Appendicitis - perforated with collection

Case contributed by Jeremy Jones
Diagnosis certain

Presentation

Right sided abdominal pain. Initially nauseated, now vomiting. Guarding in the right iliac fossa.

Patient Data

Age: 14 years
Gender: Male

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 later

ultrasound

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.

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