Presentation
Abdominal pain, nausea and vomiting for two days. White cell count: 16,000.
Patient Data
An appendicolith is identified in the proximal appendix with a fluid-filled distal appendix and free fluid in the cul-de-sac. A thickened and enhancing wall to the appendix is noted. The diameter exceeds 1 cm and there is stranding in the adjacent fat.
Case Discussion
The peak incidence of acute appendicitis is in late childhood and adolescence. Clinical findings include generalised abdominal pain that later localises to the right lower quadrant, fever, loss of appetite and nausea. CT findings may include an enlarged appendix >7 mm diameter; an appendicolith; a thick, enhancing appendiceal wall; deformity or thickening of the apex of the caecum and stranding in the adjacent mesenteric fat. Peritoneal fluid may also be seen.
In children, ultrasound for diagnosis avoids ionising radiation that is more problematic than in adults. Many sites in the US lack the skill or interest in using ultrasound for the diagnosis of appendicitis.