For three days, the man has lower abdominal pain. The 42-year-old does not suffer from nausea, constipation or diarrhea. His body temperature is normal. With these complaints, he visits the emergency room of the hospital Son Llàtzer in Palma de Mallorca, Spain.
The doctors there record his medical history. The man takes hormones because at the age of 13, both testicles had to be removed. Only ten days ago he was at the doctor, who had to postpone antibiotics on suspicion of gonorrhea. Gonorrhea, also called gonorrhea, is a sexually transmitted disease caused by bacteria. After infection, men usually suffer from vaginal discharge and pain during urination. As a result, it can cause inflammation, such as the prostate, the spermatic duct or epididymis. By antibiotics, a gonorrhea usually heals quickly.
As the doctors palpate him, he claims to feel pain in the middle and right part of the lower abdomen. In the right groin the doctors feel a small, harder area. There, the patient also has pressure pain. You suspect that it is a swollen lymph node.
A blood test indicates that the man has inflammation somewhere in the body: the value of the so-called C-reactive protein and the number of white blood cells are increased.
Signs of a hernia
The patient is therefore subjected to ultrasound. There are signs of a hernia. In this case, a gap has formed in the abdominal wall, in which then parts of internal organs can slip. It forms a so-called break bag in which, for example, a piece of the intestine can be trapped.
The radiologist essentially detects an elongated structure during ultrasound, which hurts when pressure is exerted on it. However, he can not get a sufficiently good picture of the situation. This is why computed tomography (CT) follows. There, the experts see an inflamed cecum, the tip of which is trapped in the inguinal hernia. This comparatively rare phenomenon is called Amyand hernia.
To confirm this diagnosis and remove the inflamed cecum, the doctors operate on the patient. They do this with a minimally invasive method, a laparoscopy, which requires only a small incision in the abdominal wall.
more on the subject
However, they do not find what they expected during the procedure. For one, the man has no inguinal hernia. On the other hand, the appendix of the 42-year-old is not inflamed at all and he is not in a bag, but is safe and sound right where he belongs.
Elongated, inflamed structure
However, there is the elongated, swollen structure that already struck in the ultrasound. Only this is not the cecum of the patient. It is the right vas deferens that looks like it is inflamed. Since the man no longer has testicles, the doctors decide to remove the vas deferens and have a sample examined in pathology. Then they finish the procedure.
When they talk to the patient after surgery, he admits that he has not taken the antibiotics. The pathology confirms that the vas deferens was inflamed. So, it's clear what happened: as a result of non-treated gonorrhea, the inflammation that the doctors did not correctly recognize on ultrasound and CT came on.
The doctors again prescribe the man antibiotics, which he now also takes. He can leave the clinic the day after the operation. In a self-critical manner, the doctors in the International Journal of Surgery Case Reports describe how the case illustrates how a poor doctor-patient interview combined with a degree of over-zealousness to treat a rare condition can lead to unnecessary surgery.