I had a 3rd grader come into my office mid morning the other day. She said that she felt like she may throw up. She did not have a fever, had eaten breakfast earlier in the morning, and she said she had a normal BM that morning. She had no specific area of tenderness or guarding of her abdomen. A couple other kids have had the stomach virus, so I thought she probably had the stomach virus or maybe it was from eating too much candy (this was after Halloween). I told her if she vomited or felt worse to return to the office. I told her to try to eat lunch and see what happens (lunch was about an hour later). I left to go to another school at lunch time, and I actually left a couple hours early from the other school that day for my own medical appointment so I did not follow up with anyone that day about her. The next morning I found out she had returned to the office later in the afternoon (still no vomiting or fever). They let her rest in the office for a little bit, but did not send her home. Apparently, her parents took her to the ER later that night for appendicitis, and her appendix was remove the next afternoon.
She is fine, but I hate that I didn't catch it. Is there anything you would have done differently? Anything else you think I should have done that would have helped me recognize appendicitis? Of course, anytime a child complains of a stomach ache/nausea I consider appendicitis, but in this case I just did not have much reason to believe it was appendicitis, at least not at that point of time. I just want to do better in the future and appreciate any feedback you may have!
