McBurney's Point Research Articles

Y-appendicoplasty: A technique to minimize stomal complications in antegrade continence enema

Purpose: The antegrade continence enema (ACE) is an effective method of treatment of fecal incontinence and constipation. However, the original procedure described is not easy to perform and is associated with a high complication rate, especially stomal stenosis-necrosis (55%). Even with introduction of orthotopic appendicostomy, composite series still report an incidence of 30% with stomal problems. The authors report a virtually complication-free simple modification, the Y-appendicoplasty. Methods: The base of the appendix is imbricated into cecum by 2 successive rows of interrupted seromuscular stitches. A small Y-shaped incision is made on the abdominal wall at McBurney's point, and 3 triangular skin flaps are raised. The appendix is brought out of the skin incision. The tip is excised, and 3 vertical cuts are made 120° apart. The 3 appendiceal flaps thus created are interdigitated with the skin flaps using interrupted sutures. Results: Twelve children underwent Y-appendicoplasty and orthotopic appendicostomy. Mean operating time was 1 hour. None experienced stomal complications that required intervention. Control of fecal continence with ACE ranged from excellent to good. Conclusion: Y-appendicoplasty and orthotopic appendicostomy minimizes complications for ACE and is easy to perform.

Chronic right-lower-quadrant abdominal pain: Is there a role for elective appendectomy?

Background/Purpose: Chronic right-lower-quadrant abdominal pain is a frequent problem in the pediatric population. The purpose of this report is to detail the outcome of management of these patients with appendectomy. Methods: Appendiceal colic was judged to be present if the history showed cramping abdominal pain in association with McBurney's point tenderness. This is a retrospective review of 50 consecutive pediatric patients experiencing pain for greater than 1 year. All patients were evaluated at a single institution by one surgeon and underwent elective appendectomies from April 1985 through April 1997. Results: Seventy-five percent of the patients were girls. One hundred forty-nine imaging and endoscopic studies were performed with 135 negative findings. Twenty-three patients had a minimum of one previous emergency room visit or hospitalization for the same abdominal complaints. The pathological findings were distinctly different from those of incidental appendectomies. Three patients had undergone previous diagnostic explorations for abdominal pain, the appendix was not removed, and a subsequent appendectomy relieved the discomfort. Forty-nine of the 50 patients were pain free at 1 year. Conclusions: Appendiceal colic is a clinical diagnosis. It is anticipated that patients with cramping abdominal pain associated with McBurney's point tenderness could undergo less preoperative workup and expedited resolution of the problem in the future.

GROIN PAIN - MALE SOCCER PLAYER

36 HISTORY: A 31-year-old male soccer player presents with two days of gradually worsening right groin pain that began the evening following a soccer game. He denies an acute injury during the game. The pain feels like a bruise and is occasionally sharp and stabbing in nature, with an associated dull, achy pain in the right testicle. The pain increases with deep breathing and lying supine. He is not using any anti-inflammatories or ice. He denies any change in urinary or bowel habits, abdominal pain, nausea, vomiting, numbness, tingling, or problems with sexual activity. PHYSICAL EXAM (INITIAL): Temperature is 98.3° and vital signs are normal. Exam of the abdomen and groin shows no gross visible abnormalities and normal bowel sounds in all four quadrants. There is tenderness 5-6 cm to the right of the umbilicus just superior to the inguinal ligament that worsens with deep palpation. There is no rebound, guarding, or tenderness over McBurney's point. Pain is not reproduced with passive or active range of motion of the hip or resisted motions of the hip. Exam of inguinal region shows no hernia or adenopathy. Penis and testicles appear normal and the right testicle is without any lesions. Iliopsoas strain Rectus abdominis tendinopathy Urinary tract infection or prostatitis Appendicitis Direct inguinal hernia Referred pain from lumbar spine or sacro-iliac joint Testicular tumor TESTS AND RESULTS: Urinalysis: no leukocyte esterase, nitrites, blood, white blood cells or bacteria WORKING DIAGNOSIS: Iliopsoas strain Rest: kicking, lifting or bending only as comfortable NSAIDS: ibuprofen 800 mg TID for 7-10 days Iliopsoas stretching Return to clinic if no improved in 14-21 days or sooner if worsens Emergency room if pain acutely worsens, fever, vomiting, other concerns

