Question 27

Question:

A 13-year-old male comes to the emergency room with a one-day history of nausea and vomiting. He says that yesterday, he began having pain around his belly button and skipped dinner. Today, he felt nauseated. His mother thought he had a fever and kept him home from school. He says the pain moved to his right lower quadrant and, “it hurts there when I press it.” On exam, he shows rebound tenderness and guarding in his right lower quadrant, 1/3 of the way between the right iliac crest and the umbilicus. A CBC shows an elevated white blood cell count to 14.2. What is the most appropriate next step?

Correct Answer: B.  Appendectomy

This patient is presenting with the classic symptoms of appendicitis: fever, elevated white blood cell count, and periumbilical pain migrating to the right lower quadrant. In a young male with a classic story, CT imaging is not a first-line for diagnosis. It is more important to consult a surgeon immediately to avoid the complications of a perforated appendicitis.