Make classical clinical case on acute appendicitis

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Classical clinical case: Acute appendicitis

A 19-year-old man presents to the emergency department with abdominal pain for 18 hours.

The pain began as a vague, dull pain around the umbilicus. After about 6 hours, it shifted to the right iliac fossa and became sharp and continuous. He has had anorexia, nausea, and two episodes of vomiting, occurring after the onset of pain. He reports a low-grade fever but no diarrhoea, urinary symptoms, or previous similar episodes.

Examination

Patient lies still, with the right hip slightly flexed.
Temperature: 38.1°C
Pulse: 102/min
Blood pressure: 118/74 mmHg
Tongue is dry.
Abdomen moves minimally with respiration.
Localized tenderness and guarding at McBurney's point in the right iliac fossa.
Rebound tenderness is present.
Rovsing sign is positive: palpation of the left iliac fossa produces pain in the right iliac fossa.
Psoas test is mildly positive, suggesting a possible retrocaecal appendix.
Bowel sounds are reduced.
No generalized rigidity or palpable mass.

Investigations

Hemoglobin: 13.8 g/dL
Total leukocyte count: 15,200/mm³, with neutrophilia
CRP: raised
Urinalysis: normal
Serum electrolytes: normal
In a patient of reproductive age with a uterus, a pregnancy test is essential.

Ultrasound abdomen: non-compressible blind-ending tubular structure in the right iliac fossa, diameter 8 mm, with periappendiceal fluid.
If ultrasound is equivocal in an adult, contrast-enhanced CT can show an enlarged appendix with surrounding fat stranding. Bailey and Love describes CT features including an appendix >7 mm with periappendiceal inflammatory change.

Diagnosis

Acute uncomplicated appendicitis.

Initial management

Keep the patient nil by mouth.
Establish IV access and give isotonic IV fluids.
Provide analgesia and antiemetic treatment.
Give preoperative broad-spectrum antibiotics covering enteric gram-negative organisms and anaerobes, according to local protocol.
Obtain surgical consultation.
Perform urgent laparoscopic appendicectomy, with open appendicectomy if laparoscopy is unsuitable or unavailable.
Send the appendix for histopathological examination.

Important differentials

Mesenteric lymphadenitis
Gastroenteritis
Meckel diverticulitis
Right ureteric colic
Crohn ileitis
Caecal diverticulitis
In females: ectopic pregnancy, pelvic inflammatory disease, ovarian torsion, ruptured ovarian cyst

Classical sequence supporting the diagnosis

Periumbilical visceral pain → migration to right iliac fossa → anorexia/nausea/vomiting → fever, leukocytosis, localized guarding.

The migration occurs because early visceral pain from appendiceal distension is referred to the T10 dermatome near the umbilicus. When inflammation reaches the parietal peritoneum, pain localizes to the right iliac fossa.

For selected stable adults with imaging-confirmed uncomplicated appendicitis, antibiotics alone can be discussed as an alternative, but appendicectomy remains definitive and avoids recurrence. The SAGES appendicitis guideline discusses this shared-decision approach. A 2024 Cochrane review also compares appendectomy with antibiotic therapy (PMID: 38682788).

