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Asymptomatic rhabdomyolysis of unknown etiology
1Department of Family Practice, University of Nebraska Medical Center, Omaha.
Insights
A pediatric appendectomy case presented with rhabdomyolysis, a severe muscle breakdown condition. Prompt diagnosis and management led to a full recovery, highlighting the importance of considering rare post-operative complications.
Area of Science:
- Pediatric Surgery
- Neurology
- Intensive Care Medicine
Background:
- Appendectomy is a common surgical procedure in children.
- Rhabdomyolysis, characterized by muscle breakdown, can occur post-operatively.
- Right lower quadrant pain can mimic appendicitis, necessitating careful differential diagnosis.
Observation:
- A 7-year-old boy experienced rhabdomyolysis post-appendectomy, with extremely high creatine phosphokinase levels.
- Symptoms included upper respiratory infection, fever, and abdominal pain preceding surgery.
- A normal appendix was removed; mesenteric lymphadenitis was observed during surgery.
Findings:
- The patient exhibited transient myoglobinuria and elevated creatine phosphokinase levels.
- These abnormalities resolved, and the patient remained asymptomatic post-operatively.
- The study reviews potential causes including malignant hyperthermia and infectious agents.
Implications:
- This case underscores the need to consider rhabdomyolysis in pediatric patients with abdominal pain and post-operative complications.
- Differential diagnosis for right lower quadrant pain should include conditions beyond appendicitis.
- Further investigation into the link between infections, surgical stress, and rhabdomyolysis is warranted.
Abstract:
A 7-year-old boy developed rhabdomyolysis with a peak creatine phosphokinase level of 261,400 IU/L after his appendectomy. These abnormalities occurred following a 2-3-day illness consisting of upper respiratory tract symptoms, fever, and abdominal pain mimicking acute appendicitis. At the time of operation, a normal appendix was removed, and mesenteric lymphadenitis was noted. The myoglobinuria and elevation of creatine phosphokinase were transient, and the patient remained asymptomatic. We review various causes of right lower quadrant pain and rhabdomyolysis and address the roles of malignant hyperthermia and infectious agents. The possible cause of the phenomena observed in this patient is discussed.