I received a phone call the other night from a college-aged patient who was in the middle of finals but she was also complaining of abdominal pain. She gave a great description of having had generalized abdominal pain earlier in the day and had tried to ignore it as she was studying, but over the course of about 8-10 hours the pain had gotten worse and was beginning to be more pronounced in her right lower quadrant. She was nauseated but had not vomited, and was not sure if she had a fever but felt warm. There were enough clues in her history to interrupt her studying (“are you serious?”) and send her to the local ER in her college town for an evaluation.
Guessing that she had appendicitis, I talked to the ER doctor and it was decided to ultrasound her for suspected appendicitis. Unfortunately, they could not get a good look at her appendix and the diagnosis was not confirmed.
The next radiographic test that is usually ordered when trying to diagnosis an inflamed appendix is a CT scan. Unfortunately CT scans require radiation exposure (unlike an ultrasound) and there is continued concern about cumulative radiation exposure, especially among young patients. I had just read an article published this spring in the New England Journal of Medicine. The article discussed the use of low dose CT vs. standard dose CT for diagnosing appendicitis.
The article showed that the low dose CT was not inferior to standard dose CT (if performed on non-obese patients) for diagnosing acute appendicitis. So, this young lady underwent a low dose CT scan which indeed confirmed her “hot appendix”. She was scheduled for surgery early the next am (by now it was almost dawn) and had her appendix removed laparoscopically. She was ready for discharge the following day!
Bottom line: less radiation, timely diagnosis, still able to wear a bikini as procedure used a scope vs. open incision and she was back at school in 2 days and finished her finals!! The wonders of modern medicine.
That’s your daily dose for today. We’ll chat again tomorrow