Make classical clinical case on acute appendicitis include the following points in this order: 1. Patient Identification Age and sex Occupation Date of admission Surgical ward 2. Chief Complaints Example: Abdominal pain — 12 hours Nausea/vomiting — 8 hours Fever — 6 hours Loss of appetite — 10 hours 3. History of Present Illness Describe the typical progression: Pain initially periumbilical/epigastric After several hours, pain migrates to right iliac fossa (RIF) Pain becomes continuous and increases in intensity Anorexia Nausea ± vomiting Low-grade fever Ask about diarrhea/constipation and urinary symptoms Previous similar episodes 4. Relevant Past History Previous abdominal pain/appendicitis Previous abdominal surgery GI diseases Diabetes, hypertension, etc. Drug/allergy history 5. General Examination Record: General condition Temperature Pulse BP Respiratory rate SpO₂ Hydration Pallor/icterus/cyanosis Any signs of sepsis 6. Abdominal Examination — Most Important Inspection Abdominal distension Respiratory movement Surgical scars Palpation Tenderness in RIF Maximum tenderness at McBurney's point Guarding Rebound tenderness Rigidity if perforation/peritonitis Palpable mass if appendicular mass Special signs McBurney sign Rovsing sign Psoas sign Obturator sign Dunphy sign Also examine for hepatosplenomegaly and other abdominal masses. 7. Other Systemic Examination Cardiovascular system Respiratory system CNS Genitourinary examination when indicated 8. Investigations Blood CBC → leukocytosis, neutrophilia CRP Electrolytes RFT LFT when indicated Pregnancy test in women of reproductive age Urine Urinalysis to help exclude UTI/renal pathology Imaging Ultrasound abdomen — particularly useful in children/pregnancy CT abdomen — high diagnostic accuracy when diagnosis is uncertain or complications are suspected 9. Differential Diagnosis Depending on patient: Mesenteric lymphadenitis Gastroenteritis Meckel diverticulitis Crohn disease Renal/ureteric colic UTI Female: ovarian torsion, ruptured ovarian cyst, ectopic pregnancy, PID 10. Clinical Scoring Mention Alvarado score if required: Migration of pain Anorexia Nausea/vomiting RIF tenderness Rebound tenderness Fever Leukocytosis Neutrophilia 11. Diagnosis State clearly: > Acute appendicitis, with/without localized peritonitis, perforation, abscess, or appendicular mass. 12. Management Initial NPO IV fluids Analgesia Antiemetics Antibiotics when indicated Monitor vitals and urine output Definitive Laparoscopic appendectomy — commonly preferred Open appendectomy when indicated/appropriate Complicated appendicitis Perforation/peritonitis → urgent operative management + broad-spectrum antibiotics Abscess/phlegmon → antibiotics ± image-guided drainage in selected patients, followed by individualized surgical planning 13. Postoperative Management Monitor vitals Pain control Early mobilization Gradual oral feeding Wound monitoring Antibiotics according to operative findings Watch for complications 14. Complications Perforation Generalized peritonitis Appendicular mass/phlegmon Appendicular abscess Sepsis Wound infection Intra-abdominal abscess Adhesive intestinal obstruction For an exam presentation, the key sequence is: CC → HPI → Examination → RIF signs → Investigations → Differential → Diagnosis → Management → Complications.

Reading File

Patient identification and chief complaints
History of present illness: classical migration of pain from periumbilical region to right iliac fossa, associated anorexia, nausea/vomiting, and fever
Past, drug, allergy, and relevant medical history
General physical examination: vital signs, hydration, and sepsis assessment
Focused abdominal examination: right iliac fossa tenderness, guarding, rebound, and special appendicitis signs
Other systemic and genitourinary examination
Investigations: blood tests, urinalysis, pregnancy testing when applicable, ultrasound, and CT
Differential diagnosis, including gastrointestinal, urinary, and gynecological causes
Clinical scoring, especially the Alvarado score
Diagnosis and severity classification: uncomplicated appendicitis versus perforation, peritonitis, abscess, or appendicular mass
Initial and definitive management, including resuscitation, antibiotics, and appendectomy
Postoperative care and complications

A classical presentation is migratory abdominal pain that starts near the umbilicus and localizes to the right iliac fossa, followed by anorexia, nausea or vomiting, low-grade fever, neutrophilic leukocytosis, and localized peritoneal signs. The examination should establish both the likelihood of appendicitis and whether it is complicated by perforation or generalized peritonitis.

A complete exam case should be presented in sequence: history, examination, investigations, differentials, score, diagnosis, management, and complications. Imaging is selected according to patient factors and diagnostic uncertainty: ultrasound is often preferred first in children and pregnancy, while CT is particularly useful in adults with an uncertain diagnosis or suspected complication.

