Because the appendix is not in its usual location, its inflammation may not elicit the classical McBurney’s sign, thus making the diagnosis much more difficult. In this case, the overlying skin of the inflamed appendix became erythematous and tender to touch which could micmic cellulitis. Amyand’s hernia has a male preponderance and usually develops on the right side, although
it has been described on the left side in cases Ipatasertib supplier of situs inversus, mobile cecum or intestinal malratation. Computed tomography can be helpful to establish early diagnosis in selected patients. The inflammatory status of the appendix determines the surgical options for Amyand’s hernia. Mesh hernia repair without appendectomy is adequate for a normal appendix while non-prosthetic hernia repair and appendectomy is recommended in patient with inflamed/perforated appendix. Contributed by “
“A 72-year-old man was investigated because of a 1-week history of fever, headache and myalgia. Seven years previously, he had been diagnosed Gefitinib nmr with gastric adenocarcinoma and treated with a subtotal gastrectomy. On admission to hospital, his temperature was elevated (38.3°C) but no other abnormalities were detected on physical examination. Laboratory tests revealed mild anemia (hemoglobin 114 g/l), an elevated white
cell count (12.6×109/l) and a mild elevation of C-reactive protein (13.6 mg/l), aspartate aminotransferase (53 u/l), alanine aminotransferase (65 u/l), alkaline selleck compound phosphatase (222 u/l) and γ-glutamyl transferase (264 u/l). His serum glucose was also elevated. A contrast-enhanced computed tomography (CT) scan showed several lesions of low-attenuation in both lobes of the liver (Figure 1). The differential
diagnosis included liver abscesses and liver metastases. A percutaneous aspirate was obtained under ultrasound guidance and yielded thick brown turbid fluid. In wet-fixed smears, blue colonies of actinomycosis with “bales of wool” appearance were seen on a background of mixed inflammatory cells (Figure 2). In cell-block sections, there were many irregularly lobulated or scalloped basophilic granules termed “sulphur granules” that are characteristic of Actinomyces. There was no evidence of metastatic adenocarcinoma. Gram staining revealed positive filamentous bacilli (Figure 2 inset, white arrow). The patient was treated with percutaneous drainage for 2 weeks and with high-dose penicillin-G given intravenously. His fever subsided after 2 weeks and laboratory tests gradually returned to normal. The abscesses had resolved on repeat CT scan after 2 months. Hepatic actinomycosis is a rare disease. Although cases of primary hepatic actinomycosis have been described, actinomycosis appears to spread to the liver from other abdominal sites in the majority of cases. Symptoms are often non-specific with weight loss and fever.