Mr. T Case Study

Mr T presented with acute generalised abdominal pain and vomiting over 24 hours. During his treatment for gastroenteritis the appendix perforated, leading him to have laparoscopic appendectomy. Abscesses formed around the abdominal wall causing the patient to become tachycardic and pyrexic. Most patients are discharged 24 to 36 hours after the laparoscopy, however in this case Mr T was kept in for longer to control the infection and abscesses that formed in his abdomen. As well as affecting the health of the patient, this also occupied a hospital bed for longer than necessary. It is essential to diagnose and treat perforated appendicitis when it is suspected as this complication increases the incidence of morbidity and mortality.

Background:
This in turn leads to longer hospital stays and delayed complications such as bowel obstruction. In women, there is a five-fold increased risk of infertility, which is a huge complication as a result of a common condition. GRAFF.

Case Presentation:
Following 24 hours of stomach pain and vomiting Mr T came into hospital. He woke up during his sleep with a severe 8/10 pain locating to the lower quadrants of the abdomen. Having been for a buffet dinner the night before he initially blamed this on food poisoning, but he became feverish and dehydrated so seeked further help. He had not recently travelled and no other contacts at the meal were ill.
He had opened his bowels more often than usual in the past 24 hours, but no diarrhoea or blood with the stools. The vomiting had followed a few hours after the lower abdominal pain started and there was no haemoptysis. As he vomited over 15 times, the contents ranged from food to just bile. He felt thirsty and had not eaten since the meal.
Previous to this Mr T, who works night shifts with the police, had been fit and well. He had had no previous hospital admissions and only sees his GP the occasional cough. He lives at home with his parents, and was brought into A&E by his
The white blood cell count will be elevated in 70%-90% of patients with acute appendicitis. WAGNER Pain in the right lower quadrant, abdominal rigidity and location and migration of pain to the right lower quadrant increases the likelihood of appendicitis. Similarly, the absence of these symptoms lessens the suspicion of appendicitis. The presence of vomiting before the onset of pain makes appendicitis unlikely and suggests intestinal obstruction. Diarrhoea or constipation is a less common with 18% having this symptom. WAGNER. In this case the patient presented with the 3 main symptoms of appendicitis but the diagnosis for the first 24 hours was still gastroenteritis. If appendicitis was ruled out early in the admission the perforation could have been avoided, giving this patient a better recovery time.

Gastroenteritis is a common misdiagnosis with these similar symptoms, however this should not cause significant continuous pain. Moving on from these diagnoses the clinician must decide whether to continue inpatient observation or send the patient for imaging. If a clinician has a high suspicion of appendicitis time should not be wasted on getting a CT scan and a surgeon should be called.