Make classical clinical case on acute appendicitis presentation include the following points in this order: 1. Patient Identification Age and sex Occupation Date of admission Surgical ward 2. Chief Complaints Example: Abdominal pain — 12 hours Nausea/vomiting — 8 hours Fever — 6 hours Loss of appetite — 10 hours 3. History of Present Illness Describe the typical progression: Pain initially periumbilical/epigastric After several hours, pain migrates to right iliac fossa (RIF) Pain becomes continuous and increases in intensity Anorexia Nausea ± vomiting Low-grade fever Ask about diarrhea/constipation and urinary symptoms Previous similar episodes 4. Relevant Past History Previous abdominal pain/appendicitis Previous abdominal surgery GI diseases Diabetes, hypertension, etc. Drug/allergy history 5. General Examination Record: General condition Temperature Pulse BP Respiratory rate SpO₂ Hydration Pallor/icterus/cyanosis Any signs of sepsis 6. Abdominal Examination — Most Important Inspection Abdominal distension Respiratory movement Surgical scars Palpation Tenderness in RIF Maximum tenderness at McBurney's point Guarding Rebound tenderness Rigidity if perforation/peritonitis Palpable mass if appendicular mass Special signs McBurney sign Rovsing sign Psoas sign Obturator sign Dunphy sign Also examine for hepatosplenomegaly and other abdominal masses. 7. Other Systemic Examination Cardiovascular system Respiratory system CNS Genitourinary examination when indicated 8. Investigations Blood CBC → leukocytosis, neutrophilia CRP Electrolytes RFT LFT when indicated Pregnancy test in women of reproductive age Urine Urinalysis to help exclude UTI/renal pathology Imaging Ultrasound abdomen — particularly useful in children/pregnancy CT abdomen — high diagnostic accuracy when diagnosis is uncertain or complications are suspected 9. Differential Diagnosis Depending on patient: Mesenteric lymphadenitis Gastroenteritis Meckel diverticulitis Crohn disease Renal/ureteric colic UTI Female: ovarian torsion, ruptured ovarian cyst, ectopic pregnancy, PID 10. Clinical Scoring Mention Alvarado score if required: Migration of pain Anorexia Nausea/vomiting RIF tenderness Rebound tenderness Fever Leukocytosis Neutrophilia 11. Diagnosis State clearly: > Acute appendicitis, with/without localized peritonitis, perforation, abscess, or appendicular mass. 12. Management Initial NPO IV fluids Analgesia Antiemetics Antibiotics when indicated Monitor vitals and urine output Definitive Laparoscopic appendectomy — commonly preferred Open appendectomy when indicated/appropriate Complicated appendicitis Perforation/peritonitis → urgent operative management + broad-spectrum antibiotics Abscess/phlegmon → antibiotics ± image-guided drainage in selected patients, followed by individualized surgical planning 13. Postoperative Management Monitor vitals Pain control Early mobilization Gradual oral feeding Wound monitoring Antibiotics according to operative findings Watch for complications 14. Complications Perforation Generalized peritonitis Appendicular mass/phlegmon Appendicular abscess Sepsis Wound infection Intra-abdominal abscess Adhesive intestinal obstruction For an exam presentation, the key sequence is: CC → HPI → Examination → RIF signs → Investigations → Differential → Diagnosis → Management → Complications.

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Classical clinical case: Acute appendicitis

A 19-year-old man presents to the emergency department with abdominal pain for 18 hours.

The pain began as a vague, dull pain around the umbilicus. After about 6 hours, it shifted to the right iliac fossa and became sharp and continuous. He has had anorexia, nausea, and two episodes of vomiting, occurring after the onset of pain. He reports a low-grade fever but no diarrhoea, urinary symptoms, or previous similar episodes.

Examination

Patient lies still, with the right hip slightly flexed.
Temperature: 38.1°C
Pulse: 102/min
Blood pressure: 118/74 mmHg
Tongue is dry.
Abdomen moves minimally with respiration.
Localized tenderness and guarding at McBurney's point in the right iliac fossa.
Rebound tenderness is present.
Rovsing sign is positive: palpation of the left iliac fossa produces pain in the right iliac fossa.
Psoas test is mildly positive, suggesting a possible retrocaecal appendix.
Bowel sounds are reduced.
No generalized rigidity or palpable mass.

Investigations

Hemoglobin: 13.8 g/dL
Total leukocyte count: 15,200/mm³, with neutrophilia
CRP: raised
Urinalysis: normal
Serum electrolytes: normal
In a patient of reproductive age with a uterus, a pregnancy test is essential.

Ultrasound abdomen: non-compressible blind-ending tubular structure in the right iliac fossa, diameter 8 mm, with periappendiceal fluid.
If ultrasound is equivocal in an adult, contrast-enhanced CT can show an enlarged appendix with surrounding fat stranding. Bailey and Love describes CT features including an appendix >7 mm with periappendiceal inflammatory change.

Diagnosis

Acute uncomplicated appendicitis.

Initial management

Keep the patient nil by mouth.
Establish IV access and give isotonic IV fluids.
Provide analgesia and antiemetic treatment.
Give preoperative broad-spectrum antibiotics covering enteric gram-negative organisms and anaerobes, according to local protocol.
Obtain surgical consultation.
Perform urgent laparoscopic appendicectomy, with open appendicectomy if laparoscopy is unsuitable or unavailable.
Send the appendix for histopathological examination.

