Urgent any doctors/ radiographers about?

[appendix]

Have to make a decision quickly. DD (18) ended up in A&E last night- significant right side pain, temperature, vomiting. Blood pressure plunged and they admitted her. Assumption was appendicitis.

She had a scan 2 hours ago. They've ruled out anything gynaecological but also said that from what they could see the appendix it wasn't looking inflamed. She has no other markers (not sure what these are, they are based on blood tests etc) that scream "appendix"
They need more clarity. Options are;

1. MRI (but apparently this will probably be closed on Friday afternoon as it's out of hours)

2. CT scan. This sounded the best option until the register started talking about radiation exposure and impact on fertility. She's panicking

3. exploratory surgery- go in with a camera, if it's appendicitis they carry on operating... if not she's had surgery and will need stitches/ recovery

Her A levels start in 3 weeks. She's panicking and wants to avoid anything with a recovery time like surgery.

We said MRI if they can or CT if they can't. However I was wondering- given the radiation exposure would doctors/ radiologists took it themselves if there was another option (surgery + camera?)

CT abdo/pelvis plus contrast. Radiation doses can be kept very low now, if she was having a CT scan every week then you'd worry, but a one off i wouldn't worry. It's your best chance of getting an answer quickly.

Not sure what an MR would achieve? Are they looking for gynae, bowel? You wouldn't normally do an MR for appendicitis. It wouldn't usually be the modality of choice in these situations. MR have to be quite specific and focused.

I presume she's had her ultrasound?

I had an abdominal CT for pain and nobody mentioned any effect on fertility. Since then I've gotten pregnant twice.

Radiographer, if it was my daughter I'd want her to have the CT. Get the answer quickly

CT. Will give info with low risks

Your DD is blowing it out of proportion but she is young, stressed and ill. It is a good thing that the staff are providing all info, they are being diligent, but the fertility thing is practically negligible for a one-off CT scan. She's focussing on the wrong thing. As a PP has said, CT is the better modality here and DD is not getting pregnant any time soon but does have exams in three weeks so surgery isn't ideal. Also, I'd rather have a short scan than days and days and days of recovery from surgery + associated pain, nausea and grogginess.

Thank you. She had an ultrasound which ruled out ovarian cysts and foot much else.

Thank you. She's in there now!

That was exactly our thought process. Thank you

Hope the scan give the answer and her pain gets sorted quickly.

I really hope she is okay.

Hope she's ok, OP.

Hopefully she avoids surgery, but if it's her appendix, DD had her out when she was eight. It was badly inflamed and she was up in the surgery room for over two hours. Despite that, she was back at school within two weeks and ready to go back - only stipulation was that she should avoid exercise (other than walking) and crowds/playground where she could get knocked. By the way, DD was sick and it was a grass green colour, which is very typical with an infected appendix.

I was admitted recently and had at least a dozen CT scans in 3 different hospitals and fertility wasn’t mentioned once. I find this really surprising.

Hope she's doing ok 🤞

Endometriosis could present like this. Maybe. Apart from the blood pressure. How are her periods? Any other episodes of pain?

Thanks for all the kind messages. She had the CT scan and has googled extensively and calmed down. I think we were both just running in no sleep and fever!

It ruled out everything they thought it could be (burst ovarian cyst, appendicitis, mesenteric something or other etc) It did surprise everyone by showing a massively inflamed kidney. This was a surprise as pain was front right (not her back), no cystitis previously, usual urine output, nothing showing in her urine apart from a slightly higher white count... just this big angry kidney. She's quite the novelty.
They can't get her temp down and her BP is all over the place so she's being kept in a second night but after the 3rd bag of IV antibiotics she was announcing it was a bearable pain now (which has weirdly spread up to her boobs on one side).
She's in good hands - medical staff all lovely despite the place being rammed with some frankly rude people. She's missing the viva for one of her A levels on Monday and the lovely overworked registrar volunteered to write a letter for the exam board "tonight when I get off work". So kind.

Always light, easy periods. She recently had a copper IUD fitted and this threw them for a while but apparently everything looks good down there so nothing gynaecological.

Any history of polycystic kidney disease in your family Op? Hope she recovers quickly.

Grass green vomit is true bilious vomiting. It’s indicative of an obstruction beyond the ampulla of vater where the common bile duct empties.

Potentially relevant for more than just appendix. Never to be ignored.

I'm wondering if it's because she was moved straight away to the surgical ward because they were so convinced it was appendicitis.

The surgical registrar describing her choices was very pro the surgery option and I wonder if it's because that's just what he does. Some of it was because DD is just 18 and he described it as "moving the starting blocks for total lifetime radiation exposure forward a few years". I said I'd had a CT scan a few years ago and no one mentioned this and he politely told me it was because I was already old so the cumulative impact was much less. Due to my enormous age you see...
Then the chief doc person came along and briskly told her it was the equivalent to a flight to New York and she calmed down!!!!

Surgical registrar needs to do a bit of revision I think. Very odd things to say particularly in an emergency context.

I have the same anxiety @OP . I had 2 emergency pelvic/abdominal CTs with isolation 4 days apart due to appendicitis which is now being treated with very aggressive antibiotics. I didn't know what a CT scan was and now I'm scared that I may have hurt myself or future children (I am 33). This was very recent and I relate to DD! I hope she has a swift recovery!