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You are seeing a 12-year-old boy who has right lower quadrant abdominal pain starting the night before. His pain is constant and began in the periumbilical region and migrated to the RLQ. He also complains of nausea and loss of appetite. He has had no fever, vomiting, diarrhea, or dysuria. On physical examination, his temperature is 37.8 C, HR 100, RR 20, BP 110/70, HEENT and cardiopulmonary exams are unremarkable. He has tenderness in the RLQ and a well-healed scar there from appendectomy performed for acute appendicitis 9 months prior. He has no rebound tenderness. Bowel sounds are quiet. Genital exam shows no scrotal swelling or tenderness, testes are descended. On further questioning, his appendectomy was open and uncomplicated; he was discharged in 3 days from the hospital and recovered fully without complications. His primary physical activity is cross-country running.
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March 12, 2026 at 11:41 pm
E) Appendicitis (and possibly B) Viral gastroenteritis IF it leads to mesenteric adenitis)
Stump appendicitis is a rare (0.1% or fewer post-appendectomy patients) complication seen after both open and laparascopic appendectomy (possibly more post-laparascopy). It is thought to be due to insufficient identification of the appendix base during appendectomy, resulting in a longer stump that can become re-inflamed. Clinical presentation is similar to acute appendicitis. Viral gastroenteritis alone is unlikely to lead to localized RLQ pain and tenderness, although if it leads to mesenteric adenitis that could mimic appendicitis. The patient has not done any new physical activity that would lead to localized muscular abdominal pain. His pain is not colicky, making nephrolithiasis unlikely. He has a normal genital exam and no signs of testicular torsion. An undescended abdominal testis could torse and cause localized lower quadrant pain, but his testes are descended.