It's Not Appendicitis...? Consideration of a Benign Mimicker.

Case: A previously healthy 16-year-old boy with a normal BMI presented to the emergency department with a 4-day history of severe, colicky pain in his right lower abdomen and right lower back. Before admission, while working as a cook in a restaurant, the patient reported twisting his torso and experiencing a stabbing pain on the right side of his abdomen that wrapped around to his right fl ank. The pain was so severe that he was taken by ambulance to a regional hospital. At the hospital, appendicitis was suspected, so an abdominal computed tomography (CT) scan was performed. The normal scan ruled out appendicitis and the patient was discharged with ibuprofen. However, the pain continued to worsen. Four days later, the patient arrived at this institution’s pediatric emergency department and described his pain as intermittently stabbing with movement and dull and throbbing during rest. The patient reported persistent nausea and pain when bearing down but not during defecation. He had normal bowel movements with no constipation or blood, normal urine output without blood or dysuria, and reported tactile fevers. He reported no other illnesses or symptoms before or since the onset of the pain. After re-review of the original CT showing possible early changes consistent with appendicitis and persisting peritoneal signs on examination, the attending physician requested repeat abdominal CT.