مريض ينتظر عملية الزائدة، كان يتألم بشدة في أسفل اليمين، ثم قال فجأة إن الألم خف كثيراً. بعد ساعة صار البطن كله مؤلماً وقاسياً. الحرارة ٣٩٫٠، النبض ١٢٤، الضغط ٩٨/٦٠. ما الذي حدث غالباً؟

A client awaiting appendicectomy had severe RLQ pain, then suddenly says the pain is much better. An hour later his whole abdomen is painful and rigid. T 39.0 °C, HR 124, BP 98/60. What has most likely happened?

1. Spontaneous resolution without need for surgery
2. The inflammation turning into a gallstone
3. Analgesic effect with full resolution of inflammation
4. Appendix rupture with peritonitis

Answer: D) Appendix rupture with peritonitis. Sudden pain relief followed by diffuse rigid abdomen, fever and tachycardia indicates rupture with peritonitis. Notify the surgeon immediately and prepare fluids and antibiotics.