(no po on doa) Accompanied by an older sister in the ED
Attributed the diarrhea that developed the same day to having received Hep A shot.
R testes nml flow; L testes w/ focal area of decreased echogenicity;some bloodflow seen in soft tissue surrounding the left testis no blood flow within left testis; moderate-marked inhomogeneous thickening surrounding testis which is mildly vascular; small L hydrocele; L epididymal orchitis vs peritesticular organizing hematoma vs testicular torsion.
Taken to the OR for b/l scrotal exploration w/likely L orchiectomy w/ R ochidopexy
Intraop findings:Difficult to identify the L testes completely because of significant reactive tissue changes in the left hemiscrotum. The testis appeared swollen, edematous and the decision was made to biopsy it. Given that the patient did not have torsion, there was a great deal of concern as to what pathology had resulted in the patient’s pain and a abd CT was recommended. Surgical Consult: pain not classic for appendicitis, however given uncertainty surrounding the history, agree with CT abd to r/o appy. Scrotal abscess thought to perhaps represent sequelae of a ruptured appendicitis, as the appendix was not well visualized on the study
Testicle- possibly a necrotic testicle? Admitted to PICU overnight for monitoring, observation for AM appendectomy Diagnosis: Ruptured Appendix with abscess drainage Admitted to PICU postoperatively Treated with Clindamycin, Zosyn Tranferred to B3 on HD #2 Wound Cx: Ecoli, strep viridans, provetella, bacteroides Testicular Biopsy:benign fibrovascular tissue containing small amounts of skeletal muscle w/ mild acute and chronic inflammation Appendix Biopsy: supparative appendicitits and periappendicitis w/perforation and florid fibrinopurulent exudate formation Repeat testicular U/S on HD # 4- hypoechoic L testicle surrounded by a hypervascular periphery D/C’d to home on HD# 7 w/ surgery and urology follow-up
Study done looking at closed medical malpractice claims from St. Paul Fire and Marine Insurance Co and Specturm Emergency Care, Inc were examined from 1984-1989 reviewed 66 cases of misdiagnosis of appendicitis resulting in litigation.
Initial reviews with radiology were read as RML pneumonia and AXR was read as ileus c/w Viral Gastroenteritis or current illness. Primary Care physician also concerned about the loop in RLQ c/w appendicitis, or other intestinal process.
Pediatric Case Management The Children’s Hospital at Sinai October 25, 2005