Purpose or Case Report: Purpose: To demonstrate Pediatric Acute Appendicitis with a secondary sign of an early perforation based on ultrasound findings.
Methods & Materials: Methods and Materials: 11 years old patient presented to our Emergency department with severe abdominal pain for past two days, constipation for four days, inability to tolerate food intake and non-bloody emesis. STAT portable abdomen ultrasound was ordered on this patient to rule out Acute Appendicitis by the Emergency department.
Results: Results: Ultrasound findings demonstrated markedly dilated appendix with the AP diameter of 2.5cm in right lower quadrant with a large shadowing Appendicolith near the tip of the appendix. It also demonstrated a small echogenic focus near the wall of the appendix which could represent an early perforation. After ultrasound findings, patient was rushed to the Operating room without further imaging and post-operative diagnosis demonstrated perforated appendix with fecalith and extensive pus in the intraperitoneal cavity.
Conclusions: Conclusion: Ultrasound should be an initial imaging study of choice for pediatric appendicitis. With the presence of secondary signs such as appendicolith, periappendiceal fat, free fluid and extra luminal air along the margin of the appendicular wall. Ultrasound plays an important role in diagnosis acute appendicitis in pediatric patients.