Differential Diagnosis 2 (Appendicitis)

Survey of the differential diagnoses of appendicitis in case of presentation as 'surgical abdomen'. 'Surgical abdomen' is an abdominal disease entity in which the indication for surgery seems urgent. In the forefront are pathologies with peritonitis and complications of abdominal tumor, such as torsion, hemorrhage, or rupture. Also, acute or chronic partial intestinal obstructions have to be considered, especially in infants and toddlers. A blunt abdominal trauma or a swallowed foreign body seems to be excluded if corresponding informations are missing. Because such informations are possibly concealed or not given for other reasons, the medical doctor must always consider these differential diagnoses, e.g. sequels of child abuse, or a swallowed sewing needle with intestinal perforation and peritonitis. Finally, a careful clinical examination will also exclude lesions close to the abdomen, such as testicular torsion. abdo_zz11_n.jpg / abdo_zz1_n.jpg: Plain abdominal x-rays in upright position: In abdo_zz11_n.jpg two air-fluid-levels are visible in the right lower quadrant. In abdo_zz1_n.jpg distension of the intestinal loops by air and several air-fluid-levels are recognizable in the two upper quadrants. Plain abdominal x-ray in upright position is an important tool in the differential diagnosis of surgical abdomen. Both x-rays suggest obstructive ileus of the small intestine due to the presence, number, and distribution of the air-fluid levels.