부산대학교 도서관

Introduction: Acute appendicitis is one of the most common surgical pathologies encountered in the pediatric field with complex clinical symptoms that can mimic a wide variety of diseases, so errors in diagnosis are common. Objective: To present the diagnostic challenges in the case of a 5 year old boy admitted to our hospital with a suspected right medio-basal pneumonia. Case Report: The patient didn't have a significant history. He presented with high fever for over a week, irritating cough mostly during the evening, apathy, adynamia and mid-abdominal pain. Biological investigations showed neutrophilic leukocytosis and marked inflammatory syndrome. Findings during the physical included: influenced general condition, left thoracic paravertebral muscle contracture, decreased right medio-basal vesicular murmur and left medio-basal crackles on auscultation. The chest X-Ray revealed an accentuated bilateral interstitial pattern, while the abdominal ultrasound identified a liver tumor. Computed abdominal tomography established the presence of a liver abscess, presenting a communication with the lumen of the ascending colon, which was highly distended. The presence of a calcified deposit is also noted at the level of the cecum. The patient was transferred to the pediatric surgery clinic where laparotomy, appendectomy and subhepatic abscess drainage were performed. The definitive diagnosis was: perforated acute retrocecal appendicitis and subhepatic abcess. The evolution was favorable and the patient was discharged 2 weeks after the surgery. Conclusions: The nonspecific onset (no vomiting, initial mid-abdominal pain, which became progressively generalized and the presence of intestinal transit) mad the final diagnosis truly challenging and could have negatively affected the final outcome. [ABSTRACT FROM AUTHOR]