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There is an acoustic shadow at the junction of the appendix with caecum. It is an appendicolith measuring about 13 mm. The rest of the appendix is distended with echoes. There is a breach in the gut signature sign of the appendix with adjacent intraperitoneal collection (about 12 cc). There is significant periappendiceal fat inflammation. The caecum as well as terminal ileum show thickened wall.