Tuesday, November 15, 2011

Not not appendicitis...

Since Saturday my oldest child has had intermittent abdominal pain either low along the mid line or in the lower right quadrant. He was fine Sunday evening and most of Monday, and started up again with pain/nausea/unwillingness to eat this morning. But the intensity waxes and wanes, he said his pain level (based on the frowny face chart) is usually around a 2 but has gone up to 6/7 more than once for extended periods of time.

Now I know the technical term for things, fancy yes?
He has pain at McBurney's point when palpated but pain is diffusely present throughout the lower right quadrant pretty much all the time. Doing a heel strike made it hurt but that is a new development tonight. Laying on his left side made it hurt more. Flexing his hip caused marked increased pain. He doesn't have rebound pain.

We started out at urgent care because I was hoping it was a stomach bug or something similar, but they told us to go to the ER because it had a lot of the hallmarks of appendicitis. The ER had mixed results but we didn't do anything quantifiably diagnostic (blood work, ultrasound, etc), so I was given the option of admitting him for observation or taking him home for observation. Since his symptoms were fairly mild I took him home with instructions to come back if it got worse... It hasn't gotten markedly worse but it isn't better.

So I don't know what to do. I mean we could go back to the ER but I don't know that it would do us any good since he's not much more likely to get a firm diagnosis of anything today than he was Saturday. Basically I'm just waiting around for this to either go away (fingers crossed on this option!!!) or turn into miserable acute appendicitis.

Meanwhile the doctor at the ER scared him a bit by introducing the idea of a ruptured appendix. Luckily, I could assure him that I'd seen a couple hundred appendixes a year for several years and while many of them were big and angry, very few were actually ruptured (I think he took what the doctor said to mean that his appendix would literally burst like a balloon).

I wish I had a slightly more advanced way to diagnosis this than "let's wait and see what happens" but unless it is already fairly inflamed an ultrasound might not pick it up and I'm not doing to give him the massive dose of radiation that would go along with a CT scan (which was an option presented to me by the ER doc, but presented in such a way that it was obvious he was just mentioning to have it down that he did mention the option, even though we both seemed to be in agreement that it was not going to be a viable option).

So that is where we stand. My son has pain that is not diagnosable as appendicitis, but at the same time appendicitis hasn't been ruled out.

UPDATE: The pediatrician thinks he has some bowel inflammation, so he has a prescription he will drink for a few days and hopefully things will calm down and all will be well.  

5 comments:

  1. Hmmm. Could you go back to the emerg and ask to see a pediatric general surgeon (if not already seen by one)? When I was on general surgery, a lot of the attendings would diagnose appendicitis on history and physical alone, and I personally never witnessed an attending who was wrong.

    Hope it all works out well with minimum disruption to your/your son's life.

    ReplyDelete
  2. We got an attending whose name tag said Emergency Pediatrics or something like that who consulted with the surgical people available at that time (but it was a weekend night so I don't know who was actually there). And he was borderline on the Alvarado score. It is just strange since he has symptoms but not all the time, etc.

    Right now I'm just planning to call the pediatrician in the morning and see if she thinks seeing him would do any good or if I should just take him back to the ER. He's not in acute pain right now, so I don't want to drag a happy, playing kid to the ER on a school night. :-(

    ReplyDelete
  3. It's been a week since you posted on your son's condition. How is he doing, and did you get any answers yet?

    Oh, and make sure you subscribe to this new blog! http://doctordpathology.blogspot.com/

    ReplyDelete
  4. Thanks for asking, he's doing better. I'm going to follow up with his pediatrician again.

    Oh neat, I will definitely keep an eye on your blog. Congratulations on your acceptance.

    ReplyDelete
  5. Thank you, my dear! Glad to hear all is well with your son. Hope you enjoy your Thanksgiving! Worry about that anatomy test this weekend ;)

    ReplyDelete