Briner Beware: A case of Campylobacter colitis presenting as pseudoappendicitis

Daithi Heffernan, Brown University; Eric Zhou, VA Medical Center Providence/Brown University; Daniel Goldberg, VA Medical Center Providence/Brown University

Appendicitis is one of the most common pathologies encountered by general surgeons. Cassical presentations involve right lower quadrant abdominal pain in a young patient. However, there remains a spectrum of non-surgical conditions that may mimic appendicits. 

Not all Right Lower Quadrant Abdominal Pain is Appendiictis.

Case and chart review; literature review.

A 37-year old man presented with a 3-day history of vague abdominal pain which progressed to a focal, severe, right lower quadrant abdominal pain, associated with subjective fevers, chills and nausea. He also noted a brief period of diarrhea. He had been in his usual state of health with no recent travel and no sick contacts. Notably, he had been the only household member preparing turkey for a Thanksgiving meal. Past medical history was significant for sleep apnea and GERD and he had no past surgical history.

Physical examination revealed a flushed diaphoretic man, a non-distended abdomen with focal right lower quadrant tenderness. Rovsing’s was negative.  He was tachycardic (HR 133) and febrile (38.6 C) Laboratory studies revealed a leukocytosis of 14,200g/dl. All other laboratory tests were normal. 

 In light of the episodes of diarrhea with the RLQ pain, a decision was made to undertake CT scan imaging rather than immediate operative intervention. This demonstrated cecal and ascending colon wall thickening with prominent pericecal lymph nodes (Figure 1) suggestive of ascending colitis with mesenteric adenitis. A normal-appearing appendix was visualized and no free fluid or air was demonstrated. He was managed with IV antibiotics. Stools studies were subsequently returned as positive for Campylobacter antigen. By hospital day 5 he had full resolution, full return of diet and was discharged. Follow up was unremarkable

Campylobacter is one of the most common causes of bacterial foodborne illnesses. Infection may occur from poor poultry handing(eg turkey), since poultry is the main reservoir of the pathogen. Campylobacter colitis may present as a pseudoappendicitis. We issue a cautionary note in the management of patients presenting with right lower quadrant abdominal pain associated with diarrheal episodes.