Acute appendicitis due to hair follicle obstruction: a rare case report

Acute appendicitis is one of the most common emergency surgical cases, which usually develops secondary to an obstruction. Acute appendicitis due to a hair follicle obstruction is very rare. We present 2 unique cases of acute appendicitis with hair follicle in the lumen.
Case 1. A 27-year-old male patient was admitted to the emergency department with the complaint of abdominal pain. It was learnt from his history that his pain had started in the epigastric area 2 days previously, and then localised in the lower right quadrant. He had a lack of appetite and no nausea or vomiting. The physical examination revealed tenderness in the lower right quadrant, but there were no defence or rebound. His vital parameters were normal and the laboratory analyses revealed a white blood cell (WBC) count of 12,700. The appendix could not be visualised in the abdominal ultrasonography (US). His modified Alvarado score was 6, and the computerised abdominal tomography revealed that the diameter of the appendix was 8 mm and contamination in the surrounding mesenteric tissue (suspected in terms of acute appendicitis). The patient was taken into surgery with the pre-diagnosis of acute appendicitis. The abdomen was accessed through a McBurney incision, and intraoperatively it was observed that the appendix was inflamed and oedematous, and an appendectomy was performed. No problem was observed during the post-operative follow-up, and he was discharged on the second post-operative day.
Case 2. A 16-year-old male patient was admitted to the emergency department with the complaints of abdominal pain and bile-free vomiting. It was learnt from his history that his pain had continued for 2 days, which had been accompanied by bile-free vomiting for the last day. The patient stated that he last passed stools with normal consistency 1 day ago, and his vital parameters were normal except for increased body temperature (37.7°C). A physical examination revealed significant tenderness, defence, and rebound located in the lower right quadrant. He had decreased bowel sounds, and the rectal examination revealed an empty rectum. The genital examination was normal.
The laboratory analyses revealed a WBC count of 18,400 (82% neutrophils) and an increased level of C-reactive protein (CRP) of 11.2. His anterior/posterior chest X-rays and plain abdominal X-ray in the standing position were normal, and US revealed a blind-ending aperistaltic non-compressed intestinal structure of 7 mm...


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