Acute Appendicitis

A 15-year-old boy presented with sharp, right lower quadrant abdominal pain, nausea, vomiting, and fever of 2 days' duration. His white blood cell count was 15,000/mL with a shift to the left on the differential. Right lower quadrant rebound tenderness was noted.

CT scans revealed a fecalith (A, arrow) in the appendix, which was swollen (B). An ultrasonographic examination of the abdomen depicted no abnormality. Acute appendicitis was diagnosed; the patient underwent surgery. During the appendectomy, a “U”-shaped appendix with an extremely swollen and indurated distal half was found.

Robert P. Blereau, MD of Morgan City, La, comments that the use of CT in suspected appendicitis may help limit the number of patients admitted to hospitals for observation as well as reduce the 50,000 unnecessary surgeries performed annually for presumed appendicitis. Furthermore, CT can quickly confirm the diagnosis-a distinct benefit since delayed surgery increases the rate of postoperative complications. Moreover, when the appendix is normal, CT scans may reveal other pathologic conditions that explain the patient's symptoms.

Ultrasonography is less accurate than CT in diagnosing acute appendicitis. Plain roentgenograms are rarely elucidating, but they may disclose a dilated cecum and fluid level or a fecalith. A barium enema can show absence of filling of the appendix.

This adolescent's postoperative course was uneventful.