Presentation
The patient presented to the emergency room with right lower quadrant abdominal pain that worsens in supine position, decreased appetite, and nausea for two days. No fever, vomiting, diarrhea, or constipation. Previous episode of similar pain happened two months ago and was associated with fever, diarrhea; but self-resolved. CBC showed mild leukocytosis with neutrophil predominance. C-reactive protein-high sensitivity came back elevated.
Patient Data
Dilated blind loop of bowel seen in right lower abdominal quadrant with marked wall thickening and non-compressibility. The appendix is dilated measuring up to 8 mm with abnormal wall thickening measuring up to 3 mm. No free fluid in the right lower quadrant.
Impression: acute appendicitis
Case Discussion
History and physical of the patient (history of previous similar episode, decreased appetite, location of pain, nausea, involuntary guarding of the abdominal wall); sonographic findings (dilated, non-compressible appendix with thickened wall, guarding and rigidity of the abdominal wall during the scan); Leukocytosis with neutrophil predominance and elevated CRP consistent with acute likely unperforated appendicitis.
The patient was admitted to pediatric surgery. IV fluids and antibiotics were administered.
Surgical report revealed inflamed omentum around cecum, inflamed appendix, signs of chronic inflammation and scarring around base of cecum and appendix.
The case was reviewed and discussed with Dr. Morlie L. Wang MD, MPH, Program Director of Diagnostic Radiology who stood in agreement with the findings.
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