Diagnosis of Appendicitis with left lower quadrant
A 36-year-old Hispanic female presented to the emergency department with worsening left lower quadrant
pain of 3 days' duration.
The Rovsing's sign involves RLQ pain produced upon palpation of the left lower quadrant
. Psoas sign occurs with right hip extension, and the obturator sign involves pain with right hip rotation (internal and external) (James, 2017; Lee, 2017).
The abdominal cavity was explored through a 5-mm endoscope with two additional ports of 5 and 10 mm in the suprapubic and left lower quadrant
as done for standard laparoscopic appendectomy.
Ultrasonography (USG) of the abdomen demonstrated a large anechoic abdominopelvic cystic mass extending from the left lower quadrant
of the abdomen deep in the pelvis into the rectouterine pouch.
Case 1 - A 33 year old male patient came to the emergency department with nausea and left lower quadrant
pain for 3 days.
Caption: Figure 2: Power Doppler ultrasound demonstrates no internal vascularity within the enlarged hyperechoic left lower quadrant
renal allograft raising concern for renal artery thrombosis and impending infarct.
Cutaneous examination revealed multiple papules, plaques and nodules (ranging in size from 5mms to 7cms) over the left lower quadrant
of the abdomen, superimposed on an indurated plaque.
In this present case, a solid mass measuring 4 x 3 cm in the left lower quadrant
of the abdomen, and an image compatible with invagination in the same area, was detected using abdominal tomography.
During the physical examination, large mass with no certain margin was palpable in the left lower quadrant
and pelvic region.
(A) Intraoperative pre-dissection photo of tumour in situ in the left lower quadrant
, lateral to the sigmoid colon; (B) Intraoperative photo demonstrating the mass now excised; left external iliac and left superior pubic ramus exposed; left inguinal canal opened; left inferior epigastric vessels preserved; (C) Resected tumour and spermatic cord; distal cord remnant on left and proximal on right.
The paramedic reported she had repetitive questioning en route and complained of neck pain and left lower quadrant