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Jay and listmembers -
 
Your case makes me recall a patient I saw this November:  A sexually active
13-yr old girl presented with acute RLQ pain followed by anorexia, nausea
and one episode of vomiting.  ROS was o/w negative including HEENT and GU.
Pain onset was abrupt and occurred 3 hours pta.  WBCs were 18k.  Temp 101.
abd. -> positive McBurney's point (beta hcg neg).  I called the surgeon who
laid on hands and felt it sure seemed like an appy but he kept puzzling over
the high wbc count saying it was just too fast.  He was determined to find
the cause and examined her throat (something to my great embarrassment I
hadn't done) - she had a horrible exudative pharyngitis - strep test
positive.  He cooled her down with iv antibiotics and admitted her
overnight.  She was d/c'd with a dx of strep pharyngitis - her abdomen
cleared up.  No ct was performed.
 
I told this story to a colleague who then told me the following cautionary
tale: he had a similar patient.  Treated the strep.  Pt totally resolved his
symptoms (a teen male).  But 3 days later ruptured his appy.
 
We all know there is a higher incidence of appy following AGE - is there any
increase in incidence following strep pharyngitis?
jeanne
 
 
-----Original Message-----
From: Jay Pershad <[log in to unmask]>
To: Multiple recipients of list PED-EM-L <[log in to unmask]>
Date: Friday, December 10, 1999 7:35 AM
Subject: appy
 
 
>
>The many faces of acute appendicitis never cease to amaze me. Had a case
>today of a teen with severe ABP followed a couple of hours later by emesis,
>of less than 24 hours duration. He looked ill & uncomfortable on exam, with
>a "board like" abdomen and hypoactive bowel sounds. I was almost sure he
had
>perforative appendicitis, with diffuse peritonitis.  TLC was 20K with 20 %
>bands.
>
>The surgical fellow felt the same but requested an US. I guess this is
their
>protocol for ruptured
>appy's, in conjunction with prolonged IV antibiotics and a delayed
>appendectomy.
>
>US showed a "huge" 14 mm UNRUPTURED appendix c/w acute non perforative
>appendicitis!! No free fluid was seen. Needless to say he was taken to the
>OR shortly thereafter. I  will let you know the operative findings.
>
>Jay Pershad, MD
>
>For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
>The URL for the PED-EM-L Web Page is:
>  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
 
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html