Pelvic plastron secondary to acute appendicitis in a child presented as appendiceal intussusception. A case report

Abstract

We report an unusual case of an 11-year-old Greek girl with complicated acute appendicitis. The pelvic plastron that had been formatted secondary to appendix perforation was mimicking appendiceal intussusception in the preoperative ultrasound and computed tomography images. Although acute complicated appendicitis and appendiceal intussusception may represent possible causes of acute abdomen no similar cases have reported in the literature.

Appendiceal phlegmon mimicking intussusception on ultrasound: correspondence between sonographic and operative findings

“…Very few reports have documented that ruptured appendicitis may mimic intussusception on ultrasound with consequent delays in diagnosis and management [1][2][3]. We present here a case of a periappendiceal phlegmon mimicking ileocolic intussusception on ultrasound and explain the false sonographic image on the basis of the intraoperative findings.…”

“…Two other single case reports (aged 7 and 11 years) [1,2] and a retrospective radiologic study of six cases (mean age: 4.4 years) collected from a sample of more than 1200 children with suspected appendicitis [3] demonstrated that ruptured appendicitis can be a sonographic mimic of intussusception. The current report offers a valuable surgicoanatomic explanation based on intraoperative findings for the sonographic masquerade of an appendiceal phlegmon as intussusception.…”

Appendiceal Intussusception

“…Benign tumors comprising lipomas, leiomyomas, fibromas and hemangiomas are scarcely encountered. Mucoceles of the appendix are more frequent in female patients and occur in adults (Atkinson et al, 1976, Christianakis et al, 2008Wang et al, 2010). In a case of caecocolic intussusception involving a calcified mucocele participating in the intussusception that was encountered by our surgical clinic, differential diagnosis included an inflammed Meckel's diverticulum and a mesenteric cyst.…”

Ο Ρόλος Του Λιπώδους Ιστού Στις Ιδιοπαθείς Φλεγμονώδεις Εντερικές Νόσους (ΙΦΕΝ) Και Οι Σηματοδοτικοί Μηχανισμοί Της Ουσίας Π

“…Some of these locations are ectopic and are related with disease states. Some notable examples of ectopic fat accumulation is plaque formation (including stromal cells with fat accumulation) in atheromatosis [238], muscle cell substitution with adipocytes in neuromuscular degenerative diseases (like Duchenne muscular dystrophy) [239], "creeping" fat in Crohn's disease surrounding the affected intestine [240] and the omental translocation and "sealing" of any intra-abdominal inflammatory process [241]. Ectopic accumulation of lipids in different cell types leading to adipocyte malfunction is also observed in several conditions: hepatocyte lipid accumulation [242,243] in alcoholic or non-alcoholic fatty liver disease or steatohepatitis, intramuscular lipid accumulation in obesity [244], "foam cells" (macrophages containing cholesterol and lipids) [245] in atheromatosis.…”

“…Adipose tissue can then respond to pathogens by releasing cytokines and free fatty acids to recruit immune cells and induce lipotoxicity, and this can have a local effect on the already inflamed gut through diffusion or blood flow, as well as a systematic effect in inflammatory bowel disease. A known phenomenon during surgery, which is indicative of the potential crosstalk between adipose tissue and gut in inflammatory conditions, is the migration of the omentum to cover an inflamed intra-abdominal organ and/or seal slowly forming abscesses, frequently encountered in appendicitis or cholocyctitis [241].…”