Case report on a misleading case of appendiceal perforation presented with severe generalized convulsion

Abstract

Appendicitis and convulsions are two common pathologies among children. Though appendicitis has some certain symptoms, they might present with atypical symptoms in young ages. Here we present a misleading case of a perforated appendix that presented with severe generalized convulsion, no significant abdominal symptoms and had a recent history of mild gastrointestinal problems. The primary symptoms and the related examination findings guided the differential diagnosis as viral encephalitis, febrile convulsion, and Epilepsy. The initial treatment was started accordingly with an aim to prevent further convulsion. But this case was later diagnosed as a case of peritonitis following perforated appendix and was operated successfully. After surgery, the patient recovered with no further attack of convulsion even following the postoperative withdrawal of sedative therapy. He was discharged on the 7^th postoperative day and there were no major complaints on his follow-ups. Such misleading cases usually lead to misdiagnosis and might cause morbidity, even endanger the life of the patient. Therefore regarding children of sudden generalized convulsion with even minute abdominal findings or recent gastrointestinal history, it is necessary to pay attention and evaluate the abdomen by a CT or MRI besides the nervous system at the first impression.

Keywords: Appendicitis; case report; convulsion; perforated appendix.

Figure 1

CT image showing dilated loops of the intestine (A,B,C). Hugely inflamed, gangrenous and perforated appendix following removal (D); Histopathology of the appendix (E,F).

Figure 2

Progression of the case according to time line.