Acute gangrenous appendicitis with perforation

Case contributed by Assoc Prof Craig Hacking


Sudden onset of epigastric pain radiating to pelvis. Tachycardiac with fever. Generalized abdominal tenderness and peritonism. Query perforated viscus.

Patient Data

Age: 30 years
Gender: Female

Markedly enlarged and inflamed appendix measuring 15 mm in diameter with the dense appendicolith in its mid-portion. Moderate amount of surrounding free fluid, however there is further free fluid throughout the abdomen and within the pelvis. No focal collection evident or free gas. Irregular cecal wall thickening without stenosis. The small bowel history is generally edematous and stranding. Mild diffuse small bowel wall thickening and mild dilatation with fluid-filled lumen including the terminal ileum.The solid organs are normal. No cholelithiasis. No lymphadenopathy. Lung bases are clear. Bones are unremarkable. Specifically no evidence of sacroileitis.


  • Acute appendicitis with a moderate amount of free fluid which is more than expected for simple appendicitis, suggesting complicated appendicitis such as perforation.
  • Non-specific small bowel and cecal wall thickening with small bowel dilatation is likely secondary to the inflamed appendix however there is a further DDx of enteritis which includes inflammatory bowel disease (Crohn's disease) and infection (TB warrants exclusion).

Case Discussion

Appendectomy histology = Acute gangrenous appendicitis with perforation

The colonic thickening and small bowel appearance resolved post appendectomy.

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Case information

rID: 40152
Published: 13th Oct 2015
Last edited: 27th Feb 2021
Inclusion in quiz mode: Included

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