A CASE OF MALIGNANT LYMPHOMA OF THE SMALL INTESTINE WITH A SPECIFIC MORPHOLOGY

Malignant tumors of the small intestine lack in specific symptoms so that it is difficult to diagnose in an early stage. This paper reports a case of primary malignant lymphoma of the ileum which presented difficulty in differentiation from periappendicular abscess. A 20-year-old woman was occasionally febrile and had an abdominal pain scince November in 1996. In February, 1907 she noticed a mass in the right lower quadrant, and was admitted to the hospital because of right lower abdominal pain. On admission a hard tumor whose surface was smooth was palpated on the McBurney point where there were tenderness and Blumberg's sign. Anemia and inflammatory response were also noted. At first a periappendicular abscess due to acute appendicitis was suspected by clinical features and the findings of US and CT. Finally a primary tumor of the ileum, in particular malignant lymphoma was suspected and an operation was performed. Upon laparatory, a fist-sized tumor was placed in the ilececal junction and a right hemicolectomy was carried out. Histological diagnosis was diffuse and large cell type of malignant lymphoma. Postoperatively no legion was detected in the other organs. It was diagnosed as primary malignant lymphoma of the small intestine.

Is the appendix where you think it is — And if not does it matter?

For over 100 years the recognized surface marking for the appendix has been McBurney's point (the junction of the lateral and middle thirds of a line joining the umbilicus with the right anterior superior iliac spine (ASIS)). In order to test its validity, the relationship between McBurney's point and the appendix was determined on 275 double contrast barium enemas (DCBE). A wide spread of distribution of the site of the appendix base was seen. Only 35% of appendix bases were found to lie within 5 cm of McBurney's point, and 15% were more than 10 cm distant. Seventy-five per cent of appendix bases were below and medial to a line joining the umbilicus with the right ASIS. These findings are in agreement with world-wide studies conducted by the World Organisation of Gastroenterology which showed that less than half of all patients with appendicitis have tenderness maximal over McBurney's point. A record was also made in 93 cases of the position of the appendix in relation to the caecum. The importance of these results in the diagnosis and management of patients with suspected appendicitis is discussed.

The lack of importance of Lanwei point in the diagnosis of acute appendicitis

Fifty patients with a presumptive diagnosis of acute appendicitis based on usual Western medicine criteria (e.g., McBurney point tenderness, increase WBC, history of nausea, etc.) were examined prospectively for tenderness of the Lanwei acupoint, just prior to the administration of general anesthesia, to evaluate this well known ‘Appendix’ point as a useful aid to diagnosing appendicitis. The presence or absence of tenderness was statistically not a good indicator of appendicitis.

SPECTRAL ANALYSIS OF BOWEL SOUNDS IN ILEUS

The present report demonstrates the bowel sound of ileus by dividing the findings of the spectral arrays into fourtypes. The microphone was attached to the McBurney point, and the bowel sound was recorded on a tape recorder. The spectral arrays were obtained by a continuous analysis of the sound frequencies (0-1200Hz) with the signal processer. The bowel sound in healthy adults consisted of 200-550Hz with peak frequency at 340Hz, and the high frequency sound above 900Hz was scazcely observed. Type 1 and 2: This sound was recorded by the simple obstruction as a metallic sound. Its feature is that a high frequency sound above 900Hz is seen sporadically or together. The pattern where the location of peak sounds is below or above 550Hz was classified into 1 and 2 types respectively. In case of type 2, the width of the peak sound extended to the high frequency range. Type 3: This sound is observed in the strangulating obstruction. This pattern is that a high frequency sound above 900Hz is not seen, and the peak frequency was shifted to the high frequency range. In type 3, the pattern where the width of peak frequency was narrow and isolated suggested the necessity of an operation. Type 4: This pattern was seen in the paralytic ileus.Alow peak was observed sporadically. This finding of spectral arrays of bowel sounds in the ileus is a useful tool for critical diagnosis of ileus and in decision to operate.

