What’s Your Diagnosis? 11-year-old boy with acute abdominal pain
August 29, 2019


Posted by Andy Jagoda, MD in: What's Your Diagnosis , trackback

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Case Presentation: an 11-year-old boy with acute abdominal pain

An 11-year-old previously healthy boy presents to the ED on a busy Saturday evening. He has acute abdominal pain that started 18 hours ago as diffuse periumbilical abdominal pain. Within the last 3 hours or so, the pain migrated to the right lower quadrant and worsened in severity. The child says the bumps on the car ride to the hospital were painful, and hopping up and down makes the pain worse. He says it seems to be a bit better when he lies still and does not move. Oral ibuprofen has not really helped the pain. The patient has not eaten a meal all day and has vomited 3 times today. On presentation, he has a temperature of 38.3°C (101°F). He is fully immunized and does not have any upper respiratory symptoms. He has never had similar pain in the past and has no history of previous
abdominal surgeries. He has a normal genitourinary examination. He has obvious discomfort with palpation of his abdomen with maximum tenderness in the right lower quadrant. He exhibits guarding and rebound tenderness.

His mother asks you whether this could be appendicitis, and whether he will need surgery. You begin to think…

Is this appendicitis? What else could it be? How will you definitively determine the diagnosis? What laboratory evaluation and imaging tests should you order? It is now 2:00 AM. If the patient definitely has appendicitis, does he need an emergent appendectomy or can it wait?

Case Conclusion

You sent a CBC and CRP for the 11-year-old boy with abdominal pain and vomiting. The WBC count and CRP were both elevated. An appendix ultrasound showed a dilated, noncompressible appendix with mesenteric fat stranding and appendiceal wall hyperemia, and you diagnosed the boy with appendicitis. The on-call pediatric surgeon was contacted and asked that you start antibiotics and admit the patient for appendectomy in the morning.

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Comments »

1. Gregory Jones - September 5, 2019

Need CT scan or US. Labs would only potentially confuse the picture!

2. Todd Smith - September 6, 2019

Surgical consult

3. Suzanne Walker - September 27, 2019

Make patient NPO in case needs surgery
Establish access run maintenance fluids
CBC, Culture, BMP
Stat CT scan abdomen or U/S if CT not immediately available
Surgical consult

4. Lisa Nicoletti - September 27, 2019

Ct, lab, surgery consult. Nope can’t wait. Keep NPO.

5. Muhammad Hammad - September 27, 2019

Need to do urine microbiology with CRP and WBC counts and abdomen with contrast. Its likely appendicitis and pt can be managed with Surgical consult and keeping him NPO , Pain management, and maintenance i.v fluids and Laproscopic Appendicectomy in the morning once its confirmed and if CT doesnt shows signs of peritonitis.

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