A 15-year-old adolescent girl was taken to an Illinois emergency department (ED) in February 2008 with severe abdominal pain and vomiting. The emergency physician examined the teenager and ordered diagnostic studies and intravenous fluids. Laboratory results showed an elevated white blood cell count. In the ED, the patient reported that her pain level had decreased to 0/10 after she was given antiemetic medication. She was discharged from the ED with a diagnosis of gastroenteritis and instructed to return if her symptoms worsened. The symptoms and pain continued to worsen over the next 6 days, but she did not return to the ED. On the sixth day, she was seen by a nurse practitioner at her family physician’s office. A computed tomography (CT) scan was ordered, which was suggestive of appendicitis. The patient underwent an appendectomy, which revealed a gangrenous appendix.
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