Indexing Title: JPINGUL's Medical Anecdotal Report [04-1]
MAR Title: Acute Appendicitis by history and PE only
Date of Medical Observation: April 26, 2004
Narration:
A 19-year-old female came to the ER for second opinion on her health problem of right lower quadrant abdominal pain that started 20 hours ago as an epigastric pain.
On palpation, she had direct tenderness over the right lower quadrant with muscle guarding on the right hemiabdomen
My primary diagnosis was acute appendicitis (90%) and my secondary diagnosis was a gynecologic problem (10%).
I recommended an appendectomy to which she agreed. Through a RLQ oblique incision, I noted a suppurative appendix, other RLQ and pelvic structures appear normal. After appendectomy, the patient was brought back to the ward and the pain was gone. She was afebrile and had active bowel sounds, she resumed her regular diet and was discharged with 2 days hospital stay.
Thus, my diagnosis was Acute Non-Perforative Appendicitis with 99% certainty.
After the procedure, the patient divulged to me that a surgeon in St. Lukes was recommending outright operation for which she was asked to prepare PhP 70,000.
Laboratories and a few hours ER stay cost her PhP 3,000 before going to OM.
With what I did, I saved her expenses of PhP 70,000.
She was so happy that she gave me a smile and she promised she will come back to the OPD for follow-up.
Insights (Discovery, Stimulus, REINFORCEMENT):
Acute appendicitis can be diagnosed with accuracy, based on history and PE alone. It can save unnecessary expenses, prevent OR delay, and save hospital resources.
Our protocol on the diagnosis of acute appendicitis is cost-effective and patient-friendly.