(Click the link to comment and to vote – voting not working through email, sorry!)
You are seeing a 7-year-old boy with abdominal pain since yesterday afternoon. He has had one episode each of vomiting (non-bloody, non-bilious) and diarrhea (non-bloody) each day. He has been afebrile. His appetite is poor. He points to his umbilicus as his area of pain but is tender on palpation both periumbilical and in the right lower quadrant. Vital signs and the remainder of his exam are unremarkable. His CBC shows a WBC of 8.1 with 50% neutrophils, and his UA has no pyuria. RLQ ultrasound is read by the radiologist as appendix not visualized, no fat stranding or other signs of inflammation noted. He says he feels better and that he would eat pizza if he could.
Loading ...
September 30, 2025 at 7:31 pm
C) Repeat physical examination
The patient’s initial history and physical examination were concerning enough for appendicitis to warrant a work-up. There is no leukocytosis or left shift but WBC count is neither sensitive nor specific for appendicitis. The US results neither support nor rule out appendicitis. Therefore, a repeat physical examination is in order. If the patient still has significant RLQ tenderness, a CT scan is indicated in most cases (some may prefer serial examinations if the tenderness is minimal). Sometimes a patient’s pain is temporarily improved just after the appendix perforates. And children may say they are hungry and would eat something simply because they want to go home and don’t want further testing.