Sudden Pain

A 6 year old girl presents with lower abdominal pain for 6 hours, which was sudden in onset. She is also mildly febrile.

There was no history of nausea or vomiting. No urinary or bowel symptoms were present.

Her medical, surgical and drug histories are uneventful.

Select Relevant Investigations
FBC & CRP

Performed

WBC: 14,350/mm3 (4,000-11,000)
80% Neutrophils; left-shift noted.
Hb: 13.4 g/dl (11.5-18.5)
Plt : 285,000/mm3 (150,000-350,000)
C-Reactive Protein: 1.7 mg/dL (< 6)
Ultrasound Abdomen

Performed

The abdominal cavity is difficult to visualize due to the child's obesity. However, a hyperechoic mass is seen just beneath the abdominal wall in the right iliac fossa. The appendix cannot be visualized clearly.
CT Abdomen and Pelvis

Performed

There is a triangular, heterogenous fatty mass located between the anterior abdominal wall and the ascending colon, with surrounding inflammatory changes. The appendix appears normal.
Urinalysis

Performed

The urinalysis is unremarkable.

Select Relevant Management
Emergency Laparotomy
Analgesics
IV Antibiotics
Laxatives