Acute appendicitis presenting as chest pain.
BACKGROUND
Abdominal pain is the primary presenting complaint of patients with acute appendicitis. Acute appendicitis presenting as chest pain is extremely rare and according to our search such presentation due to herniation of appendix into thorax through congenital diaphragmatic defect has not yet been reported.


METHODS
We present a case of a 12year old male child who presented with acute chest pain. ECG was suggestive of ischemic changes. Echocardiogram and cardiac enzymes were within normal limits. Chest X-ray and gastrograffin contrast study confirmed the diagnosis of congenital diaphragmatic hernia. On exploration inflamed appendix was found herniated through the diaphragm along with caecum, ascending colon and transverse colon. Histology confirmed the diagnosis of acute appendicitis.


CONCLUSIONS
Acute appendicitis may sometimes have very varied and rare presentation. In late presenting CDH, the most important factor responsible for acute or chronic presentation seems to be the type of herniated viscera.


CONCLUSIONS
This report presents a rare case of late-presenting CDH with herniated appendix along with caecum, ascending colon and transverse colon. Unusual presentation of chest pain was due to an attack of acute appendicitis. Late-presenting CDH is a very intriguing defect with a wide spectrum of clinical manifestations. It should be suspected in cases of unexplained acute or chronic respiratory or gastrointestinal symptoms, and abnormal chest radiographic findings. The prognosis is favorable with correct diagnosis and prompt surgical repair.
Department of Surgery, Krishna Institute of Medical Sciences University, Karad 415110, Maharashtra, India.
Ashok Yadavrao
AY
Kshirsagar
Sumit Suresh
SS
Bansal
Shreyas Ramesh
SR
Somnath
Abhishek Narayan
AN
Prabhu
Vithal
V
Dhulkhed
Dhiraj B
DB
Nikumbh