Aberrant Diagnostic Imaging Resulting in Misdiagnosed Acute Perforated Appendicitis: A Case Report.

A 31-year-old male with a history of diverticulitis presented for acute abdominal pain and was found to have several small areas of free air on computed tomography (CT) of the abdomen/pelvis. Due to inflammatory changes seen around the sigmoid colon and small bowel, he was diagnosed with perforated diverticulitis. The patient complained of significant right-sided abdominal pain with significant tenderness on abdominal examination. The patient was initially treated with diagnostic laparoscopy and was actually found to have acute perforated appendicitis with mild appendiceal adherence to the sigmoid colon. This case highlights the importance of careful history and physical examination in an era where imaging often precedes the surgeon's evaluation. The case also provides support for laparoscopy in select cases of pneumoperitoneum, sparing patients the morbidity of undergoing an open laparotomy.