An 11-year-old with abdominal pain

摘要

A previously healthy 11-year-old girl presented to an emergency department in Boston with a 2-day history of abdominal pain and vomiting. She did not have a fever, diarrhea, melena, or hematochezia by history. She had immigrated to the United States from central Ethiopia 2 months earlier. Her temperature was 37.7degC. She had diminished bowel sounds and lower abdominal tenderness, with guarding and a positive psoas sign. Hematological testing demonstrated a mildly elevated white blood cell count of 11,000 cells/microliter, with a differential of 90 neutrophils, 2 lymphocytes, 6 mono-cytes, 0 eosinophils, and 1 basophils. Abdominal imaging showed evidence of a complex fluid collection in the pelvis. She underwent abdominal surgery and was found to have a ruptured appendix, which was removed.