I Get Butterflies...

This is a plea to the tattoo artists of the world. In practicing your craft, please consider us poor surgeons who have to face your tattoos when we do our incisions. I get butterflies doing surgery on tattooed people. As a resident doing research surgery on calves, I was delighted to find that at the end of the procedure, the cosmetic closure of the thoracotomy was facilitated by the accurate alignment of the spots. The mama cow could be proud. However, I confronted with trepidation a rule-out appendicitis diagnosis in a young woman with a butterfly tattoo at McBurney's point. Luckily, I solved the dilemma by ruling it out nonoperatively. How should I select the puncture site of the Veres needle for laparoscopy in a rotund man with a completely undraped female figure sketched upon his epigastrium? Gratefully, it was merely a subcostal cholecystectomy incision and not a cutdown that

先天性第XIII因子欠乏症の急性壊疸性虫垂炎の手術例

A case of acute gangrenous appendicitis in a adult patient with congenital factor XIII deficiency is reported.T. K., 40 years old male, had had repeated episodes of excessive bleeding from wound and muscular hematoma since his childhood. The diagnosis of congenital factor XIII deficiency was established at the Department of Pediatrics, Nara Medical University in 1966 (Jap. J. Clin. Hemat. 15: 191, 1974).On Octover 22, 1973, the patient was admitted to Nara Medical University Hospital, because of nausea, abdominal pain and fever for one day.Physical examination revealed a moderate muscle defense, press pain of McBurney's point and positive Rosenstein's sign. No ecchymosis on the trunk and extremities. An appendectomy was performed under a cover of infusion with 6gm human fibrinogen preparations. The factor XIII activity rose to 10U/ml (20% of normal value) one hour after the infusion. The operation was done uneventfully. The appendix was purulent and gangrenous. On 7th postoperative day, the factor XIII activity demonstrated to be 2.5U/ml, and 4gm of human fibrinogen preparation was infused again. Shortly after the infusion threads were removed partially. No bleeding was observed. A complete removal of the suture was done on the 13th postoperative day, without an abnormal bleeding. On the 16th postoperative day, 4gm of human fibrinogen was given as the plasma level of factor XIII decreased to 2.5U/ml (5% of normal value). The wound healed normally. The patient was discharged after six week-hospitalization.

Case of terminal ileitis due to Yersinia pseudotuberculosis

A 26-year-old housewife was admitted because of right lower quadrant pain of 4 days duration, vomiting, dizziness and fever. At the time of admission, body temperature was 38.2°C and leucocyte count was 8200 per cu mm. Percussion tenderness on abdomen was maximum at McBurney's point but muscular guarding and Blumberg's sign were equivocal.She was treated symptomatically without laparatomy. Abdominal pain decreased in severity with subsiding of fever within 10 days after the onset of illness. Slight ileocecalgia, however, had persisted for about one and half months.Alimentary X-ray examination on the 17th and 34th days of illness revealed hyperplasia of mucosal folds and stenosis of the terminal ileum with regional tenderness. X-ray examination, however, on the 72nd day, when she had become free from complaints, disclosed resolution of the pathological findings before observed. Thus diagnosis of terminal ileitis was decided.A strain of Yersinia was isolated from feces of the 9th day of illness. Its biochemical properties were identical to Y. pseudotuberculosis. Cross-absorption test for O-antigen showed that the strain was antigenically similar to the reference strain, Y. pseudotuberculosis type III (No.83).Agglutinin titer of convalescent serum to O-antigen of patient's own strain was 1: 160 on the 34th day.The organism, when isolated, was non-motile but became motile after serial subcultures at 25°C using Cragie's tubes. The motile strain showed several peritrichous flagella under electron microscope.Single-disc sensitivity test revealed the organism to be sensitive to benzyl-penicillin, cephaloridine, gentamicin, nalidixic acid and sulfisomezole and resistant to streptomycin, erythromycin and spiramycin.

Acute appendicitis in pregnancy and the puerperium.

