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Ruptured Appendicitis

Capra JC - MedPix (2006)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Ruptured Appendicitis

History: 18yo man presents to the ER c/o 5d of RLQ abdominal pain and nausea. The patient states that his siblings have had flu-like illnesses recently with nausea and vomiting, so he initially attributed his symptoms to a virus. However, over the last 5 days the pain has progressively worsened. Pain is described as intermittent, stabbing, improved with Tylenol, and aggravated by movement. The patient has never had pain like this before. ROS: significant for RLQ abdominal pain, nausea, 1 episode of non bloody, non bilious vomiting 2 days prior to admission, and subjective chills. Denies fevers, diarrhea, hematochezia, or dysuria.

Findings: Supine and upright abdominal radiographs: No evidence of free air. Evidence of free fluid within the pelvis with indistinctness of the fat planes. Two calcifications are seen within the right pelvis, one measuring approximately 12mm and one measuring approximately 5 mm in size. Bowel gas pattern unremarkable, no air fluid levels Abdominal CT: The appendix is markedly enlarged and edematous. There is a large inflammatory mass surrounding the appendix. There is enhancement of the wall of the appendix. There are two appendicoliths within the appendix, one measuring 12 mm in greatest diameter and a smaller 6 mm appendicolith. There is a moderate amount of free fluid within the pelvis. The appendix is dilated to a maximum diameter of 12.5 mm. There is no evidence of free air.

Ddx: Ruptured Appendicitis Mesenteric Adenitis Psoas abscess Ureteral Calculus

Dxhow: CT of abdomen and open surgical removal of ruptured appendix with subsequent pathologic tissue examination.

Exam: Vitals: Temp: 103.1, BP 132/71, HR 88, RR 30, O2 sat 995 on RA General: Thin appearing male laying still on exam table, in tears due to pain Heart: No murmurs Lungs: Clear to auscultation BL, no wheezes or rhonchi Abdomen: No discoloration, no distension. + bowel sounds. Tender to percussion and palpation over McBurney’s point. No rebound tenderness. + Rovsing’s sign. Genitalia: Normal ext male genitalia, testes descended Rectal: Normal tone, no masses, tender with pressure aimed towards RLQ, no masses. CBC: 12.1 > 15.5/45.6 < 166 CMP: 139/4.4/102/30/17/1.0/100 Ca: 9.2 AST: 13 ALT: 29 AP: 84 UA: Yellow, clear, SG 1.026, Ph 6.0, neg prot, ket, gluc, bili, nitrite, LE. 1-3 WBC, Mod Blood, 4-10 RBC, squam 1-2/HPF

No MeSH data available.


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Ruptured Appendicitis

Capra JC - MedPix (2006)

© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2515&req=5

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Ruptured Appendicitis

History: 18yo man presents to the ER c/o 5d of RLQ abdominal pain and nausea. The patient states that his siblings have had flu-like illnesses recently with nausea and vomiting, so he initially attributed his symptoms to a virus. However, over the last 5 days the pain has progressively worsened. Pain is described as intermittent, stabbing, improved with Tylenol, and aggravated by movement. The patient has never had pain like this before. ROS: significant for RLQ abdominal pain, nausea, 1 episode of non bloody, non bilious vomiting 2 days prior to admission, and subjective chills. Denies fevers, diarrhea, hematochezia, or dysuria.

Findings: Supine and upright abdominal radiographs: No evidence of free air. Evidence of free fluid within the pelvis with indistinctness of the fat planes. Two calcifications are seen within the right pelvis, one measuring approximately 12mm and one measuring approximately 5 mm in size. Bowel gas pattern unremarkable, no air fluid levels Abdominal CT: The appendix is markedly enlarged and edematous. There is a large inflammatory mass surrounding the appendix. There is enhancement of the wall of the appendix. There are two appendicoliths within the appendix, one measuring 12 mm in greatest diameter and a smaller 6 mm appendicolith. There is a moderate amount of free fluid within the pelvis. The appendix is dilated to a maximum diameter of 12.5 mm. There is no evidence of free air.

Ddx: Ruptured Appendicitis Mesenteric Adenitis Psoas abscess Ureteral Calculus

Dxhow: CT of abdomen and open surgical removal of ruptured appendix with subsequent pathologic tissue examination.

Exam: Vitals: Temp: 103.1, BP 132/71, HR 88, RR 30, O2 sat 995 on RA General: Thin appearing male laying still on exam table, in tears due to pain Heart: No murmurs Lungs: Clear to auscultation BL, no wheezes or rhonchi Abdomen: No discoloration, no distension. + bowel sounds. Tender to percussion and palpation over McBurney’s point. No rebound tenderness. + Rovsing’s sign. Genitalia: Normal ext male genitalia, testes descended Rectal: Normal tone, no masses, tender with pressure aimed towards RLQ, no masses. CBC: 12.1 > 15.5/45.6 < 166 CMP: 139/4.4/102/30/17/1.0/100 Ca: 9.2 AST: 13 ALT: 29 AP: 84 UA: Yellow, clear, SG 1.026, Ph 6.0, neg prot, ket, gluc, bili, nitrite, LE. 1-3 WBC, Mod Blood, 4-10 RBC, squam 1-2/HPF

No MeSH data available.