Acute appendicitis is usually at the upper end of a 1-10 pain scale, but this patient potentially needed a scale of 2-20, given his two inflamed appendices.

The British man in his late 70s presented to ED after seven days of right-sided abdominal pain, malaise, reduced appetite and urinary retention.

His medical history included hypertension, autoimmune conditions, BPH and hypercholesterolaemia.

He exhibited tenderness in the right iliac fossa and had an Alvarado score of nine, indicating a high likelihood of acute appendicitis, his doctors wrote in BMJ Case Reports.