Appendicitis continues to be the most common acute surgical emergency. We report a fatal case of acute appendicitis, illustrating that the early presentation of appendicitis is non-specific and that serial examination is the key to the diagnosis to avoid a fatal outcome. We also present an evidence-based approach to the diagnosis of acute appendicitis in the emergency department and highlight the pearls and pitfalls of diagnosing acute appendicitis.
WagnerJ.M., McKinneyW.P., CarpenterJ.L.Does this patient have appendicitis?JAMA1996; 276(19): 1589–94.
4.
WakeleyC.P.The position of the vermiform appendix as ascertained by an analysis of 10,000 cases. J Anat1933; 67(Pt 2): 277–83.
5.
PooleG.V.Anatomic basis for delayed diagnosis of appendicitis. South Med J1990; 83(7): 771–3.
6.
CardallT., GlasserJ., GussD.A.Clinical value of the total white blood cell count and temperature in the evaluation of patients with suspected appendicitis. Acad Emerg Med2004; 11(10): 1021–7.
7.
GraffeoC.S., CounselmanF.L.Appendicitis. Emerg Med Clin North Am1996; 14(4): 653–71.
8.
TerasawaT., BlackmoreC.C., BentS., KohlwesR.J.Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med2004; 141(7): 537–46.
9.
FlumD.R., McClureT.D., MorrisA., KoepsellT.Misdiagnosis of appendicitis and the use of diagnostic imaging. J Am Coll Surg2005; 201(6): 933–9.
10.
BendeckS.E., Nino-MurciaM., BerryG.J., JeffreyR.B.Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology2002; 225(1): 131–6.
11.
AlvaradoA.A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med1986; 15(5): 557–64.
12.
OhmannC., YangQ., FrankeC.Diagnostic scores for acute appendicitis. Abdominal Pain Study Group. Eur J Surg1995; 161(4): 273–81.
13.
HostetlerB., LeikinJ.B., TimmonsJ.A., HanashiroP.K., KissaneK.Patterns of use of an emergency department-based observation unit. Am J Ther2002; 9(6): 499–502.
14.
RusnakR.A., BorerJ.M., FastowJ.S.Misdiagnosis of acute appendicitis: common features discovered in cases after litigation. Am J Emerg Med1994; 12(4): 397–402.
