Appendicitis with microperforation: promontoric type

Case contributed by David Preston
Diagnosis almost certain

Presentation

Generalized abdominal pain, fevers and anorexia.

Patient Data

Age: 35 years
Gender: Female

Plain abdominal radiographs showed no specific diagnosis.

The appendix is dilated measuring up to 1.2 cm in diameter. There are extensive inflammatory changes surrounding the appendix with a visualized appendicolith. There is tiny locule of extraluminal gas seen adjacent to the inflamed appendix. Findings are in keeping with acute appendicitis with microperforation.

There is free fluid in the pelvis. There is no intra-abdominal or pelvic collection demonstrated. There are secondary inflammatory changes involving the loops of small bowel adjacent to the inflamed appendix.

Case Discussion

The appendix is directed medially along the sacral promontory and classified as promontoric type appendix.

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