Adama M., 18

Adama is an 18-year-old girl and the second child in her family. She comes from a humble background and has endured significant hardship from a young age. Sadly, her mother passed away last year, leaving the family emotionally devastated and creating additional challenges for their survival. Her father, Muhammad, is a local farmer and the family's primary source of support. However, his farming activities generate only about ₦14,000 per month, an income that is barely enough to provide food and other basic necessities. Following her mother's death, Adama moved in with her aunt, who has been caring for her and providing emotional support despite the family's financial difficulties. Adama presented to the hospital with a long history of recurrent pain in the lower right side of her abdomen, which had become increasingly severe over the past few days. She also complained of nausea, loss of appetite, low-grade fever, and occasional vomiting. She reported experiencing similar episodes of abdominal pain several times over the previous months, but the symptoms would temporarily improve with pain medications before returning. On examination, Adama had marked tenderness in the lower right part of her abdomen, with findings suggestive of inflammation of the appendix. Laboratory investigations and an abdominal ultrasound confirmed the diagnosis of acute-on-chronic appendicitis, meaning she had long-standing inflammation of the appendix with a recent severe flare-up. Because of the severity of her condition, Adama was admitted and prepared for an emergency appendectomy to remove the inflamed appendix and prevent serious complications.

Adama was admitted to the surgical ward and immediately prepared for treatment. She was kept nil per os (NPO), started on intravenous fluids to maintain hydration, and given broad-spectrum intravenous antibiotics to control the infection. Adequate pain relief was provided, and after preoperative assessment, she underwent a successful emergency appendectomy (surgical removal of the inflamed appendix). Following surgery, Adama was closely monitored for her vital signs, wound healing, and any signs of postoperative complications. She continued to receive antibiotics, analgesics, and intravenous fluids until she was able to tolerate oral feeding. Her recovery was uneventful, with gradual resolution of abdominal pain and improvement in her overall condition. She was encouraged to ambulate early, maintain good nutrition, and attend scheduled follow-up visits. Medications administered included: Ceftriaxone 1 g IV once daily. Metronidazole 500 mg IV every 8 hours, followed by oral therapy. Paracetamol 1 g every 6–8 hours as needed for pain and fever. Diclofenac 75 mg IM or oral NSAIDs for postoperative pain relief (if not contraindicated). Intravenous Normal Saline or Ringer's Lactate for hydration. Omeprazole 40 mg IV or orally once daily to reduce gastric irritation during treatment. Adama responded well to treatment. Her pain subsided, the surgical wound healed satisfactorily, and there were no signs of infection or other complications. She was discharged in stable condition with oral medications, instructions on wound care, personal hygiene, adequate nutrition, and follow-up appointments. With adherence to the prescribed treatment and follow-up care, she is expected to make a full recovery and resume her normal daily activities within a few weeks.

Doctor's Opinion Adama is an 18-year-old girl diagnosed with acute-on-chronic appendicitis, a condition in which a previously inflamed appendix develops an acute infection, resulting in severe abdominal pain and increasing inflammation. Based on her clinical presentation, physical examination, and laboratory findings, urgent surgical intervention was indicated to prevent progression to appendiceal rupture, generalized peritonitis, intra-abdominal abscess, sepsis, and other life-threatening complications. Prognosis The prognosis is excellent if the condition is recognized early and treated promptly with surgery. With proper wound care, adherence to medications, adequate nutrition, and follow-up visits, Adama is expected to make a full recovery and return to her normal daily activities within a few weeks. However, delayed treatment can result in rupture of the appendix, severe abdominal infection (peritonitis), and sepsis.