61 years old female patient arrived to the ER complaining of acute onset of right iliac fossa pain. WBC = 14.7 with predominant neutropenia.
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There is a blind ended tubular like structure in front of and communicating the cecum and measuring about 1 cm in diameter "appendicitis" and associated with wall contrast uptake, peri-appendicular fat stranding, mesenteric congestion and small perpendicular transudation fluids. There is adjacent cecal mucosal thickening and mesenteric lymph nodes also noted.
Post-operative pathology specimen confirmed acute appendicitis and excluded malignancy.
Perforation of acute appendicitis is more frequent in elderly and carries a higher risk of morbidity and mortality for those patients, CAT scan is more specific and sensitive than ultrasound specially if the patient is stable.