Presentation
Right sided abdominal pain. Initially nauseated, now vomiting. Guarding in the right iliac fossa.
Patient Data
Distended and dilated appendix consistent with acute appendicitis. Fat-wrapping around the appendix. Small adjacent fluid collection.
Concern for perforation and peri-appendiceal abscess.
Initially treated with IV antibiotics, but continued spiking temperatures. Repeat ultrasound requested.
24 hours after original presentation, there has been some deterioration in appearances with a walled off collection adjacent to the appendix and a second larger collection at the tip of the liver.
Case Discussion
US-guided drainage of the perihepatic collection was performed without complication and was successfully drained. IV antibiotics were continued and elective appendectomy will be performed in 3 months time.