NMS. Casos Clínicos

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Part II ♦ Specific Disorders

Figure 8-14: Appendectomy using endoloop. A: Minimally inflamed appendix with soft mesentery, suitable for removal with endoloop. B: Secure the mesentery with clips as shown or Harmonic scalpel. C: First application of endoloop to base. (From Scott-Conner CEH. Scott-Conner & Dawson: Essential Operative Techniques and Anatomy , 4th ed. Wolters Kluwer Health; 2013, Fig. 95-3. Figure parts B and C from Scott-Conner CEH, Hall TJ, Anglin BL, et al. Laparoscopic appendectomy: Initial experience in a teaching program. Ann Surg . 1992;215:660–668, with permission.) Case Variation 8.14.2. Minimal dysuria and a urinary WBC count of 8–10/hpf ◆ ◆ This finding would not be unusual in acute appendicitis, in which the local inflammatory process is in continuity with some part of the urinary tract. It would be appropriate to remain highly suspicious for appendicitis. Case Variation 8.14.3. Urinary red blood cells (RBCs) too numerous to count ◆ ◆ This finding could be a severe UTI or a kidney stone. Most surgeons would perform an ultrasound or a CT scan without contrast (to examine for a stone). Case Variation 8.14.4. History of pelvic inflammatory disease ◆ ◆ Pelvic inflammatory disease tends to recur. Appendicitis may still develop. A careful pelvic examination is necessary. Case Variation 8.14.5. Tenderness of cervix on pelvic examination ◆ ◆ This finding tends to confirm pelvic inflammatory disease and should prompt gynecologic consultation. SAMPLE