Appendicular Gastralgia Revisited: A Case Series of Rare Presentations

In the myriad of clinical presentations of acute appendicitis, appendicular gastralgia remains a poorly researched entity. In this article, authors present a series of three cases of acute appendicitis that initially presented as appendicular gastralgia. A 35-year-old gentleman initially presented with complaints of epigastric pain of six hours’ duration with an Alvarado score of 3/10 and was managed medically. Re-examination after six hours of unresolved pain revealed Right Iliac Fossa (RIF) tenderness. Similarly, a 13-year-old boy presented with epigastric pain of 12 hours’ duration with a normal clinical examination and an Alvarado score of 5/10. The pain radiated to RIF after 12 hours with RIF tenderness. A 58-year-old lady presented with pain in the epigastrium of six hours’ duration and had a normal clinical examination, haematological and radiological parameters. She was initially managed medically. However, due to the non resolution of symptoms despite treatment, she underwent Contrast Enhanced Computed Tomography (CECT) Abdomen, which revealed a localised appendicular perforation with appendicoliths. All three patients underwent emergency laparoscopic appendectomy and had an uneventful postoperative recovery with no recurrence of epigastric pain. Low Alvarado scores, non specific clinical findings and equivocal imaging delay diagnosis in these cases. Through this article, attempt was made to enhance awareness of this entity amongst clinicians.