A Common Diagnosis Delayed by Three "Wrong Footing" Anchoring Errors - it is Difficult to Remember What You Have...

Area of Science:

• Medicine
• Clinical Diagnosis

Background:

• Left lower quadrant abdominal pain is often attributed to conditions other than appendicitis.
• Clinical practice frequently sees clinicians anchored to the most prominent symptom, leading to diagnostic detours.

Purpose of the Study:

• To present a case of appendicitis presenting with left lower quadrant pain.
• To discuss diagnostic challenges and anchoring biases in appendicitis diagnosis.
• To propose strategies for avoiding diagnostic errors in similar cases.

Main Methods:

• Case report of a 40-year-old male with persistent lower left abdominal pain and fever.
• Diagnostic workup included physical examination, abdominal ultrasound, and non-contrast-enhanced computed tomography.
• Laparoscopic appendectomy was performed.

Main Results:

• The patient presented with left lower quadrant pain and fever, initially suspected to be related to a left hydroureter and constipation.
• Diagnostic delay occurred due to anchoring biases: atypical pain location, presence of left hydroureter, and constipation.
• Laparoscopic appendectomy confirmed appendicitis.

Conclusions:

• Unexplained lower left abdominal pain warrants a "searchlight" diagnostic strategy.
• A "vertical tracing" strategy is recommended when a hydroureter has no apparent source obstruction.
• Implementing "pivot and cluster" strategies early can prevent misdiagnosis by considering key differential diagnoses and avoiding anchoring bias.