Right lower Abdominal Pain-8

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     I opened the abdomen in right lower quadrant for an appendicectomy some 12 years back in a 50 bedded hospital.I found the appendix which was a little congested but the appearance did not convince me that the patient was suffering from appendicitis.I looked in side the abdomen a little upwards and swept my hand.There was pus coming from up.I thought it be be a perforated stomach or duodenum.The wound was extended and a perforated duodenum from acid peptic disease was discovered and adequate surgery was carried out.The patient recovered nicely.I thanked God because if I would have become satisfied with an appendicectomy only , could have landed in trouble as well as the patient.


    The patient presented with the features of acute abdomen then.He had pain in the right lower abdomen .The available test for perforation of stomach and duodenum was only a plain X-rays.That should show free gas under the diaphragm in about 80 to 90 percent of patients.That did not show gas .An ultrasonogram was not available there.Also features suggested the case to be a perforated appendix.Mostly we depend on clinical findings to diagnose a case of appendicitis.That is why I went for the appendicectomy.

A Removed Appendix

So till date I remember the case .An ultrasonogram at that stage would have helped.Of course ,no harm was done to the patient.Removing an appendix along with any other surgery is done if feasible.Some times pus and other exudates from a perforated stomach or duodenum gravitate down to the right lower abdomen to simulate a case of appendicitis.