Important differentials

Mesenteric lymphadenitis
Gastroenteritis
Meckel diverticulitis
Right ureteric colic
Crohn ileitis
Caecal diverticulitis
In females: ectopic pregnancy, pelvic inflammatory disease, ovarian torsion, ruptured ovarian cyst

Classical sequence supporting the diagnosis

Periumbilical visceral pain → migration to right iliac fossa → anorexia/nausea/vomiting → fever, leukocytosis, localized guarding.

The migration occurs because early visceral pain from appendiceal distension is referred to the T10 dermatome near the umbilicus. When inflammation reaches the parietal peritoneum, pain localizes to the right iliac fossa.

For selected stable adults with imaging-confirmed uncomplicated appendicitis, antibiotics alone can be discussed as an alternative, but appendicectomy remains definitive and avoids recurrence. The SAGES appendicitis guideline discusses this shared-decision approach. A 2024 Cochrane review also compares appendectomy with antibiotic therapy (PMID: 38682788).1. Patient identification and chief complaints
2. History of present illness: classical migration of pain from periumbilical region to right iliac fossa, associated anorexia, nausea/vomiting, and fever
3. Past, drug, allergy, and relevant medical history
4. General physical examination: vital signs, hydration, and sepsis assessment
5. Focused abdominal examination: right iliac fossa tenderness, guarding, rebound, and special appendicitis signs
6. Other systemic and genitourinary examination
7. Investigations: blood tests, urinalysis, pregnancy testing when applicable, ultrasound, and CT
8. Differential diagnosis, including gastrointestinal, urinary, and gynecological causes
9. Clinical scoring, especially the Alvarado score
10. Diagnosis and severity classification: uncomplicated appendicitis versus perforation, peritonitis, abscess, or appendicular mass
11. Initial and definitive management, including resuscitation, antibiotics, and appendectomy
12. Postoperative care and complications

A classical presentation is migratory abdominal pain that starts near the umbilicus and localizes to the right iliac fossa, followed by anorexia, nausea or vomiting, low-grade fever, neutrophilic leukocytosis, and localized peritoneal signs. The examination should establish both the likelihood of appendicitis and whether it is complicated by perforation or generalized peritonitis.

A complete exam case should be presented in sequence: history, examination, investigations, differentials, score, diagnosis, management, and complications. Imaging is selected according to patient factors and diagnostic uncertainty: ultrasound is often preferred first in children and pregnancy, while CT is particularly useful in adults with an uncertain diagnosis or suspected complication.This is a full surgical long-case format rather than a single short case. I can develop one section in an exam-ready format next.

Finding Sources

Searching PubMed

"appendicitis"[MeSH Terms]

Searching the Web

SAGES guideline diagnosis treatment appendicitis 2024

Classical Clinical Case Presentation: Acute Appendicitis

1. Patient Identification

Name: Mr. A.B.
Age/Sex: 22-year-old male
Occupation: College student
Date of admission: 27 September 2026
Ward: Surgical Ward

2. Chief Complaints

Abdominal pain for 12 hours
Loss of appetite for 10 hours
Nausea and vomiting for 8 hours
Fever for 6 hours

3. History of Present Illness

The patient was apparently well 12 hours before admission, when he developed a vague, dull, poorly localized pain around the umbilicus. The pain was initially mild to moderate in intensity.

After approximately 5 to 6 hours, the pain migrated to the right iliac fossa (RIF). It subsequently became sharp, continuous, and progressively more severe. The pain is aggravated by walking, coughing, and movement. The patient prefers to lie still with his right hip slightly flexed.

He has had loss of appetite since the onset of pain. This was followed by nausea and two episodes of non-bilious, non-projectile vomiting. He developed low-grade fever 6 hours before admission, with no chills or rigors.

There is no history of diarrhea, constipation, abdominal distension, melena, or bleeding per rectum. There are no urinary symptoms such as dysuria, frequency, urgency, hematuria, or loin pain. There is no history of previous similar episodes.

4. Relevant Past History

No past history of recurrent right iliac fossa pain or diagnosed appendicitis.
No history of previous abdominal surgery.
No history of peptic ulcer disease, inflammatory bowel disease, tuberculosis, or other chronic gastrointestinal illness.
No history of diabetes mellitus, hypertension, asthma, cardiac disease, or renal disease.
No regular medication use.
No known drug or food allergies.
No significant family history.

