The classic clinical presentation of acute appendicitis consists of vague, poorly localized, periumbilical pain followed by anorexia, nausea, and possibly vomiting. Over a period of 4 to 48 h the pain will migrate to the right lower quadrant. 4 Low-grade fever is also a later finding in acute appendicitis. The clinician must be aware, however, that many diagnostic errors occur because the physician fails to consider the variability in the presentation associated with acute appendicitis.
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