Richard W. Holt

Sarcoidosis manifesting as acute appendicitis

PURPOSE: This report presents a patient who developed signs and symptoms of acute appendicitis because of sarcoid involvement of the appendix. METHODS: This is a retrospective case review with review of the English language literature. RESULTS: The patient underwent appendectomy for suspected acute appendicitis. Histologically the appendix had no signs of acute inflammation but did have noncaseating granulomas. The patients abdominal pain resolved following appendectomy, and she has had no further similar pain in the two years since the operation. CONCLUSION: Patients with sarcoidosis may develop signs and symptoms of acute appendicitis without inflammation. Operative exploration should not be delayed in equivocal cases of right lower quadrant abdominal pain in patients with sarcoidosis.

Adhesional obstruction of the colon.

Adhesional colonic obstruction, although unusual, must be included in the differential diagnosis of mechanical intestinal obstruction. A series of four patients is reported, including a case of large-bowel necrosis secondary to adhesions. Observations are made regarding this disease process and circumstances that may increase patient vulnerability.

Esophageal obstruction from a tonic bottle screw-on cap

Occasionally, patients will present to an emergency room with esophageal obstruction secondary to a foreign body. Most often the foreign body is a food bolus, fish or chicken bone, or coin. Recently, there have been reports of obstruction of the esophagus secondary to beer bottle caps. I, 2 We report a case of esophageal obstruction due to a screw-on bottle cap from a non-alcohol containing carbonated beverage. A 22-year-old man was seen in the emergency room of D.C. General Hospital after opening a bottle of tonic water with his teeth. In removing the screw-on cap, the force of compressed gas in the bottle pushed the loosened cap into the proximal esophagus where it lodged. There was no respiratory distress but the patient could not swallow his oral secretions. Roentgenograms confirmed the position of the foreign body. The patient was taken to the operating room where under general anesthesia the bottle cap was removed via a rigid esophagoscope. His recovery was uneventful. The patient presented here had no predisposing factors for esophageal obstruction by a bottle cap including stricture, neuromuscular disturbance, or intoxication. The smooth non-serrated edge of the screw-on bottle cap made it less likely to cause esophageal perforation. The large lumen of the rigid esophagoscope facilitated grasping and withdrawal ofthe foreign body. Bottles of carbonated drinks including non-alcohol containing beverages with screw-on caps should not be opened with the teeth and may be marketed most safely in cans.