Presentation
Fever and abdominal pain with peritoneal signs in the right iliac fossa. History of rectal cancer surgery four months ago, currently under surveillance for liver metastases.
Patient Data
The appendix, located in the right iliac fossa, is enlarged (diameter ~15 mm), with intraluminal fluid, gas, and multiple faecaliths. There is periappendiceal fat stranding, adjacent peritoneal thickening, and suspected discontinuity of the appendiceal wall at its base, associated with extraluminal gas in the surrounding region.
A hypodense lesion (17 × 13 mm) in hepatic segment VII, with central calcification and poor contrast enhancement, is suspicious for metastasis.
A simple renal cyst (11 mm) is present in the right kidney.
Postoperative calcified material in the rectum. The anastomotic site remains patent, with no significant mural thickening, abnormal contrast enhancement, or surrounding fat infiltration.
Linear atelectasis in bilateral segment 10.
Surgical report:
upon exploration, a large amount of cloudy fluid was found in the right iliac fossa, Douglas pouch, and subhepatic region. The omentum was adhered and converging toward the right iliac fossa
the appendix, located in the right iliac fossa, measured 1 x 8 cm and showed signs of necrotising inflammation, with a perforation near its base, surrounded by extensive fibrinous exudate
the local peritoneum was congested and inflamed, with multiple firm and thickened areas, raising suspicion of possible metastatic lesions
an appendicectomy was performed, and peritoneal drainage was placed in the Douglas pouch and subhepatic region
Case Discussion
Imaging and surgical findings are consistent with acute appendicitis complicated by perforation and pneumoperitoneum.
Postoperatively, clinical symptoms improved significantly.
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