Appendicitis? Really???

  1. 0 Young person, early 20s, classic presentation of periumbilical pain, onset 3 days ago, localizing to RLQ today.

    No fever. No white count. ESR not ordered. Abdominal CT with triple contrast negative. Pt. appears nontoxic.

    Doctor admits for appendicitis. What am I missing???? Is the doctor diagnosing on the basis of the symptoms alone, despite negative labs and imaging? Can appendicitis be subclinical in this way?
  2. Visit  Anna Flaxis profile page

    About Anna Flaxis, ASN

    Anna Flaxis has '11' year(s) of experience and specializes in 'Emergency'. From 'U.S.'; Joined Oct '10; Posts: 2,396; Likes: 6,493.

    11 Comments so far...

  3. Visit  Rose_Queen profile page
    3
    Yep. I've taken out quite a few angry appendixes (sp?) on people with normal labs. WBC high end of normal, but still within range. Appendix not visualized on CT/US. Doc went with gut intuition and took that bad boy out. In the OR, you should see some of these things! One with normal labs had an 8" long appendix that was quite red, but labs still all normal. Don't understand how that one wasn't seen on CT though. I've also had plenty of people with the classic presentation including the out of whack labs whose appendixes looked absolutely normal. Still took them out to be safe and also, hey, we're in there, have permission to do it, at least this way they don't come back with appendicitis some other time.
    Altra, sheronep, and Anna Flaxis like this.
  4. Visit  tokmom profile page
    1
    Yep, I have seen quite a few appy's be the real deal even though labs, scans were neg.
    Anna Flaxis likes this.
  5. Visit  Perpetual Student profile page
    0
    I read a case report a while back of a fellow who presented similarly, was d/c'd from the ED, and returned later after it ruptured that same day. I can understand a doc's reluctance to get sued like the doc in the above case.

    I am curious what the plan was for the patient--repeat CBC and CT after a little time passed (maybe 4-8 hours?), or just go for it and cut that puppy out?
  6. Visit  classicdame profile page
    0
    I had a patient scheduled for appendectomy but on assessment I found buboes in both axilla. Told surgeon. He decided to try ABX for 1-2 doses unless she got worse. She got better. Bubonic plaque is seen in southwest Texas, where tot had visited.
  7. Visit  Altra profile page
    0
    Triple contrast? It's always fascinated me, how drastically radiology protocols vary from place to place.
  8. Visit  snow_bear profile page
    0
    I had my appendix removed with NO scans before surgery because the doc was so convinced by my symptoms and I did have a high WBC.
  9. Visit  Anna Flaxis profile page
    0
    Altra, at my facility, CT scan to r/o appy requires rectal contrast in addition to PO and IV. Seems like overkill to me, but it's what the radiologists want.
  10. Visit  rgroyer1RNBSN profile page
    0
    Quote from ~*Stargazer*~
    Altra, at my facility, CT scan to r/o appy requires rectal contrast in addition to PO and IV. Seems like overkill to me, but it's what the radiologists want.
    You are kidding I hope, when I had appendicitis I would have killed someone if they tried to give me rectal contrast oral was bad enough jeez poor people.Rod RN, BSN
  11. Visit  Anna Flaxis profile page
    0
    Not kidding. As I said, the radiologists require it. And guess who gets to tell the patient?
  12. Visit  Rose_Queen profile page
    0
    Boy, I hope I never end up in your ER with the need of an abdominal CT! I'd probably leave AMA and go elsewhere if I was told I was getting triple hit like that! Swallowing that chalky crud is bad enough, adding in rectal?
  13. Visit  Anna Flaxis profile page
    0
    It's only for RLQ/rule out appys.


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