• Collins Ekere, Alice Lillie, Chaitanya Mehta, and Andrew Clarke.
• Department of General Surgery, Poole Hospital NHS Trust, United Kingdom. Electronic address: collinsekere@doctors.org.uk.
• Int J Surg Case Rep. 2013 Jan 1; 4 (12): 1091-2.

IntroductionDespite reported poor sensitivity and specificity, plain abdominal radiographs have a role in the investigation of suspected appendicitis.Presentation Of CaseWe report a case of a previously healthy 47 year old man, who presented with sudden onset abdominal pain associated with a raised temperature. He gave a short history of pain around the umbilicus, which radiated to his right iliac fossa over a period of hours. On examination his abdomen was soft with rebound tenderness in the right iliac fossa. Investigations revealed white cell count 11.2×109/L, CRP 4mg/L and normal haemoglobin, renal and liver function tests. An inflamed appendix was visible with thickened walls on a plain abdominal radiograph and was confirmed during laparoscopic appendectomy and subsequent histology. He made good recovery and was discharged.DiscussionProminent appendiceal wall and air in the appendix has been described in the literature as a CT finding that can distinguish appendicitis from other differential diagnoses and here we present a case of diagnosis of appendicitis on a plain abdominal radiograph showing this sign which to the best of our knowledge is rarely seen on abdominal films.ConclusionCareful assessment of plain abdominal films in suspected appendicitis is encouraged not just for exclusion of other causes of pain but also in the possible detection of an inflamed appendix.Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

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