Today, my ward was active, so there is a admission of 20 yr-old man who presented with right iliac fossa pain for 2 days, associated with recurrent vomiting and fever. Clinically, patient abdomen is tender and guarded at RIF area and it’s should be a perforated appendicitis. Then, at end of interview, the young man father told me that patient had a “minor accident”, a day prior to the symptoms. Gosh, this piece of info changes the whole diagnosis, and i need to exclude abdominal injury.

To my surprise, my MOs decided after reviewing the patient, the pain may due to the muscle injury as result of the accident….???

Finally, when my specialist saw the case, he ordered a emergeny CT scan, suspecting bowel perforation which now lead to peritonitis…

I don’t know the CT result as it’s already 5pm………and I’m not oncall..

I’m just thinking clinical assessment and it’s correlation with the physical finding are crucial for making the right diagnosis.

p.s

The diagnosis of the CT scan is perforated appendicitis. Haha……my intial diagnosis is correct!!!!!