Acute appendicitis with appendicoliths

Case contributed by Dr Henry Knipe

Presentation

Abdominal pain with constipation ?bowel obstruction.

Patient Data

Age: 25 years
Gender: Male

Non-specific bowel gas pattern with no convincing evidence of obstruction. RIF calcifications, probably fecoliths/appendicoliths.  No free gas. Lung bases are clear.

The appendix is dilated with hyperenhancing walls with surrounding fat stranding. Two appendicoliths are seen at the base and ostia of the appendix. Small volume free fluid. No free gas. 

The patient proceeded to appendectomy. 

Histopathology

MACROSCOPIC DESCRIPTION: "Appendix": An appendix 75 mm in length, up to 15 mm in width with minimal mesoappendix attached. The serosa is covered by a pale brown thick exudate. On cut section a hard, yellow, 20 x 14 x 10 mm fecolith is present. No perforation or solid tumors are seen.

MICROSCOPIC DESCRIPTION: Sections of appendix show transmural acute neutrophilic inflammation including serositis. There is hemorrhagic necrosis of mucosa. No perforation is seen. There is no evidence of dysplasia or malignancy.

DIAGNOSIS: Acute suppurative appendicitis, fecalith.

Case Discussion

In a patient with abdominal pain the presence of RIF calcifications should increase the suspicion for appendicolith causing appendicitis. However, it should be noted that appendicoliths can also be a incidental finding. 

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