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Tricky Diagnosis: Is It Really Appendicitis?

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So many of us have been there, in reality or in our nightmares: that 3 a.m. wake-up call from a child doubled over in pain. And it’s the subject of Dr. Perri Klass’ article in the New York Times this week, entitled, "That Middle-of-the-Night Bellyache: Appendicitis?" on the difficulty physicians continue to have in diagnosing appendicitis in children.

We went through it with our son Ben last year, although the pain started in the late afternoon. Our pediatrician’s office wouldn’t give us an appointment until late the next morning, even though I’d explicitly stated that Ben was writhing on the floor, sobbing in pain. (I know, I know, we’ve left the practice.) If the pain reliever I’d given him wasn’t working, the nurse directed, then I should take him to the ER.

I took Ben to the hospital, fearing appendicitis, but expected to be sent home -- following some finger wagging from a doctor for being overly dramatic. Long story short, it was a highly traumatic experience, involving catheterization for a urine sample (Ben wasn’t yet potty trained), several x-rays, concern over a possible bowel blockage that would have necessitated emergency surgery, transfer to a regional medical center with a full pediatric surgery team… and ultimately, a middle of the night discharge into a brewing blizzard, with a “We think it was probably just gas” shrug of the shoulders from the doctors.

In her article, Dr. Klass explains that diagnosing appendicitis in kids remains particularly tricky and controversial. It’s tricky because young children often don’t have the vocabulary to fully describe their pain and because appendicitis in children doesn’t always follow the textbook presentation, and controversial because new imaging techniques (including CT scans) can help to make a diagnosis and potentially help avoid unnecessary surgery, but also risk exposing children to radiation.

Moms, have you ever been through a middle-of-the-night medical emergency with your kid(s)? What happened? How did you handle it?

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