I saw, last week, a seven year old boy who was complaining of pain in
his right buttock after falling off of a bicycle. He was tender about
at the distal end of the gluteus muscles directly posterior. I found
no bruise, swelling or sign of trauma. Perianal area was normal. He
returned with worse and more widely distributed pain around his right
hip area. He now had a low (38) fever.
Extensive evaluation in the ED turned up a physical, including
rectal that was not diagnostic, normal back and hip plain films,
normal ultrasound of the hips and legs, and finally a CT scan that
included the abdomen and showed free fluid in the peritoneum.
He had a hot, not yet ruptured appendix removed. (Work up took 16
hours with all the consultations from ortho and surgery and radiology)
Has anyone seen an appendix present like this, with pain referred to
the back of the leg area?