PoCUS Enhanced Physical Examination in the Diagnosis of a Silent Appendicitis

Resumo

Acute abdomen is an abdominal pain of abrupt onset, comprising a vast group of diagnoses. Appendicitis, included within this group of diseases, is the most common surgical abdominal emergency worldwide and can lead to high mortality and morbidity. Although this diagnosis is clinical, there are some cases where it is difficult to distinguish from the different abdominal conditions.

The use of ultrasound (US) in the emergency department (ED) has become widespread. However, given the time constraint and patients' critical conditions, there is a need for a focused and specific approach according to patients' symptoms. Therefore, point-of-care augmented clinical exam (PACE) has assumed an increasingly important role, namely in the acute abdomen, because it allows early recognition and diagnosis and consequently prompt initiation of interventions.

We describe the case of a patient with an acute abdomen in which PACE, performed by an experienced professional, helped to diagnose appendicitis despite all other complementary exams being normal.