b'SCIENTIFIC ASSEMBLY PACEP 2023 CPC HIGHLIGHTThe Resolution:CPC CASE STUDY The Case58-year-old male patient presented with 6 days of fever and abdominal pain and states I have typhoid fever RESULTSTHE TEST TO ORDER:PATIENTS COURSE:CT of Abdomen/Pelvis with contrastAcetaminophen level 10Received 1L fluids and antibioticsDIAGNOSIS:N-acetylcysteine initiatedPerforated appendicitis with abscessConsult to surgery and infectious diseaseAdmitted to surgery with plan for IR percutaneous drainage ACUTE APPENDICITIS FUN-FACTS: Most common abdominal surgical emergenciesworldwide Incidence 100 per 100,000 person years Most common age group 10-19 Male to female ratio 1:4 More cases of perforated appendicitis in menthan women PATIENT OUTCOME Completed course of N-acetylcysteine,transaminitis improvedPositive for perforated appendicitis. There is a IR drain placed with drainage of feculent material3.9 x 3.7 cm abscess at the point of appendicealAbdominal fluid cultures positive for perforation with several small appendicoliths.pseudomonas, candida and bacteroids There are a few small regional bubbles ofDischarged with drain in placepneumoperitoneum. No bowel obstruction. There Elective interval laparoscopic appendectomyis edema in the adjacent paracolic gutter.RELEVANCE TO EM:SECONDARY DIAGNOSIS:Common presentations are common despite chronic acetaminophen toxicity unusual travel history Initial features are often nonspecific or atypical PACEP News | Fall 2023 23'