From the Umbilicus to McBurney’s Point: A Clinically Classic Presentation of Acute Appendicitis with Clinical-Ultrasonographic-Operative Concordance-A Case Report

Abstract

Background: Acute appendicitis is a common surgical emergency in which early recognition and timely intervention are essential to prevent complications such as perforation and peritonitis. Diagnosis is primarily clinical but may be supported by laboratory investigations and imaging where available.

Case presentation: A 21-year-old male student, previously well, presented with a one-day history of sudden-onset abdominal pain that initially began in the periumbilical region before migrating approximately eight hours later to the right iliac fossa, where it became sharp, constant, and severe. The pain was associated with anorexia, nausea, two episodes of non-projectile vomiting, and fever, and was aggravated by walking and coughing. On examination, he was ill-looking, febrile, mildly dehydrated, and had marked right iliac fossa tenderness with localized guarding. Rovsing’s and psoas signs were positive. Laboratory investigations revealed leukocytosis of 15,000/mm³ with neutrophilia of 82% and an elevated C-reactive protein of 60 mg/L. Abdominal ultrasonography demonstrated a non-compressible, blind-ending tubular structure measuring greater than 6 mm in diameter, with a thickened wall and peri appendiceal fluid, findings highly suggestive of acute appendicitis. His Alvarado score was 9/10. Following initial resuscitation and antimicrobial therapy, he underwent emergency open appendicectomy through a McBurney incision.

Intraoperatively, the appendix was inflamed, hyperemic, and edematous, with minimal serous fluid and no evidence of perforation. He had an uncomplicated postoperative recovery and was discharged on postoperative day three with wound-care advice, analgesia, and follow-up instructions.

Conclusion: This case demonstrates the value of integrating characteristic clinical features with laboratory and ultrasonographic findings in the diagnosis of acute appendicitis. Early recognition and timely surgical intervention resulted in an uncomplicated outcome, highlighting the importance of prompt assessment and definitive management in patients presenting with a classic clinical picture.