitis associated with non-typhoidal S almonella infection is also described 16 17. There were no measles-specific histological features in the appendix specimen.…”

Appendicitis in non-typhoidal salmonella bacteraemia

“…Invasive systemic disease such as bacteraemia is a known clinical manifestation in typhoidal salmonella infections but uncommon in non-typhoidal salmonella infections which typically manifests as self-limiting gastroenteritis [ 4 ]. Appendicitis is a rare form of presentation of acute abdomen in Salmonella infections [ 5 ]. Van Noyen et al [ 6 ] showed that only an estimated 8% of culture-proven bacterial enteritis had histologically proven appendicitis due to Salmonella.…”

“…Van Noyen et al [ 6 ] showed that only an estimated 8% of culture-proven bacterial enteritis had histologically proven appendicitis due to Salmonella. Two mechanisms on how Salmonella causes appendicitis have been described; either by direct invasion or via blood or lymphatics resulting in inflammation [ 3 , 5 ].…”

“…Although our patient was a poor candidate for surgical intervention, the positive cultures obtained from his stool and blood samples played an important role in his recovery by prompt use of culture-guided antibiotics. Steward-Parker et al [ 5 ] described how timely microbiological analysis of stool and intraoperative pus samples were important for selection of the most appropriate antibiotics for eventual effective treatment. Some clinicians believe that intraoperative bacteriology in appendicitis is of minimal benefit [ 7 ], but several studies believe otherwise especially in the context of atypical presentations [ 7 , 8 ].…”