Emergency Cases Northwest Group

Case 054 Purulence Not Poop

Situation

A man had constipation, but it was appendicitis.

Background

A 58 year old man presented with 10 days of constipation and overflow diarrhoea. No bloods done, staff assumed this was simple constipation and all he needed was an enema and out of the department.

Assessment

He had 7 days of RIF pain. Examination showed severe tenderness with guarding in RIF. X-ray showed faecal loading and bloods showed mildly elevated infection markers. CT scan done in ED: ruptured appendix with an abscess. Referred to surgeons.

Recommendation

Pay attention to abdominal tenderness and don't be biased towards diagnoses that others have already made for you.

Content source: Dr OLUTOLA AWOSEMO

PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group