Non toccarmi con la mano

The paper reports the case of a 4-year-old boy presenting with atypical abdominal pain, initially without fever or vomiting. While traditional manoeuvres like the jumping sign were negative, the patient’s active defence during palpation of the right iliac fossa raised suspicion of acute appendicitis. Subsequent clinical worsening and laboratory findings led to laparoscopic surgery, confirming phlegmonous appendicitis. This case highlights that in paediatric patients behavioural cues and active physical defence during examination may be more critical diagnostic indicators than standard clinical signs.