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 . While CT scan may also diagnose other causes of abdominal pain (Table 1), it may prolong ED length-of-stay  and may not be available in low-resource settings. Since Puylaert et al. first described the graded compression technique for diagnosing appendicitis in 1986 , radiologist-performed ultrasound for SA, but not PoCUS, has been reported in the literature  as having the same as acute appendicitis. Published literature shows that PoCUS by emergency physicians has high specificity (97%)  and positive predictive value (91%)  to rule-in appendicitis [8, 11,12,13]. PoCUS can decrease ED length-of-stay compared to radiologist-performed ultrasound and CT scan, avoids radiation , 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 . 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  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 . 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.