A case of acute appendicitis at atypical localization

I Basara, M Secil
2014 The Belgian Journal of Radiology  
LIEUTENANT K. W., aged 35, was admitted to hospital on March 18, with a history of influenza fourteen days before. admission, and complaining of abdominal pain which had persisted for five days. , On admission the patient stated that he had been eating a full hotel diet with relish, that he had no nausea', vomiting or constipation, but for several days had been troubled 'by a constant diffuse pain across the abdomen and above the level of the umbilicus. 'fhis pain became worse on movement, and
more » ... e on movement, and occasionally he felt vague pains in the small of tlie back. No history of primary symptoms was forthcoming. _ On examination the patient looked ili and debilitat'ed; and' preferred to lie with both thighs slightly flexed. The tongue was moist and covered with Br thin white fur, the temperature was 97'4° F., ·pulse 64, and respira-I tions normal. Examination of the chest was negative. The abdomen' moved freelS on respiration, there was no rigidity nor area of hyperresthesia, and th'e abdominal reflexes were normal. On very deep pressure over the appendix the patient admitted some tenderness, but digital palpation per rectum failed to demonstrate any tender spot. The nervous system was normal. Routine and catheter specimens of urine were examined and no abnormal constituent was found. -A soap and water enema given shortly after admission relieved the patient's pain, and on the following morning he could lie co~fortably with thighs fully extended. ' . . I For the first three days he was placed on a strict milk diet, but on the fourth day,. as the tongue had cleaned and the patie!lt was complaining of hunger,'o. little thin bread and butter was added. In the meantime the patient's chest and abdomen were examined twice daily and nothing which would throw fresh light on the case could be discovered. On the morning of March 22 the ,temperature was still normal and the pulse varying between 50 and 60 beats per minute. It was thought, however, that slight resistance could be detected over the appendix, and on digital examination of the rectum the patient. complained that the right side was definit~ly more tender than the left~ This aroused the suspicion that an appendix abscess might' be forming, so a total leucocyte count was carriea. out and reported to be 9,775 white c e l l s . ' . On the morning of March 23 it was considered safe to administer a halfounce dose of. liquid paraffin. The patient had then been under observa-, tion for six days; temperature, pulse, leucocyte count were all normal; the pain still'remaine,d supra-umbilical in position and had never becom~ guest.
doi:10.5334/jbr-btr.81 fatcat:tyswipurhzdchnfxuqmnnwba6m