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Complicated appendicitis — RCPSC EM MCQ

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ModerateGI/Abdominal emergenciesComplicated appendicitisRCPSC EM

A 44-year-old man has right lower quadrant pain for 18 hours, anorexia and fever. Examination shows focal peritonism. WBC is 15 x 10^9/L and CT shows an enlarged appendix with periappendiceal fat stranding and a 2 cm abscess. What is the most likely diagnosis?

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Correct answer: C — Complicated appendicitis with local abscess

CT evidence of appendiceal inflammation with periappendiceal abscess is complicated appendicitis. Management requires antibiotics and surgical consultation, with drainage or operation depending on abscess size and local practice.

Reference: Canadian Association of General Surgeons appendicitis principles; Rosen's Emergency Medicine