Perforated gangrenous appendicitis after an initial misdiagnosis of indigestion: a case report
DOI:
https://doi.org/10.5281/zenodo.21917216Keywords:
appendicitis, intestinal perforation, acute abdomen, delayed diagnosis, diagnostic errors, case reportAbstract
Objective: To describe a case of perforated gangrenous appendicitis in a young adult man whose initial presentation was misinterpreted as indigestion.
Methods: We report the case of a 33-year-old man with a history of bronchial asthma without maintenance treatment, who presented with persistent and progressive abdominal pain associated with vomiting. Seven hours earlier he had been evaluated in the same emergency department, where the picture was interpreted as indigestion and he was discharged after partial relief with an antiemetic and a proton-pump inhibitor.
Results: On re-presentation, pain was located in the hypogastrium and right iliac fossa, with later typical migration to the latter. Laboratory studies showed leukocytosis with left shift, and abdominal ultrasound showed reactive mesenteric nodes, a finding initially interpreted in the context of probable mesenteric adenitis. Surgical evaluation confirmed the intraoperative and histopathological diagnosis of perforated gangrenous appendicitis. The patient underwent appendectomy and piperacillin-tazobactam antibiotic therapy, with a favorable postoperative course, good oral tolerance and adequate analgesic control, and was discharged.
Conclusion: This case illustrates how an atypical or nonspecific presentation of acute appendicitis —initially interpreted as indigestion— can delay diagnosis and favor progression to gangrene and perforation, and underscores the need to maintain a high index of suspicion and to actively reassess patients whose abdominal pain persists after discharge.
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Copyright (c) 2025 Adrielle Fraga Correia, Zara Escobar Benítez (Autor/a)
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