Ingested foreign body mimicking acute appendicitis

The incidence of acute appendicitis is approximately 250,000 cases per year in the United States with a lifetime risk of 7% (Gupta & Dupuy, 1997). However, despite strongly associated clinical signs, diagnostic accuracy based on history and physical exam alone is only 70% (Jess et al., 1981). This is in large part due to the multitude of mimics found in the differential diagnosis of appendicitis. As a result highly sensitive imaging such as computed tomography scan has become standard of care.

We present a case of an otherwise healthy 20year old male presenting to the emergency department with acute onset of right lower quadrant pain and leukocytosis consistent with a diagnosis of appendicitis. Ultrasonography was grossly negative as was a computed tomography scan. Given the peritoneal nature of the patient's abdominal exam, general surgery was consulted. The patient was taken for exploratory laparoscopy where a long, thin, metallic foreign body was found to have perforated the small intestine.

Discussion includes a literature review of computed tomography negative appendicitis, as well as the frequency of foreign body mimicking appendicitis. This case demonstrates the importance of the clinical exam even in the face of negative highly sensitive imaging modalities.

In conclusion, there are several mimics of acute appendicitis and we present an unusual case of a foreign body mimicking this disorder in a young person. Highly sensitive imaging coupled with history and physical examination remains the standard of care for diagnosing appendicitis; however, clinical acumen must be utilized to formulate a broad differential.