Summary: A series of 55 cases of acute appendicitis in pregnancy and the puerperium over the 6‐year period, 1960–1965 is presented. Pregnancy modifies the classical presentation of the disease, partly because of the altered position of the appendix, and partly because of less efficient localization of the infection. Accordingly, the site of maximum tenderness may be above McBurney's point and peritonitis is a frequent complication and this may be associated with abortion and perinatal death. Immediate appendicectomy is the correct treatment; combination with Caesarean section should be avoided whenever possible.

PSEUDOTUMOR OF THE OMENTUM PRESENTING AS A SURGICAL EMERGENCY.

THE CASE to be reported concerns a nonneoplastic tumor of the omentum which we have designated as a pseudotumor (benign pseudoneoplasm); Ackerman's 1 classification of omental tumors does not refer to this type of tumor. Report of a Case History.— A 28-year-old Negro university student was admitted to the Cottage Hospital on June 4, 1964, giving a 24-hour history of abdominal pain localizing in the right lower quadrant. This was associated with nausea and vomiting. He had a somewhat similar episode three months previously which had subsided spontaneously in 48 hours. His only previous illness was prostatitis in 1960. Physical Examination.— The patient's temperature was 99.4 F (37 C); abdominal tenderness was most marked over McBurney's point. Guarding and rebound were present in the same area. Laboratory Studies.— White blood cell count was 11,900/ cu mm with 1% young neutrophils, 84% segmented neutrophils, 9% lymphocytes, and 6% monocytes. Urine was

Metastatic carcinoma in the liver simulating the acute surgical abdomen. Report of three cases.

Fever, leukocytosis, and right upper quadrant pain is a common symptom complex seen on every Surgical Service. However, intra-abdominal carcinoma with liver metastases is not usually found as a cause for, or in association with, the above clinical traid. Recently we had three patients on our Surgical Service, each presenting with symptoms of a right upper quadrant inflammatory lesion. At emergency laparotomy all three patients were found to have diffuse liver metastases from an unsuspected intraabdominal carcinoma. Report of Cases Case 1. —Two months prior to admission, this 26-year-old white man experienced sudden onset of constant dull pain in his right upper quadrant and at McBurney's point. The pain disappeared slowly over a three-week period, only to recur again one week later, lasting again for three weeks and subsiding. At the time of admission to the hospital, the patient had an exacerbation of the right upper quadrant pain with tenderness,

Recognition of the combination of acute appendicitis with strangulated intestinal obstruction caused by Meckel's diverticulum

Patient U., 17 years old, I / VIII-58, at 22 o'clock with a diagnosis of acute appendicitis, was taken to the surgical department. Suddenly fell ill at 7 o'clock. ago. Pains appeared in the right half of the abdomen, nausea. Abdominal pains were noted in 1953 and 1956; was treated on an outpatient basis. The abdomen is moderately tense in the right iliac region, soreness at McBurney's point, Blumberg-Shchetkin's symptom on the right is positive. The tongue is not coated. Temperature - 37.0 . Pulse - 84, satisfactory filling.

Intraluminal mesentery as cause of small-bowel obstruction.

