A ten-year-old boy, with no personal history of interest, presented to the emergency department of the primary care centre with abdominal pain lasting four hours, fever of 40°C, vomiting of food and diarrhoea with traces of mucus. Abdominal examination revealed diffuse abdominal pain, slightly more in the right iliac fossa, with signs of peritoneal irritation. Laboratory tests showed 12,200 leukocytes/µl (91% neutrophils) and slightly elevated C-reactive protein (CRP). The patient was referred to the nearest hospital with the suspicion of an acute abdomen for further investigation. An abdominal ultrasound was performed, showing a tubular image, aperistaltic and incompressible with the transducer, compatible with acute appendicitis. It was decided to perform surgery, after receiving informed consent from the parents, and an appendectomy was performed, during which a cecal appendix with mild inflammatory signs was observed.
The postoperative course was torpid, with persistent fever (38.8°C), generalised abdominal pain without peritonism, vomiting and diarrhoea. An abdominal ultrasound scan showed dilatation of the small bowel loops, suggesting incomplete obstruction. The CBC continues to show leukocytosis with left shift and elevated C-reactive protein. Given the incongruence of the patient's symptoms and the operative findings, it was decided to opt for conservative treatment, a stool culture was performed and empirical antibiotherapy was started while awaiting the results of the stool culture, which showed Campylobacter jejuni sensitive to gentamicin. Antibiotic treatment with gentamicin was started, with which the patient's evolution was satisfactory, as the clinical picture resolved and the patient was discharged ten days after surgery.
The anatomopathological study of the cecal appendix was reported as cecal appendix with inflammatory signs.