NMS. Casos Clínicos

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Part II ♦ Specific Disorders

Figure 8-12: Position of normally located and retrocecal appendix. A: Common location. B: Retrocecal location.

A

B

Common location

Retrocecal location

Q: How does this alter management? A: With further localization and persistence of the worsening pain, this patient fits a picture of appendicitis. Imaging with an ultrasound or CT to visualize the appendix and other abdominal and pelvic organs can make the diagnosis (Fig. 8-13). Q: What are the surgical options? A: There are two surgical options: 1. The most common approach, laparoscopy and visualization of the appendix, is well tolerated and also allows for removal of the appendix (Fig. 8-14). 2. Open exploration, in which a McBurney incision is performed and the appendix is visualized and removed.

You decide to explore the patient. You find acute appendicitis and perform an appendectomy.

Q: What is the postoperative plan? A: As soon as the patient will tolerate feeding, it should begin. Discharge is usually appropriate at that time, and follow-up may continue in the office until the patient has made a complete recovery. SAMPLE Case 8.14  Right Lower Quadrant Pain with Dysuria and Increased WBCs You are asked to see a woman with a history and physical examination similar to that described in Case 8.13. Q: How might the following admission findings change the evaluation and management? Case Variation 8.14.1. Dysuria and a urinary WBC count of 10,000/hpf ◆ ◆ These findings are suggestive of a urinary tract infection (UTI) and could cause RLQ pain similar to appendicitis, but they could also be secondary to an appendiceal abscess in conti- nuity with the bladder. It would be appropriate to continue to follow the patient for further signs of appendicitis, although these are less likely.