Sunday, September 04, 2005
No rules for diagnosis of acute appendicitis.
Recently I came across some atypical presentation of appendicitis:
Case 1: A 35 y /o male patient c/o RLQ local tenderness but no rebound pain. After IV hydration, his S/S improved except for mild local tenderness.
WBC 15000>>12000>>8000(NO LEFT SHIFT NOR INCREASING LEUKOCYTOSIS).
Finally abd. CT showed enhanced appendix , so appendectomy had done.
Case 2: A 24 y/o female patient c/o epigastric pain and shift to RLQ
WBC 77100 seg 45 >>8100 seg 63 (NO LEFT SHIFT NOR LEUKOCYTOSIS)
Finally persisted RLQ pain and laparoscopic appendectomy had done.
Conclusions:
1. Always consider appendicitis if the patient didn't had appendectomy before.
2. Always look for the operation scar in RLQ area.
3. If you impressed appendicitis , do not rely too much on lab data, clinical S/S are more
important.
Case 1: A 35 y /o male patient c/o RLQ local tenderness but no rebound pain. After IV hydration, his S/S improved except for mild local tenderness.
WBC 15000>>12000>>8000(NO LEFT SHIFT NOR INCREASING LEUKOCYTOSIS).
Finally abd. CT showed enhanced appendix , so appendectomy had done.
Case 2: A 24 y/o female patient c/o epigastric pain and shift to RLQ
WBC 77100 seg 45 >>8100 seg 63 (NO LEFT SHIFT NOR LEUKOCYTOSIS)
Finally persisted RLQ pain and laparoscopic appendectomy had done.
Conclusions:
1. Always consider appendicitis if the patient didn't had appendectomy before.
2. Always look for the operation scar in RLQ area.
3. If you impressed appendicitis , do not rely too much on lab data, clinical S/S are more
important.
# posted by ER Palm @ 3:22 AM 
Comments:
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There's about 10--15% patients of appendicitis with a normal white blood count. Accurate diagnosis depends on prudent P.E. and Lab data references.
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# posted by 
: 2:11 AM
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