Pneumoperitoneum with Unperforated Acute Appendicitis in a Patient Undergoing Peritoneal Dialysis
Pneumoperitoneum with unperforated acute appendicitis Letters Pneumoperitoneum with Unperforated Acute Appendicitis in a Patient Undergoing Peritoneal Dialysis. Nobuhiro Hieda,1) Tetsuya Makiishi,2,3) Shinya Yamamoto,2,3) Sayako Maeda,2,3) Takashi Konishi3) and Kunihiko Hirose3) 1) Department of Internal Medicine, Division of Gastroenterology, Otsu Red Cross Hospital, Otsu 2) Department of Internal Medicine, Division of Nephrology, Otsu Red Cross Hospital, Otsu 3) Department of Cardiology, Otsu Red Cross Hospital, Otsu Key Words: acute appendicitis, peritoneal dialysis, pneumoperitoneum Gen Med : 2011 ; 12 : 89-90 A 51-year-old man was admitted to our hospital A plain computed tomography(CT)scan of the with worsening abdominal pain, nausea and vomiting abdomen was performed to check for abdominal over the previous 4 hours. He did not have diarrhea pathology. The axial CT scan showed a fluid-filled, and had no history suggestive of food poisoning or dilated appendix with a calcified fecalith in the viral gastroenteritis in his family. He had been on appendiceal neck(Figure 1A). A PDcatheter was peritoneal dialysis(PD)for 7 months because of shown in the same figure. The CT scan also showed chronic renal failure caused by chronic glomerulo- the presence of intra-abdominal free air(Figure 1B), nephritis. Vital signs showed temperature of 36.4℃, which raised the possibility that the appendix might pulse rate of 84 beats per minute, and blood pressure be perforated. Inflammatory changes of the fat, of 140/70 mmHg. The physical examination was however, were limited to the cecum, indicating that significant for rebound tenderness in the right lower the air did not originate from perforation of the quadrant and was positive for McBurney point appendix, but rather from peritoneal dialysis proce- tenderness.
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