Appendicolithiasis causing diagnostic dilemma: a rare cause of acute appendicitis (report of a case)

Appendicolithiasis is a condition characterized by a concretion in the vermiform appendix. Appendicoliths are found in 10% of patients with acute appendicitis, but they are seen more frequently in perforated appendicitis and in abscess formation. We herein report a case of acute appendicitis due to appendicolithiasis, which mimics acute disorders of the genitourinary tract and causes diagnostic confusion. A 38-year-old man presented to our emergency department with a history of intense, acute, recurrent, crampy right lower quadrant pain radiating to the right groin region, accompanied by nausea. Physical examination revealed muscular defense and rebound tenderness in the right lower quadrant, tenderness in the line of the right ureter and right costovertebral angle tenderness. On X-ray examination, a right kidney stone was identified as was an incidental 3-cm density in the right lower quadrant. The patient underwent appendectomy. The diagnosis was made by operation and also X-ray examination of the appendectomy material showing appendicolithiasis. Acute appendicitis may manifest as a variety of genitourinary disorders. The possibility of an appendicolith with or without acute appendicitis must always be considered in the differential diagnosis of acute lower abdominal and pelvic disorders, and in the consideration of common acute urological disorders.

Tanýsal ikileme neden olan apandikolitiyazis: Akut apandisitin nadir görülen bir sebebi (Olgu sunumu)

Apandikolitiyazis, apandis içerisinde taþlaþma meydana gelmesi þeklinde tanýmlanan bir durumdur. Apandis taþlarý, akut apandisitli hastalarda %10 oranýnda bulunur, fakat daha sýklýkla perfore apandisitte ve apse oluþumunda görülür. Biz burada genitoüriner sistemin akut hastalýklarýný taklit eden ve tanýsal karýþýklýða neden olan apandikolitiyazise baðlý bir akut apandisit olgusu sunuyoruz. Otuz sekiz yaþýndaki bir erkek hasta þiddetli, ani baþlangýçlý, tekrarlayan, sað kasýk bölgesine doðru yayýlan, bulantýnýn eþlik ettiði kramp tarzý karýn sað alt kadran aðrýsý ile acil servise baþvurdu. Fiziksel incelemede karýn sað alt kadranda defans muskuler ve ribaund hassasiyeti, sað üreter trasesinde hassasiyet ve sað kostovertebral açý hassasiyeti saptandý. Direkt grafide, sað böbrek taþý ve karýn sað alt kadranda 3 cm çapýnda insidental opasite olduðu görüldü. Hastaya apandektomi yapýldý. Taný operasyonla ve apandikolitiyazisi gösteren apandektomi materyalinin direkt grafisiyle konuldu. Akut apandisit, çeþitli genitoüriner hastalýklar þeklinde ortaya çýkabilir. Akut apandisitle birlikte veya birlikte olmadan bir apandis taþý olasýlýðý, akut alt karýn ve pelvik hastalýklarýn ayýrýcý tanýsýnda ve sýk görülen akut ürolojik hastalýklardan dolayý her zaman düþünülmelidir.