While it is difficult to be absolutely certain that one has found a “new” entity, we have not been able to find in the literature any mention of mesentery within the lumen of the bowel. We feel, therefore, that this single case, with striking roentgenologic features, is worthy of reporting. We will, in addition, consider the possible mechanisms of the occurrence. Case Report A 26-year-old colored male gave a two-year history of intermittent abdominal pain, unrelated to exercise, food intake, or trauma. The bouts of severe periumbilical pain, with radiation to the right lower quadrant, usually lasted from one to three days. During the attack the patient suffered from obstipation and would often vomit bile-stained material, but there was no hematemesis or feculent vomitus. Alkalis offered no relief. The symptoms subsided spontaneously with the passage of a copious stool, and the patient was left without ill effects. On admission to University Hospital, the chief complaint was severe abdominal pain with nausea and vomiting. These symptoms had been present for three days, during which time there had been no bowel movement and no flatus had been passed. Examination revealed an acutely ill patient, whose temperature was 99° F., pulse 100 per minute, and blood pressure 130/80. The slightly distended abdomen was generally tender to palpation, especially in the right lower quadrant. Muscle guarding was present on the right, with rebound tenderness at McBurney's point. No enlarged organs or masses were palpable. Rectal examination revealed tenderness on both the right and left sides; there were no feces in the ampulla. Findings on proctosigmoidoscopy were normal except for minimal hemorrhoid formation. Laboratory Studies: The hemoglobin was 7.3 gm.; hematocrit 27 per cent; leukocyte count 9,300, with 69 polymorphonuclears, 29 lymphocytes, 1 eosinophil, 1 monocyte. The following were normal: urinalysis, sickle-cell preparation, serum amylase, serum calcium, nonprotein nitrogen. Roentgenologic Examination: Three days prior to admission, chest films were normal. Upright and supine views of the abdomen demonstrated a relative absence of gas throughout the colon, with a few scattered loops of small bowel principally in the right upper quadrant. On the third hospital day a barium meal revealed mild duodenal and jejunal dilatation. On the ninth day examination of the colon was about to be started when the fiuoroscopist noticed that loops of small bowel on the left were still filled with the barium given six days previously. This opacification is demonstrated on Figure 1 against the background of the filled colon. Figure 2 shows the loops “opened up” on the left anterior oblique projection. Course: Since the clinical picture was that of bowel obstruction, the patient was put on Wangensteen suction. Supportive therapy included blood, intravenous fluids, and antibiotics.

Ileocecal Tuberculosis

The diagnosis of ileocecal tuberculosis requires roentgenologic confirmation. From the experience at the Triboro Hospital for Tuberculosis, it is felt that the roentgen findings are sufficiently constant to permit this diagnosis to be made with some degree of certainty. The problem at this hospital is simplified since all patients are presumably suffering from tuberculosis. The finding of organic lesions of inflammatory nature in the ileocecal region in a tuberculous patient is strong presumptive evidence that the process here is also tuberculous. The roentgenologic task, therefore, resolves itself into determining whether organic inflammatory disease is present. A differential diagnosis must, of course, always be made. We have found, however, that other conditions may readily be ruled out by the roentgen evidence. In the random case seen in a general hospital the problem would certainly be more difficult. Nevertheless, our experience would suggest that the roentgen findings may be sufficiently constant to indicate the diagnosis under any circumstance. If the patient is known to have tuberculosis, the presumption is stronger. As a corollary to this, chest roentgenograms would be indicated in the differential diagnosis of obscure ileocecal disease. No discussion of the clinical syndrome will be given. It is to be noted, however, that there is a wide variation in the signs and symptoms. Even in the clear-cut cases, abdominal pain is of varying constancy and intensity. Indeed, it is not uncommon to find extensive ileocecal tuberculosis at autopsy in a patient who has had no gastro-intestinal symptoms or whose other complaints were so great as to overshadow completely any abdominal manifestations. The pain, when present, is usually greatest in the right lower abdominal quadrant. On palpation, tenderness about McBurney's point is often found, although the pain may be more generally distributed. A tumefaction is occasionally present. In some cases this may be palpated only during attacks of pain, suggesting a transient volvulus at the ileocecal valve. The diagnosis of acute appendicitis requires exclusion. Diarrhea may be present in varying degrees, and occasionally the stools are bloody. Cultures of the stools may be negative for acid-fast bacilli. In one patient a search for the cause of a rapid pulse led to the discovery of extensive ileocecal disease which was giving no symptoms. The varying and uncertain clinical picture increases the diagnostic value of the roentgen study. Direct roentgen evidence of organic disease is sought in the terminal ileum, the ileocecal valve, and the cecum. Indirect confirmatory evidence is furnished by the remainder of the ileum, the appendix, and the remainder of the colon, all of which may be involved. Important evidence is likewise contributed by the psoas shadows; the right psoas shadow is frequently obliterated, possibly by regional lymph nodes or tumefaction.

