You are the Intern / Foundation Doctor / Junior doctory person on duty in the Accident & Emergency Department. Its the middle of the night. You are tired. The vending machine has run out of red bull and you forgot to bring ‘lunch’.
A 7 year old boy presents at 01:00 with right sided lower abdominal pain.
Mum tells you that he complained of some mild RLQ pain yesterday but he otherwise has been himself. He played football after school.
He went to bed at his usual time, but then awoke at 23:00 with worsening pain. He has intermittently been sleeping since.
He has not vomited or had any diarrhoea. He was eating and drinking as normal throughout the day.
He hasn’t had any urinary symptoms.
His observations are unremarkable. He doesn’t have a fever. His BP is normal.
His abdomen is soft and mostly non-tender, however there is a tenderness in the right inguinal region. There is a small (about 2cm) smooth, firm, round mass in the inguinal region which is moderately tender.
Have a go at the best differential below. Answer on page three. Votes of other users shown below after voting.