Misdiagnosis of Influenza Leads to a Ruptured Appendix

ByJason Cohn

Updated on

Misdiagnosis of Influenza Leads to a Ruptured Appendix

Case Overview

This case involves a fifteen-year-oldĀ female who went to the local emergency room with complaints of abdominal pain. Laboratory studies were ordered and indicated a high white blood cell count. Imaging studies were not ordered and the patient was discharged with a diagnosis of influenza. The patient then went to her family medicine doctor the following day, where once again, a diagnosis of influenza was made. Three days later, the patient visited another doctor who identified a ruptured appendix. The patient was rushed to the hospital where an emergency appendectomy was performed. However, she suffered from numerous complications resulting from the ruptured appendix and may require additional surgeries in the future. Additionally, there was a strong possibility that she was infertile as a result of the delayed surgical intervention.

Questions to the Occupational Medicine expert and their responses

Q1

Should the family medicine doctor have performed specific physical exam maneuvers to rule out the possibility of appendicitis?

The diagnosis of appendicitis should become apparent after a routine history and physical examination administered by the physician. This should reveal previous peri-umbilical pain that then migrates to the right lower abdomen (known as McBurney's point). The patient will also typically indicate a lack of appetite as well as nausea and vomiting throughout the day. The patient may also have a fever. Upon palpation, the patient's abdomen will be extremely tender. Appendicitis could also produce a positive psoas and/or obturator sign.

About the expert

This expert has been practicing family medicine for almost 30 years. He has won numerous awards and honors, including three last year. He provides many community interests and services in his hometown, and on medical missions to underdeveloped countries. He's written almost 20 books, newspaper articles, and other publications, as well as been a presenter to his peers and students at national and regional presentations. Also, he has published considerably in peer reviewed medical journals on a wide array of topics.

Expert headshot

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About the author

Jason Cohn

Jason Cohn

Jason is a 4th year medical student pursuing a career in Otolaryngology/Facial Plastic Surgery. His Interest include sports, fitness, chemistry, otolaryngology, plastic surgery, allergy/immunology, surgical oncology, human genetics, public health, preventative medicine, and rheumatology.

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