Khalid Masood, Muhammad Akhtar.
Atypical Appendicitis
Pak Armed Forces Med J Jun 2005;55(2):170-1.
Combined Military Hospital, Mardan

A 09 years old male child, presented with pain in left lower abdomen for one day. Pain started form peri-umbilical region, then migrated to the left lower abdominal quadrant. Child vomited frequently and did not pass stools for the next 24 hours. He lost his appetite and had fever of 101° F. Physical findings included a pulse of 112/ min and a Blood Pressure of 90/60 mm/Hg. The patient`s entire abdomen was diffusely tender, especially in the left iliac fossa with involuntary guarding. Rebound tenderness was also present. His complete blood count showed raised TLC (12000/ cmm) and urine was clear. X-Rays plain abdomen showed air filled loops of small and large bowel with a few air/fluid levels. Having a clinical clue of peritonitis, his laparotomy was planned after resuscitation and abdominal cavity was opened via a lower mid-line incision. Small gut was found slightly distended and cecum was lying in the left iliac fossa due to its free mobility. Distal ileum and cecum were full of round worms; two of them had penetrated into the lumen of appendix leading to obstructive appendicitis. Appendicectomy was done and most of the worms removed from the luminal hole at the base of appendix and remaining were milked in sigmoid colon. Appendicular base was closed by transfixing with catgut and then buried in the cecum. The cecum was repositioned and fixed in right side of the abdominal cavity.

Category: Case Reports
Keywords: Appendix. Appendicitis. Appendicectomy.

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