Ureteral Pain as Determined by Faradic Stimulation in Man

In studying the ureteral contractions by the electrical method as described by Paladini, it occurred to us that the localization of ureteral pain could be studied by applying a stimulus to the electrode and having the patient describe the area in which the pain was felt. Experiments of this kind have been extensively done on the pleura, pericardium and peritoneum by Capps and more recently by Boyden and Rigler on the gastrointestinal tract. Since the electrodes used in the contraction studies were not quite suitable for pain distribution studies, a special electrode with a single metal contact at the tip was manufactured for this purpose by the American Cystoscope Makers, Inc. A Harvard inductorium was used for the source of current with 6 volts on the primary circuit. The inactive electrode was applied to the chest. The patient was cystoscoped, the ureteral catheter electrode was introduced into the ureter and stimulation was made at various levels up the ureter. The distance between stimulation points was 5 cm., since it was felt that too frequent stimulation led to indefinite and inaccurate interpretation. After the conclusion of the experiment pyeloureterograms were taken to exclude pathology in the urinary tract. In the lower one to 2 cm. of the ureter, the pain was referred suprapubically, being almost in the midline and extending upward about 4 cm. Pain into the perineum occurred in some cases but was not constant. Five centimeters from the ureteral orifice the pain was higher and somewhat lateral to the midline. The pain was always below the iliac crest and somewhat medial to McBurney's point.

The attitude of the obstetrician to surgery during pregnancy

1. Appendicectomy at 14 weeks gestation. (Mr. T. Lane.) Mrs. B., ~et. 33. One full term, one abortion. Seen a t 12 noon 312/38. History of vomiting a t 1 p.m. previous day, and at tack of pain 2 p . m , s tar t ing in epigastrium and moving to r ight side. DiarrhoEa during day. Slept a t night and fel t much bet ter in the morning, but on g e t t i n g up noticed some pain and stiffness in r ight side. Temp., 97.6 ~ F. pulse, 80. Abdomen moved freely and was quite relaxed except f.or a l i t t | e " guarding " and deep tenderness about McBurney's point. L.M.P.~ 26110132. P.V. Normal pregnancy. Seen by Mr. Lane and, as appendicitis could not be eliminated, abdomen was opened a t 5 p.m. The a p p e n d i x was gangrenous and there was pus in the peri toneal cavity. Drainage. Uninter rupted recovery. Pregnancy continued to term.

Mixed Tumor of Parotid Type, Orbital in Location

Article1 November 1927Mixed Tumor of Parotid Type, Orbital in LocationEARL D. CUMMING, M.D.EARL D. CUMMING, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-1-5-310 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptOn October 17, 1921, Mrs. Minnie Beese, age 52, presented herself at St. Luke's Out Patient Department for physical examination, with two complaints:(1.) Pain in lower right abdomen, and(2.) A prominence, very pronounced, of the right eye.Present Illness:For the past seven years patient has had intermittent attacks of pain in the right lower abdomen associated with tenderness on pressure at approximately McBurney's point. She has never had nausea or vomiting with these attacks, and it is this disturbance that lead her to consult a physician rather than the prominence of her right eye, which she accepted... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Cleveland, Ohio*Presented to the American College of Physicians, St. Luke's Hospital, Cleveland, Ohio, February 22, 1927. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 November 1927Volume 1, Issue 5Page: 310-312KeywordsAbdominal painNauseaOutpatientsPatient advocacyVomiting Issue Published: 1 November 1927 PDF DownloadLoading ...

ECHINOCOCCUS CYST OF APPENDIX

A Chinese soldier, aged 32, had three attacks of abdominal pain in the past ten years. The present, or fourth, attack lasted about twenty-four hours, with severe colic in the epigastrium, vomiting once, and constipation. Examination showed deep tenderness at McBurney's point, but no rigidity. The temperature was 99.4; the total white count, 13,800. Appendectomy relieved the symptoms. The proximal half of the appendix was bound down to the ileocecal junction by peritoneum. It was 8 cm. long and 1.5 cm. in diameter, with a smooth, white surface, tightly distended, fluctuating, and possessing hydatid fremitus. When opened, a cyst cavity was revealed containing many secondary and tertiary cysts. This cavity extended from the tip to the narrowed base of the appendix, where the lumen was obliterated. A small, incompletely separated compartment at the tip suggested that the process may have started here in the wall of the appendix.