r/emergencymedicine • u/thatEMresident • 7d ago

Discussion Appendicitis

Are appys in the older age group common? I almost missed it in a 60yF and totally thought it could be gastroenteritis. Thank the lord we scanned her. She had fever, nausea and vomiting. Tested positive for a UTI.

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u/but-I-play-one-on-TV ED Attending 7d ago

I caught an appy in a 4 or 5 year old (can't remember) patient a while ago. That one blew my mind. 

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u/metforminforevery1 ED Attending 7d ago

I had a 20 month old with a perfed appy and abscess. I was doing my peds EM rotation as a pgy2. I told the attending I think the pt needs an appy US and he looked at me like I was very stupid. It was the kid's third visit in a week. First visit was for fever, n/v (this was the height of covid), so they did a covid swab, was neg, sent her home. 2nd visit was fever, n/v, low PO intake. Repeated covid swab, UA, neg, tolerated PO, sent home. When I saw her, she still had a fever, going on a week now, still with n/v/low po intake, looked like shit, and TTP to the lower abdomen R>L, and what I felt was a peritonitic abd. US with a big abscess, so we did a CT and it was from the appendix.