Abstract
A 25-year-old male presents to the emergency department with a 1-day history of periumbilical abdominal pain which has now shifted to the right lower quadrant. He describes the pain as constant and a 7/10. After the onset of pain, he subsequently developed nausea and has vomited twice. He has not eaten for 24 hours due to a lack of appetite. Physical examination is significant for a temperature of 38 °C, absent bowel sounds, and marked tenderness to palpation at 1/3 the distance from the anterior superior iliac spine to the umbilicus. When palpating in the left lower quadrant (LLQ), he reports pain in the right lower quadrant (RLQ). Active flexion of his right hip and internal rotation of the right leg reproduces the pain. His skin in the RLQ is hypersensitive to touch. There is no rebound tenderness. Laboratory values are significant for a white blood cell (WBC) count of 13.5 × 103/μL (normal 4.1–10.9 × 103/μL), with 15% bands. The urinalysis demonstrates 1+ WBCs without bacteria.
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Di Saverio S, Sibilio A, Giorgini E, Biscardi A, et al. The NOTA Study (Non Operative Treatment for Acute Appendicitis): prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow-up of conservatively treated suspected appendicitis. Ann Surg. 2014;260(1):109–17.
Guidry SP, Poole GV. The anatomy of appendicitis. Am Surg. 1994;60:68.
Izbicki JR, Knoefel WT, Wilker DK, et al. Accurate diagnosis of acute appendicitis: a retrospective and prospective analysis of 686 patients. Eur J Surg. 1992;158:227.
Liu JL, Wyatt JC, Deeks JJ, et al. Systematic reviews of clinical decision tools for acute abdominal pain. Health Technol Assess. 2006;10:1.
McCutcheon BA, Chang DC, Marcus LP, Inui T, et al. Long-term outcomes of patients with nonsurgically managed uncomplicated appendicitis. J Am Coll Surgeons. 2014;218(5):905–13.
Pittman-Waller VA, Myers JG, Stewart RM, et al. Appendicitis: why so complicated? Analysis of 5755 consecutive appendectomies. Am Surg. 2000;66:548.
Salminen P, Paajanen H, Rautio T, Nordström P, et al. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA. 2015;313(23):2340–8.
Smith MC, Chung PJ, Constable YC, Boylan MR, Alfonso AE, Sugiyama G. Appendectomy in patients with human immunodeficiency virus: not as bad as we once thought. Surgery. 2017 Apr;161(4):1076–82.
Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults. A prospective study. Ann Surg. 1995;221:278.
Varadhan KK, Humes DJ, Neal KR, Lobo DN. Antibiotic therapy versus appendectomy for acute appendicitis: a meta-analysis. World J Surg. 2010;34:199.
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de Virgilio, C., Grigorian, A., Petrie, B.A., Arnell, T.D. (2020). Right Lower Quadrant Abdominal Pain. In: de Virgilio, C., Grigorian, A. (eds) Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-05387-1_23
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DOI: https://doi.org/10.1007/978-3-030-05387-1_23
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