A 4½-year-old boy has experienced several hours of right-sided abdominal pain without emesis, change in bowel habits, loss of appetite, or dysuria. On examination, his rectal temperature is 37.9°C (100.3°F), and his other vital signs also are normal. He walks hunched over but is in no respiratory distress. His abdomen appears full, and he has right lower quadrant tenderness, without guarding or rigidity. His white blood cell(WBC) count is 9.9 × 109/L (9.9 ×103/mcL) with a normal differential count. Urine dipstick results are negative. After 2 hours of observation,he appears more comfortable, the abdominal splinting has resolved,and he is sent home.

The child remains comfortable until the next evening, when he experiences increasing pain and anorexia. On examination, he is afebrile, moves easily, and the tenderness has shifted more cephalad. His WBC count is 9.5 × 109/L (9.5 ×103/mcL) with 60% segmented...

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