CT scan of the patient's abdomen and pelvis revealed a 1.2 cm dilated appendix with adjacent stranding consistent with acute appendicitis without perforation or abscess. Also noted was mild dilatation of the terminal ileum likely representing focal ileus.
General surgery was consulted. Intravenous Cefazolin was ordered. The patient was taken to the operating room within the hour.
General surgery was consulted. Intravenous Cefazolin was ordered. The patient was taken to the operating room within the hour.
Acute Appendicitis
Background
- most common abdominal surgical emergency in the United States
- caused by obstruction (appendecolith, foreign material, adhesions, etc)
- may occur as result of lymphoid hyperplasia after viral infection
- highest incidence in ages 10 - 30
- Hightest misdiagnosis rate in extremes of age (infants and elderly)
Presentation
- pain initially vague and poorly localized in periumbilical region with nausea, anorexia and fever
- subsequent RLQ pain over next 24 hours as peritonitis develops
- atypical presentations:
- RUQ pain (pregnant patients)
- right lower back pain (retrocecal appendix)
- pelvic/adnexal pain (appendix near ovary)
- dysuria (appendix near bladder)
- diagnosis commonly delayed in infants and elderly due to atypical presentation and results in perforation rates >50% in these groups
Diagnosis
- primarily clinical
- leukocytosis in 80% of cases
- CT scan has >90% sensitivity and specificity
- ultrasound is not as sensitive or specificity but is imaging modality of choice for children and pregnant women
Treatment
- early surgical consultation
- antibiotics
- surgery
References:
Martinez JP, Mattu A, Palmer G, Emergency Medicine: A Focused Review of the Core Curriculum, 1st Ed, 2008, Chapter 3: Abdominal and Gastrointestinal Disorders, pages 205-206
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