LAUSR

Right iliac fossa pain represents 50% of all cases of acute abdominal pain and is the most common presentation to the acute surgical take [1]. While the most common cause is appendicitis, accurate preoperative diagnosis remains challenging in some groups of patients. Despite widespread use of abdominal CT scan [2], the Alvarado score and algorithms employing various combinations of laboratory markers (C-reactive protein, white cell count, procalcitonin) [3], in real life the surgical team still encounters scenarios where the cause of the symptoms remains inconclusive and this translates intra-operatively into negative appendicectomies or, infrequently, unexpected findings. In this video (Video S1 in the online Supporting Information) we present the case of a young man with a history, clinical examination and laboratory results supportive of acute appendicitis. We proceeded to a laparoscopic approach identifying an infarcted omentum, which was resected. The patient was discharged on the day of surgery. Our case demonstrates the benefit of a laparoscopic approach, which allows a better exposure and inspection of the entire abdominal cavity, permits a correct alternative diagnosis, has minimal wound comorbidity and facilitates faster discharge. Every surgeon providing emergency surgical care in the 21st century should master at least the technical skills of diagnostic laparoscopy, as lack of laparoscopic skills in the management of right iliac fossa pain could lead to suboptimal surgical care in some patients.