Presentation
High fever, pain in the right hypochondriac region, elevated inflammatory markers in the blood.
Patient Data
On the CT scan of the abdomen, before and after contrast administration, the appendix in the right iliac fossa is seen originating and lying behind the cecum, with its tip positioned high near the right liver (subhepatic in location). The base and body of the appendix are enlarged, measuring 17 mm in diameter; the structure of the tip is no longer clear. A fluid collection is noted under the right liver, measuring 44x54x86 mm, containing small gas bubbles, with surrounding fat infiltration and thickened peritoneum. The wall is thick and shows peripheral enhancement after contrast administration. The lesion extends into the parenchyma of the right liver segment VI and compresses the right kidney parenchyma.
There is diffuse thickening of the colonic wall at the hepatic flexure, submucosal edema, and surrounding fat infiltration.
A small amount of free fluid is present in the pouch of Douglas.
Case Discussion
The findings on the CT scan are consistent with an abscess in the tip of the appendix accompanied by a complication of an abscess in the adjacent right liver segment VI and colitis involving the hepatic flexure.
The patient had blood tests showing elevated values of WBC, %NE, and PCT.
The patient then underwent laparoscopic drainage of the abscess and received antibiotic treatment, resulting in a significant improvement in clinical symptoms.
After nearly one month of treatment, a follow-up abdominal ultrasound showed no abnormalities, and the abscess had completely resolved
In this case the liver abscess is most likely due to direct extension rather than portal pyaemia.
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