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Sunday, 5 June 2016

CASE 381 : HIP PAIN in APPENDICITIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM



Woman 56 yo, pain in RLAQ  1 week ago, ambulatory treatment, pain in the back and to the right hip, difficulty in walking.
XRay of  the  right hip looked like fracture.

MRI  showed that R. hip no fracture but  fluid  collection in retroperitoneum space,  intrapsoas  muscle to pelvis and to righ thigh with intramuscular air detection ( MRI 1, 2 , 3 ).





Ultrasound  examination of pelvis  detected cystic  mass with air inside  likely an abscess..( US 1,US 2, US 3 detected air in muscle of righ thigh).




The sonologist  diagnosis is  abscess of the right thigh muscle.
Blood tests =  very high WBC= 19,6 k  with neutrophil 1,3 k,  hsCRP=   207.9ng/ml/.
Emergency CT scan of abdomen  and hip, thigh detected   retroperitoneum  abscess from the  coecum extending to liver and the righ thigh with air in muscle ( CT 1, CT 2, CT3)





Emergency operation confirmed  abscess due to necrosis of retrocoecum appendix  with perforation of cecum  extending to liver and the righ thigh.

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