Case 40: Acute Abdomen

Abstract

A 13-year-old girl (120 lbs) presents with acute colicky abdominal pain and is scheduled for an emergency appendectomy. Her history is unremarkable. The mother informs you that the onset of the pain may be related to the patient having her first menses. Neither the patient nor the immediate family has had a general anesthetic. The mother informs you that she believes that the girl’s father’s family has an “upset metabolism.” She knows nothing more about this abnormality except to say that she is sure it has nothing to do with succinylcholine. The father is unavailable for comment. The patient is taking no medication and is classified as an American Society of Anesthesiologists physical status II (ASA 2). The patient complains of severe abdominal pain and is very nauseous. You examine the patient and nothing abnormal is detected. The abdominal wall is lax. Some rebound tenderness is noted in the right iliac fossa, but much less than would be expected from acute appendicitis. No blood analysis or urinalysis is done. The surgeon is anxious to proceed.