5. General Examination

The patient is conscious, cooperative, and oriented. He appears uncomfortable because of abdominal pain but is not toxic-looking.

Parameter	Finding
General condition	Fair, mildly ill-looking
Temperature	38.1°C
Pulse	102/min, regular, good volume
Blood pressure	118/74 mmHg
Respiratory rate	20/min
SpO₂	98% on room air
Hydration	Mild dehydration, dry tongue
Pallor	Absent
Icterus	Absent
Cyanosis	Absent
Clubbing/lymphadenopathy/edema	Absent
Features of sepsis	Mild tachycardia and fever; no hypotension or altered sensorium

6. Abdominal Examination

Inspection

Abdomen is not distended.
Umbilicus is central and inverted.
There are no visible scars, sinuses, dilated veins, or hernias.
Respiratory movement of the lower abdomen is mildly reduced, more marked on the right side.
No visible peristalsis or pulsations are seen.

Palpation

Local rise of temperature is present in the right iliac fossa.
There is marked tenderness in the right iliac fossa.
Maximum tenderness is present at McBurney's point, at the junction of the lateral one-third and medial two-thirds of a line joining the right anterior superior iliac spine to the umbilicus.
Voluntary guarding is present in the right iliac fossa.
Rebound tenderness is present in the right iliac fossa, suggesting localized peritoneal irritation.
There is no generalized rigidity.
No palpable right iliac fossa mass is felt.
Liver and spleen are not palpable.
No other intra-abdominal mass is palpable.

Percussion

Localized tenderness is present on percussion over the right iliac fossa.
No shifting dullness is present.
Liver dullness is preserved.

Auscultation

Bowel sounds are present but mildly reduced.

Special Signs

Sign	Finding	Interpretation
McBurney sign	Positive	Maximum RIF tenderness at McBurney's point
Rovsing sign	Positive	Palpation of left iliac fossa causes pain in RIF
Psoas sign	Mildly positive	Suggests possible retrocaecal appendix
Obturator sign	Negative	Pelvic appendix less likely
Dunphy sign	Positive	Coughing worsens pain in RIF

7. Other Systemic Examination

Cardiovascular System

Heart sounds S1 and S2 are normal.
No murmur, gallop, or added sound.

Respiratory System

Bilateral air entry is equal.
No crepitations, wheeze, or pleural rub.

Central Nervous System

Conscious and oriented.
No focal neurological deficit.

Genitourinary Examination

External genital examination is normal.
No costovertebral angle tenderness.
In a female patient, pelvic examination should be performed when clinically indicated to exclude gynecological causes of right iliac fossa pain.

8. Investigations

Blood Investigations

Investigation	Result	Interpretation
Hemoglobin	13.6 g/dL	Normal
Total leukocyte count	15,400/mm³	Leukocytosis
Differential count	Neutrophils 84%	Neutrophilia
CRP	Raised	Supports acute inflammation
Serum electrolytes	Within normal limits	Baseline assessment
Renal function tests	Normal	Preoperative assessment
Liver function tests	Normal	Done if alternative hepatobiliary pathology is suspected
Blood group and cross-match	Sent	Preoperative preparation

For women of reproductive age, a urine or serum beta-hCG test must be obtained to exclude pregnancy and ectopic pregnancy.

Urine Examination

Urinalysis: no pus cells, no red cells, no nitrites, and no significant bacteriuria.
This helps exclude urinary tract infection and renal or ureteric pathology.

Imaging

Ultrasound abdomen:

Non-compressible blind-ending tubular structure in the right iliac fossa.
Outer diameter approximately 8 mm.
Localized probe tenderness.
Mild periappendiceal fluid.
No appendicular abscess or appendicular mass.

Interpretation: Findings suggest acute appendicitis.

CT abdomen with contrast, if performed because of diagnostic uncertainty or suspected complication, may demonstrate an enlarged appendix, wall thickening, periappendiceal fat stranding, appendicolith, free fluid, abscess, or perforation. CT is especially useful in adults with an uncertain diagnosis; ultrasound is often preferred first in children and pregnancy.

