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Portomesenteric air from acute necrotizing appendicitis
© Springer-Verlag London Ltd 2009
Received: 2 January 2009
Accepted: 18 January 2009
Published: 24 February 2009
A 75-year-old man presented to the emergency department (ED) with a history of 2 days of abdominal distention. He complained of mild nausea with vomiting but no abdominal pain or reported fevers. His temperature was 94.8°F (34.9°C), pulse was 106, and blood pressure was 99/59. He was awake and alert and did not appear toxic. His abdomen was firm and distended without significant tenderness. Initial laboratory tests, including white blood cell count, were essentially normal.
Morbidity and mortality in elderly patients with appendicitis ranges as high as 70% versus approximately 1% in the general population . It is a difficult diagnosis to make since more than one half of elderly patients do not present with fever or leukocytosis. In addition, approximately one third do not localize pain to the right lower quadrant and one quarter do not have appreciable right lower quadrant tenderness. Portomesenteric gas is rare, but is often associated with fatal outcome .
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