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. 1989 Feb;35:235–239.

Use of Clinical and Paraclinical Data to Diagnose Appendicitis in a Patient with Abdominal Epilepsy

Stephen Lloyd, Ashok Sharma
PMCID: PMC2280258  PMID: 21248880

Abstract

We report a case of acute appendicitis in a 36-year-old patient with recurrent abdominal pain diagnosed seven years previously as abdominal epilepsy. Prior to his reported presentation, he successfully managed his pain at home by self-administration of phenobarbital, but on three previous occasions the patient required emergency-department treatment for severe pain. Our patient had been symptom free for several months prior to this presentation. This case raises several important questions regarding the approach to the diagnosis of acute appendicitis in the emergency department. The case illustrates the relative value of clinical and paraclinical data in establishing the diagnosis. We evaluate accepted clinical and paraclinical data used to diagnose acute appendicitis and advocate using likelihood ratios to increase diagnostic accuracy.

Keywords: appendicitis, diagnosis, likelihood ratios, abdominal epilepsy

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986 May;15(5):557–564. doi: 10.1016/s0196-0644(86)80993-3. [DOI] [PubMed] [Google Scholar]
  2. Bell M. J., Bower R. J., Ternberg J. L. Appendectomy in childhood. Analysis of 105 negative explorations. Am J Surg. 1982 Sep;144(3):335–337. doi: 10.1016/0002-9610(82)90014-9. [DOI] [PubMed] [Google Scholar]
  3. De Dombal F. T., Leaper D. J., Horrocks J. C., Staniland J. R., McCann A. P. Human and computer-aided diagnosis of abdominal pain: further report with emphasis on performance of clinicians. Br Med J. 1974 Mar 2;1(5904):376–380. doi: 10.1136/bmj.1.5904.376. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Doris P. E., Strauss R. W. The expanded role of the barium enema in the evaluation of patients presenting with acute abdominal pain. J Emerg Med. 1985;3(2):93–100. doi: 10.1016/0736-4679(85)90039-3. [DOI] [PubMed] [Google Scholar]
  5. Douglas E. F., White P. T. Abdominal epilepsy--a reappraisal. J Pediatr. 1971 Jan;78(1):59–67. doi: 10.1016/s0022-3476(71)80264-0. [DOI] [PubMed] [Google Scholar]
  6. Dunn E. L., Moore E. E., Elerding S. C., Murphy J. R. The unnecessary laparotomy for appendicitis-can it be decreased? Am Surg. 1982 Jul;48(7):320–323. [PubMed] [Google Scholar]
  7. Graham D. F. Computer-aided prediction of gangrenous and perforating appendicitis. Br Med J. 1977 Nov 26;2(6099):1375–1377. doi: 10.1136/bmj.2.6099.1375. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Grosfeld J. L., Weinberger M., Clatworthy H. W., Jr Acute appendicitis in the first two years of life. J Pediatr Surg. 1973 Apr;8(2):285–293. doi: 10.1016/s0022-3468(73)80096-x. [DOI] [PubMed] [Google Scholar]
  9. LIVINGSTON S. Abdominal pain as a manifestation of epilepsy (abdominal epilepsy) in children. J Pediatr. 1951 Jun;38(6):687–695. doi: 10.1016/s0022-3476(51)80130-6. [DOI] [PubMed] [Google Scholar]
  10. Levine J. S., Gomez G. A., Dove D. B. Negative appendix with suspected appendicitis: an update. South Med J. 1986 Feb;79(2):177–179. doi: 10.1097/00007611-198602000-00010. [DOI] [PubMed] [Google Scholar]
  11. Levine M. S. Plain film diagnosis of the acute abdomen. Emerg Med Clin North Am. 1985 Aug;3(3):541–562. [PubMed] [Google Scholar]
  12. Nase H. W., Kovalcik P. J., Cross G. H. The diagnosis of appendicitis. Am Surg. 1980 Sep;46(9):504–507. [PubMed] [Google Scholar]
  13. Nauta R. J., Magnant C. Observation versus operation for abdominal pain in the right lower quadrant. Roles of the clinical examination and the leukocyte count. Am J Surg. 1986 Jun;151(6):746–748. doi: 10.1016/0002-9610(86)90057-7. [DOI] [PubMed] [Google Scholar]
  14. Neutra R. R. Appendicitis: decreasing normal removals without increasing perforations. Med Care. 1978 Nov;16(11):956–961. doi: 10.1097/00005650-197811000-00006. [DOI] [PubMed] [Google Scholar]
  15. SHEEBY B. N., LITTLE S. C., STONE J. J. Abdominal epilepsy. J Pediatr. 1960 Mar;56:355–363. doi: 10.1016/s0022-3476(60)80187-4. [DOI] [PubMed] [Google Scholar]
  16. White J. J., Santillana M., Haller J. A., Jr Intensive in-hospital observation: a safe way to decrease unnecessary appendectomy. Am Surg. 1975 Dec;41(12):793–798. [PubMed] [Google Scholar]
  17. Young G. P. CBC or not CBC? That is the question. Ann Emerg Med. 1986 Mar;15(3):367–371. doi: 10.1016/s0196-0644(86)80587-x. [DOI] [PubMed] [Google Scholar]

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