Abdominal pain, diarrhea, vomiting is gastroenteritis? This pit of misdiagnosis must be avoided

Thanks to Lilac Garden station friends, Lilac Master @mimilani for sharing the case:

A 4-year-old male patient came to the clinic with “abdominal pain for 3 days”, and was treated with oral Shenqu Xiaoshi oral liquid and probiotics, and had yellow loose stools, 1 3 to 5 times a day. One day, the child had increased abdominal distension, obvious abdominal pain, anorexia, vomiting, no obvious fever, and no rash.

Physical examination: Consciousness, poor spirit, obvious abdominal distension, tenderness throughout the abdomen, weak bowel sounds, no mass.

Abdominal ultrasound: The abdominal distension was obvious, and the abdominal cavity and right lower quadrant no obvious abnormality.

The child has poor diet, poor spirit, diarrhea, abdominal distension, and vomiting. What should be considered in the initial diagnosis? Acute gastroenteritis.

Recommended hospitalization, but the parents refused, and asked to continue oral medication and complete the results of routine fecal examination.

In the afternoon, the child came to the clinic again, with aggravated abdominal pain and abdominal distension, and elevated C-reactive protein in blood routine. Diagnosed with “intestinal obstruction” and admitted to pediatric surgery.

After admission, a CT scan of the abdomen is shown below:

Preoperative diagnosis: Acute appendicitis.

Intraoperative diagnosis:1. Acute suppurative appendicitis; 2. Intestinal obstruction

Laparoscopic appendectomy and intestinal adhesion release were performed. Intraoperatively, the intestinal tube was seriously adhered, pus was seen in the right abdominal cavity, the appendix was suppuration, and it was tightly adhered to the ileum and the ascending colon of the cecum.

Why do children with appendicitis develop bowel obstruction? The child has loose stools 3 times a day, why can it still be intestinal obstruction?

Looking back at the entire diagnosis and treatment process, do you see intestinal obstruction? Are appendix ultrasonography reliable in children with severe abdominal distension?

What are the “pits” of abdominal pain in children? Do you have any good suggestions?