Huge Atypical Appendicitis in a 14-Year-Old Male: A Case Rep
Abstract
Normal appendix is 4 to 5 mm in diameter and approximately 8 cm in length; although it may be up to 30 cm long. Appendicitis is the inflammation of the appendix and is the most common cause of acute abdominal pain. Right lower quadrant pain, nausea, vomiting and fever are common signs of appendicitis but 20% to 33% of patients with suspected appendicitis present with atypical features. Case presentation:
we presented a 14-year-old boy with abdominal pain predominantly in hypogastric area and LLQ (Left Lower Quadrant) that after ultrasound and CT study a large appendix
22 mm in diameter and 17 cm in length was detected. Conclusion: appendix position and size is very variable and appendicitis could be presented by different clinical features. In this case, the patient was presented with LLQ pain rather than RLQ (Right Lower Quadrant) pain due to its large size and elongation to the left side.

Case Presentation
A 14 years old boy presented with abdominal pain predominantly in hypogasteric area and LLQ, nausea and vomiting since 12 hour before admission. WBC count was 12,000 with 80% neutrophils. Abdominopelvic sonography was done for patient. Findings of ultrasound study was a large noncompressible tubular structure, 22 mm in diameter which was elongated from RLQ to LLQ, containing fluid and three ehogenic lesions inside the tubule; The largest was 14 mm (appendicolith) in length (Figure 1 and Figure 2). Small amounts of free fluid in pelvis and several lymph nodes in RLQ was also detected; with largest diameter of 5 mm in short axis....

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