Sepsis, Sickle Cell, and The Surgical Abdomen: A Triple Threat in a Young Adult

Abstract

Anchoring bias poses a major obstacle in the timely diagnosis of surgical abdomen in patients with sickle cell disease (SCD). Clinicians must remain aware that not all pain experienced by patients with SCD is necessarily due to vaso-occlusive crisis (VOC). A high index of suspicion is needed, especially when pain becomes atypical, localized, or unresponsive to standard VOC management. This case illustrates the consequences of diagnostic delay in a 24-year-old Saudi male with known SCD who initially presented with what was presumed to be VOC. As his condition deteriorated into septic shock—with persistent fever, leukocytosis, and hypotension—broad-spectrum antibiotics were initiated, and an abdominal CT was finally performed. Imaging revealed acute appendicitis complicated by perforation and abscess formation. He underwent emergency exploratory laparotomy, which confirmed a perforated appendix with purulent peritonitis. Appendectomy, peritoneal lavage, and drain placement were performed, followed by targeted antibiotic therapy in the intensive care unit. The patient gradually improved and was later discharged in stable condition.