9. Differential Diagnosis

The differential diagnoses for right iliac fossa pain include:

Mesenteric lymphadenitis
Acute gastroenteritis
Meckel diverticulitis
Crohn disease involving the terminal ileum
Caecal diverticulitis
Renal or ureteric colic
Urinary tract infection
In females:
- Ectopic pregnancy
- Pelvic inflammatory disease
- Ovarian torsion
- Ruptured or hemorrhagic ovarian cyst

10. Clinical Scoring: Alvarado Score

Parameter	Points	Present in this case
Migration of pain to RIF	1	Yes
Anorexia	1	Yes
Nausea/vomiting	1	Yes
Tenderness in RIF	2	Yes
Rebound tenderness	1	Yes
Fever	1	Yes
Leukocytosis	2	Yes
Neutrophilia	1	Yes
Total	10	10/10

Interpretation: A score of 7 or more strongly supports acute appendicitis, although the score supports but does not replace clinical judgment and imaging where needed.

11. Diagnosis

Acute uncomplicated appendicitis with localized peritonitis.

There is no clinical or ultrasonographic evidence of perforation, generalized peritonitis, appendicular abscess, or appendicular mass in this case.

12. Management

Initial Management

Admit under the surgical team.
Keep the patient nil by mouth (NPO).
Establish IV access.
Start IV crystalloid fluids and correct dehydration or electrolyte abnormalities.
Provide adequate analgesia. Analgesia should not be withheld while evaluating suspected appendicitis.
Give antiemetics for nausea and vomiting.
Administer preoperative antibiotics with coverage for enteric gram-negative organisms and anaerobes, according to the local hospital antibiotic policy.
Monitor temperature, pulse, blood pressure, oxygen saturation, abdominal signs, and urine output.
Obtain informed consent for laparoscopic appendectomy with possible conversion to open appendectomy if necessary.

Definitive Management

Laparoscopic appendectomy is commonly preferred for this patient because it permits visualization of the appendix and the abdominal cavity, usually facilitates recovery, and can help identify alternative pathology.

Open appendectomy may be appropriate when laparoscopy is unavailable, contraindicated, technically difficult, or when conversion is required intraoperatively.

The appendix should be sent for histopathological examination.

If Complicated Appendicitis Is Found

Perforation or generalized peritonitis: urgent source-control surgery, peritoneal lavage as indicated, and broad-spectrum antibiotics.
Appendicular abscess or phlegmon: selected stable patients may be managed with antibiotics with or without image-guided drainage. The need and timing of later appendectomy should be individualized.

The 2024 SAGES appendicitis guideline supports individualized diagnostic and treatment decisions. Recent evidence also continues to assess antibiotic-first treatment for selected uncomplicated cases, but appendectomy remains the definitive treatment. A 2024 Cochrane systematic review is indexed as PMID: 38682788.

13. Postoperative Management

Monitor vital signs, urine output, abdominal findings, and signs of sepsis.
Continue IV fluids until oral intake is adequate.
Provide analgesia and antiemetics as required.
Encourage early mobilization and breathing exercises.
Start oral liquids after recovery from anesthesia and advance to a normal diet as tolerated.
Inspect the wound or port sites for bleeding, erythema, discharge, or infection.
Continue antibiotics according to intraoperative findings. A simple uncomplicated appendicitis generally needs only perioperative antibiotic prophylaxis, whereas perforated or gangrenous appendicitis may require a postoperative course.
Review histopathology.
Advise the patient to return if fever, worsening abdominal pain, vomiting, wound discharge, or abdominal distension develops.

14. Complications

Complications of Acute Appendicitis

Gangrene of appendix
Perforation
Localized or generalized peritonitis
Appendicular mass or phlegmon
Appendicular abscess
Sepsis

Postoperative Complications

Wound or port-site infection
Intra-abdominal or pelvic abscess
Ileus
Fecal fistula, rarely
Adhesive intestinal obstruction
Deep venous thrombosis or pulmonary complications in high-risk patients

Exam Presentation Summary

“This is a 22-year-old male who presented with migratory abdominal pain, initially periumbilical and later localized to the right iliac fossa, associated with anorexia, nausea, vomiting, and low-grade fever. On examination, he has right iliac fossa tenderness maximal at McBurney's point, guarding, rebound tenderness, and positive Rovsing and Dunphy signs. Blood investigations show neutrophilic leukocytosis and raised CRP. Ultrasound demonstrates a non-compressible, dilated appendix. My diagnosis is acute uncomplicated appendicitis with localized peritonitis. The patient requires resuscitation, antibiotics, and laparoscopic appendectomy.”