To our knowledge, this is the first report of SA diagnosed with ED PoCUS. Before the advent of CT scan, definitive preoperative diagnosis of SA was not possible [
10]. While CT scan may also diagnose other causes of abdominal pain (Table
1), it may prolong ED length-of-stay [
8] and may not be available in low-resource settings. Since Puylaert et al. first described the graded compression technique for diagnosing appendicitis in 1986 [
7], radiologist-performed ultrasound for SA, but not PoCUS, has been reported in the literature [
5] as having the same as acute appendicitis. Published literature shows that PoCUS by emergency physicians has high specificity (97%) [
11] and positive predictive value (91%) [
11] to rule-in appendicitis [
8,
11‐
13]. PoCUS can decrease ED length-of-stay compared to radiologist-performed ultrasound and CT scan, avoids radiation [
8], and may be performed serially in non-operative management. One literature review of 51 reported cases of SA indicated that radiologist-performed ultrasound may well have a high accuracy in establishing the diagnosis of SA as it does for acute appendicitis, but no studies on sensitivity and specificity for SA have been published [
14]. Nevertheless, the choice between ultrasound and CT in this clinical setting is largely dependent on institutional preference and available expertise [
5,
14,
15].
A treatment of choice for SA is completion appendectomy either by open or laparoscopic intervention [
6,
16]. There is one reported SA case that was successfully treated with non-operative treatment [
2] as was our case. However, Hendahewa et al. reported a case of SA which was managed operatively initially, but developed recurrent SA again 3 years later, and subsequently underwent laparoscopic appendectomy [
17]. Non-operative management for SA may be suitable for some patients, especially in those patients having multiple comorbidities or at risk for poor outcomes during surgery. Close follow-up in these patients is warranted, as concern for recurrent SA may approach recurrence rates in non-operatively managed appendicitis.