A big stone causing RIF pain

History

This patient presented with gradual onset RIF pain, which was maximal in the right lower paracolic gutter, just above the iliac crest.

https://gmep.org/media/11236

Answer

[DDET Ultrasound findings, video with commentary]

https://gmep.org/media/11237

[/DDET]

[DDET Take home messages]

    • The appendix lies in highly variable locations.
    • Ensure you explore throughout the right side of the abdomen in your search for the appendix, but particularly at the site of maximal pain.
    • An appendicolith is often but not invariably seen in appendicitis.
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  • Steps in diagnosis are:
    • Find the appendix – a grid search of the abdomen using a high frequency linear transducer
    • Confirm it is the appendix
    • Assess for features of appendicitis – distended to >6mm across, tender, appendicolith, surrounding free fluid, surrounding echogenic mesenteric fat, hyperaemia
    • Assess for complications – perforation, abscess formation
    • Assess for alternate causes of the pain

[/DDET]

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