Appendicitis with perforation

Case contributed by Andrew Dixon
Diagnosis almost certain

Presentation

3 day history of increasing abdominal pain and constipation for 2 days. Past medical history of Crohn disease.

Patient Data

Age: 45 years
Gender: Male

Mildly thick-walled retrocecal appendix measuring 11 mm in transverse diameter. Adjacent to the appendiceal tip, there is a small low-density collection with a single intraluminal gas locule, consistent with local perforation. Additional small locules of free gas adjacent to the appendix and elsewhere within the right side of the abdomen. Mild peri-appendiceal inflammatory stranding. Prominent mesenteric nodes measuring up to 12 mm in transverse diameter.  Mild circumferential wall thickening of the terminal ileum in keeping with Crohn's disease without definite active inflammation.

Case Discussion

Perforated appendicitis with small volume periappendiceal fluid collection and trace pneumoperitoneum. 

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