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In clean appendectomies, a routine investigation of subjacent tissues is strongly urged as the part of wisdom. The following is a case in point:
R. M., a youth, aged 16, whose previous health had been good, was taken suddenly ill early in the morning of Aug. 7, 1925. He evinced severe pain in the abdomen, centering at the umbilicus, together with constant nausea. He attributed his symptoms to having eaten largely of watermelon the evening before. I saw him for the first time at 10:30. His expression was anxious; the abdomen was normal in contour but with some rigidity of both rectus muscles. He complained of pain in the umbilical region, and of tenderness on deep pressure at McBurney's point. He experienced almost equal tenderness slightly above the umbilicus. The temperature was 99.8; pulse, 94; respiration, 22. The heart was normal. The urine had some albumin and a few hyaline
Davis RT. PECULIAR COMPLICATION OF APPENDICITIS. JAMA. 1926;86(22):1689. doi:10.1001/jama.1926.26720480003008c
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