Presentation
Lower abdominal and back pain.
Patient Data
Dilated, fluid filled appendix with periappendiceal inflammation. Several dense filling defects are consistent with fecaliths. A few small locules of gas are present within the lumen. The appearance mimics that of a small bowel loop.
Case Discussion
Acute appendicitis with multiple fecaliths. The degree of distention of the appendix with gas, fluid, and intraluminal material makes it somewhat difficult to distinguish from adjacent loops of small bowel in the right lower quadrant.
Careful inspection in three planes increases diagnostic confidence that this structure arises from the base of the cecum and is blind-ending, and therefore represents acute appendicitis rather than terminal ileitis, enteritis, or Meckel diverticulitis.
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