Perforated appendix presenting with severe diarrhea. Findings on barium-enema examination.

Severe diarrhea and marked lower abdominal cramps are unusual manifestations of appendicitis. The authors performed a barium-enema examination (BE) on 9 pediatric patients who were ultimately shown to have a perforated appendix and pelvic abscesses. In 8 cases, the atypical symptoms initially led to an incorrect clinical diagnosis. In all 9, the BE demonstrated extensive inflammatory changes of the rectosigmoid colon, caused by the surrounding pelvic infection. Recognizing this clinical and radiographic association could lead to earlier diagnosis and treatment.