title: Unusual presentation of a perforated appendicitis in a four-year-old girl - a case report from Yazd, Iran.
abstract: Difficulties in the early diagnosis of appendicitis, particularly in children, often lead to complications, such as perforation of the appendix, within 36 hours of the onset of symptoms. A four-year-old girl presented to the Emergency Department at Shohadaye Kargar Hospital in Yazd (a city in central Iran) in February 2013 with a history of chronic abdominal pain that began 20 days before admission. Her physical examination revealed a low-grade fever, conjunctivitis, dysuria with malodorous urine, and a mass in right, lower quadrant without localized tenderness in that area. Intestinal intussusception was suggested as the most likely diagnosis, and a laparotomy was performed. The appendix was perforated and an appendicular abscess had caused intestinal obstruction. The rarity of this case, with its unusual presentation and findings, which included unexplained chronic pain, necessitated an immediate operation that revealed the acute presentation of a mechanical obstruction of the intestine. Appendicitis must be kept in the differential diagnosis of any child who presents with chronic abdominal pain. In conclusion, chronic abdominal pain in children is not always of functional origin, and discerning the correct diagnosis can be very challenging. Therefore, clinicians should think broadly since multi-disciplinary input may be inevitable.
authors.affiliation: Medical Scientific Association, Student of Public health, Islamic Azad University, Yazd branch, Yazd, Iran.
authors.forename: Mohammadhosain
authors.initials: M
authors.lastname: Afrand
authors.affiliation: Assistant professor of Pediatric Gastroenterology, Pediatric Department, Islamic Azad University, Yazd branch, Yazd, Iran.
authors.forename: Vajiheh
authors.initials: V
authors.lastname: Modaresi
keywords: abdominal pain; appendicular abscess; children; perforated appendicitis