"Endome..WHAT?! No, thanks!We're surgeons!" Ultrasonography in Acute abdomen in emergency setting: Appendicitis or endometriosis?

Abstract text (incl. references and figure legends)

BACKGROUND: Endometriosis affects between 5% and 45% of women of reproductive age, with chronic pelvic pain, dysmenorrhoea, dyspareunia, dyschezia. It is commonly defined as a gynecological pathology but the surgeon may find himself in an emergency regime to deal with this pathology in cases of suspected acute abdomen pictures with different differential diagnoses. What can the surgeon do to reduce the diagnostic error with the potential of transabdominal ultrasound TAS in the differential diagnosis in the emergency department? CASE REPORT: An hispanic 33 years old pregnant woman, admitted in ED complaining about abdominal pain in right lower quadrant for a few hours. The patient reported similar previous episodes whereby she was discharged from the hospital without a clear diagnosis. Medical history: past c-section, no medication, negative for dysmenorrhea. On Physical examination: pain on right lower quadrant, no rebound tenderness, no fever. Alvarado score was of 3 points. White Blood Cell count and C-reactive Protein were nominal. With a point of care ultrasound we discovered a patchy solid mass measuring 44 x 17 x 24 mm, with an anechoic part and Doppler signal, seemingly growing from the right rectus abdominis muscle and infiltrating the peritoneum (Image 1). The appendix presented normal caliber and sonographic features. No free fluid was present. We discharged the patient, scheduling an ultrasound guided thru-cut biopsy within few days. The biopsy finding was endometriosis and the patient was referred to a specialized centre.CONCLUSIONS: Opening up to these aspects not yet investigated by the literature could provide tools that reduce the diagnostic delay of the pathology which is still too wide today. TAS is considered to be scarcely sensitive to the pathology, but the question we ask ourselves as emergency surgeons is: do we know what to look for through this instrument? We report our experience with TAS images related to reported clinical cases.

Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)

NO