Unusual cause of appendicitis: Orthodontic wire

Appendicitis is one of the most common childhood diseases requiring surgery and the appendectomy is the most common surgical procedure performed in children. Typical findings on physical exam and imaging points the child toward a surgical consult and, ultimately, removal of the in flamed appendix. Our aim is to present an interesting case and, to our knowledge, never before described cause of appendicitis in the pediatric population. We introduce the case of an 11-year-old female who presented with 3 days of abdominal pain, unremarkable laboratory findings, and a computer tomography (CT) showing a radiopaque object in the terminal ileum adjacent to the appendix. She underwent diagnostic laparoscopy with findings of a metallic wire that perforated the ileal wall and irritated the appendix. The wire was removed without need for intestinal repair and a standard appendectomy was performed. The patient recovered uneventfully. While standard presentation and treatment of appendicitis is at the forefront, occasionally imaging or intraoperative findings can present a surprise. This case of clinical symptoms of appendicitis but discordant imaging, led the patient to the operating room for the intended surgery. A foreign body was the irritator of the appendix, a differential to consider.