{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:48:00Z","timestamp":1782362880371,"version":"3.54.5"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute appendicitis is the most common surgical abdominal emergency in children. Its atypical presentations remain a significant source of diagnostic error. The presentation of an appendiceal abscess as an isolated abdominal wall mass, in the complete absence of abdominal pain, represents a misleading manifestation that directly contradicts the classic teaching that peritoneal signs are essential for diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A previously healthy 13-year-old boy presented with a 10-day history of a painful right lower abdominal wall swelling, explicitly denying any abdominal pain. Initially misdiagnosed with a soft tissue infection based on a focused abdominal wall ultrasound, he was referred after 10\u202fdays of unsuccessful treatment. A non-contrast computed tomography scan revealed a secondary abdominal wall abscess connected via an inflammatory tract to a large periappendiceal abscess. Management followed a staged strategy: intravenous antibiotics led to resolution, followed by an uncomplicated delayed laparoscopic appendectomy 3\u202fmonths later. The patient recovered fully.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>This case illustrates a critical diagnostic pitfall where the absence of expected abdominal pain and a prominent local finding led to initial misdiagnosis as soft-tissue infection. This case highlights the diagnostic challenge posed by this presentation and serves to remind clinicians of the importance of considering an intra-abdominal source and obtaining a comprehensive ultrasound evaluation in children with an unexplained abdominal wall mass, even in the absence of abdominal pain. A diagnostic consideration pathway is presented as a teaching schematic to illustrate a systematic approach to evaluation in such ambiguous scenarios. It is crucial to emphasize that this pathway is derived from a single case and is presented for educational purposes, not as a validated clinical tool.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1863642","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:21:53Z","timestamp":1782361313000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Appendiceal abscess mimicking a painless abdominal wall mass in an adolescent: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Guanghua","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of General Surgery, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongqiang","family":"Bian","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1001\/jama.298.4.438","article-title":"Does this child have appendicitis","volume":"298","author":"Bundy","year":"2007","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e2122248","DOI":"10.1001\/jamanetworkopen.2021.22248","article-title":"Clinical features and preventability of delayed diagnosis of pediatric appendicitis","volume":"4","author":"Michelson","year":"2021","journal-title":"JAMA Netw Open"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e946543","DOI":"10.12659\/AJCR.946543","article-title":"Uncommon presentation of perforated appendicitis: Abdominal Wall abscess and fistula formation","volume":"26","author":"Kauffman","year":"2025","journal-title":"Am J Case Rep"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"111390","DOI":"10.1016\/j.ijscr.2025.111390","article-title":"Complicated appendicitis presenting as anterior abdominal wall abscess in a diabetic patient: a case report","volume":"131","author":"Shrestha","year":"2025","journal-title":"Int J Surg Case Rep"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1186\/s13256-016-1122-1","article-title":"Complicated acute appendicitis presenting as a rapidly progressive soft tissue infection of the abdominal wall: a case report","volume":"10","author":"Beerle","year":"2016","journal-title":"J Med Case Rep"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s13017-020-00306-3","article-title":"Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines","volume":"15","author":"Di Saverio","year":"2020","journal-title":"World J Emerg Surg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1097\/00001888-200308000-00003","article-title":"The importance of cognitive errors in diagnosis and strategies to minimize them","volume":"78","author":"Croskerry","year":"2003","journal-title":"Acad Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1493","DOI":"10.1001\/archinte.165.13.1493","article-title":"Diagnostic error in internal medicine","volume":"165","author":"Graber","year":"2005","journal-title":"Arch Intern Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"S252","DOI":"10.1016\/j.jacr.2019.02.022","article-title":"ACR appropriateness criteria\u00ae suspected appendicitis-child","volume":"16","author":"Koberlein","year":"2019","journal-title":"J Am Coll Radiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"S81","DOI":"10.1093\/cid\/ciae346","article-title":"2024 clinical practice guideline update by the Infectious Diseases Society of America on complicated intra-abdominal infections: risk assessment, diagnostic imaging, and microbiological evaluation in adults, children, and pregnant people","volume":"79","author":"Bonomo","year":"2024","journal-title":"Clin Infect Dis"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1136\/bmjqs-2011-000149","article-title":"Cognitive interventions to reduce diagnostic error: a narrative review","volume":"21","author":"Graber","year":"2012","journal-title":"BMJ Qual Saf"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1111\/acem.13181","article-title":"Diagnostic accuracy of history, physical examination, laboratory tests, and point-of-care ultrasound for pediatric acute appendicitis in the emergency department: a systematic review and meta-analysis","volume":"24","author":"Benabbas","year":"2017","journal-title":"Acad Emerg Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"S445","DOI":"10.1016\/j.jacr.2022.09.011","article-title":"ACR appropriateness criteria\u00ae right lower quadrant pain: 2022 update","volume":"19","author":"Kambadakone","year":"2022","journal-title":"J Am Coll Radiol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.ijsu.2012.02.006","article-title":"Diagnosis of acute appendicitis","volume":"10","author":"Petroianu","year":"2012","journal-title":"Int J Surg"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1016\/j.surg.2015.01.008","article-title":"Initial antibiotic treatment for acute simple appendicitis in children is safe: short-term results from a multicenter, prospective cohort study","volume":"157","author":"Gorter","year":"2015","journal-title":"Surgery"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e37","DOI":"10.1016\/j.jacr.2024.03.016","article-title":"Optimizing advanced imaging of the pediatric patient in the emergency department: technical report","volume":"21","author":"Marin","year":"2024","journal-title":"J Am Coll Radiol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1863642\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:21:54Z","timestamp":1782361314000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1863642\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,25]]},"references-count":16,"alternative-id":["10.3389\/fmed.2026.1863642"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1863642","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,25]]},"article-number":"1863642"}}