A 17 year old girl presents with history of generalised abdominal pain, fever, recurrent vomiting. On examination, she has a temperature of 103degF, Right Iliac fossa tenderness, and WBC are 19600/mm' ?
Ans. is 'a' i.e., Ruptured appendicular abscess Abdominal pain and vomiting suggest the most likely diagnosis of appendicitis. High temp (103degF) and high WBC count suggest appendiceal rupture. Schwaz writes - "Rupture should be suspected in the presence of fever greater than 39degC (102degF) and a WBC count greater than 18,000/mm3." Other options are less likely, as fever and vomiting is uncommon in them. Intussusception Is usually seen in children younger than 2 yrs of age Fever, leucocytosis is not seen. Ruptured ectopic pregnancy Schwaz writes - "Rupture of . tubal or ovarian pregnancies can mimic appendicitis. Patients usually give a history of abnormal menses; either missing one or two periods or noting only slight vaginal bleeding. The diagnosis of ruptured ectopic pregnancy should be relatively easy. The presence of a pelvic mass and elevated levels of chorionic gonadotropin are characteristic While the leukocyte count rises slightly (to approx. 14,000), the hematocrit level falls as a consequence of the intraabdominal haemorrhage. Vaginal examination reveals cervical motion and adenexal tenderness." Twisted ovarian cyst Shaw's writes - "A twisted ovarian cyst causes sudden pain in abdomen with occasional vomiting, but pyrexia is usually absent or very low. An abdominal lump is felt distinctly.
Ruptured Appendicular Abscess
Twisted Ovarian cyst
Ruptured Ectopic Pregnancy
Intussusception