Presentation
Right lower quadrant pain.
Patient Data
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The appendix is markedly enlarged, with thick enhancing wall and surrounding stranding.
The patient went on to have a appendectomy.
Histology
MACROSCOPIC DESCRIPTION
An appendix measuring 95 mm in length x 32 mm in diameter at the fundus. There is attached fat surrounding the appendix. The surface of the appendix and adjacent fat is covered in cream colored exudate. Section of the tip of the appendix reveals a communication between the lumen of the appendix within surronding fat. However no discrete lesion identified. No fecolith within the lumen
MICROSCOPIC DESCRIPTION
The appendix lumen contains pus. There is an intense transmural acute inflammatory cell infiltrate, with a thick fibrinopurulent exudate on the free serosal surface. There is also focal rupture into the mesoappendix with abscess formation. No malignancy is identified
DIAGNOSIS
Appendix - acute suppurative appendicitis with abscess formation confirmed.
Case Discussion
This patient had a strikingly enlarged and thickened appendix, so much so that it looks similar to adjacent small bowel.