A 15-years-old boy presented to our emergency services with right sided abdominal pain for 3 days and fever for one day. On examination, he had fever and high pulse rate. His abdomen was tender (on pressing his abdomen, he winced with pain) at right lower abdomen and guarding (on pressing his abdomen, he experienced pain and voluntarily contracted his muscles to reduce the pain). His white blood cell count was 17,000 (normal is upto 10,000) with increase in the neutrophils to 92% (neutrophils increase suggests an acute inflammatory response). Ultrasound abdomen revealed probe tenderness in right abdomen. A diagnosis of acute appendicitis was made. The need for surgery was explained in view of the examination findings, increased white cell count and free fluid in the abdomen. The options of open surgery and laparoscopic surgery were offered to the patient along with his parents, explaining the advantages of laparoscopic surgery. Considering the advantages of faster recovery in view of his approaching examinations, parents preferred the laparoscopic surgery. A laparoscopic surgery was performed under general anesthesia.   

Laparoscopy revealed 100ml pus in right abdomen, pelvis (lower abdomen). Omentum (fat over the intestines) was seen to be covering the appendix. Pus flakes were noted over the appendix. A hole was noted in the appendix base. Appendix was removed after tying and dividing the base. Surgery consisting of pus drainage, appendicectomy was successfully completed laparoscopically. Patient tolerated the procedure well and recovered uneventfully. He was discharged on post-operative day 5.