Acute Appendicitis

Patient Presentation:
L.B., a 10 year old female presented to the Emergency Department’s triage room on a cold December evening stating: “My stomach really hurts.” The patient was quiet and lethargic. Her vital signs were: T-38.1, P-124, BP-92/64, RR-22, PaO2- 98%, and pain 7/10 in the abdomen. When asked to point to the pain, the patient pointed to the periumbilical region but that it was starting to move to her right lower quadrant region. She reported nausea, but no vomiting or diarrhea.

Differential List:
Given the patient’s age, differentials include: appendicitis, gastroenteritis, urinary tract infection, intussusception, small bowel obstruction, Crohn disease or ulcerative colitis, or onset of menarche.

Diagnosis:
In order to diagnose the patient, the MD ordered a BMP (normal), CBC (elevated WBC), LFTs (normal), blood culture (later found to be negative), urinalysis (normal) and an abdominal CT with IV and oral contrast. The patient had rebound tenderness upon palpation of the right lower quadrant. The patient was diagnosed with acute appendicitis and the pediatric surgeon was called.

Treatment:
Treatment for the patient was initiated immediately. She was given a bolus of normal saline, a small dose of Morphine for the pain, and Zofran® for nausea. She was kept NPO to prepare for surgery and was sent to the OR in the middle of the night for an emergency appendectomy. The patient made a full recovery within a few weeks.

Outcome:
Most patients with appendicitis recover easily with surgical treatment, but complications can occur if treatment is delayed or if peritonitis occurs. Recovery time depends on age, condition, complications, and other circumstances, including the amount of alcohol consumption. If peritonitis occurs, the patient is at risk for sepsis and death.

Case created by Laura Badalamenti, 2010.