Acute appendicitis and incidental pelvic kidney

Case contributed by Dr Yair Glick

Presentation

Diffuse abdominal pain, wandered to right lower quadrant.

Patient Data

Age: 20 years
Gender: Male

A mildly thickened, mildly hyperemic appendix is coursing medially from the cecum. The periappendiceal fat is echogenic. There is slight bowel wall thickening, probably reactive, in the adjacent ileal loop.

Left kidney located in left iliac fossa, normal dimensions and echotexture.

Liver, spleen, pancreas, and right kidney are of normal dimensions and echotexture. Gallbladder preserved, common bile duct not dilated.

Case Discussion

Presented to the ER in the morning with right lower quadrant abdominal pain radiating to the groin that had started as diffuse abdominal pain the previous evening. Had vomited after having eaten a "bad" pizza, since then felt nauseous.
On physical examination: right lower abdominal tenderness with local peritoneal irritation.
Full blood count: 13K leukocytes with a mild left shift.

Ultrasonography showed signs of acute appendicitis and a left pelvic kidney was discovered.

Acute appendicitis was confirmed at surgery:
"Acute phlegmonous appendicitis, its tip covered in fibrin, adhering to the peritoneum."

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