Appendicitis (with thickening of the terminal ileum)
Right iliac fossa pain.
CT Abdomen and pelvis
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The appendix is swollen measuring up to 9.5 cm in diameter with a proximal hyperdense appendicolith. There are adjacent fluid and fat stranding extending into the pelvis. In addition, there is the appearance of a peripherally enhancing collection anterior to the appendix which is continuous with the distal appendix. No free gas. There is marked mural thickening of the distal ileum over approximately 10 cm. Several prominent mesenteric lymph nodes. No aortocaval lymphadenopathy. The kidneys, adrenals, spleen, pancreas and liver are normal in appearance.
The appearances, in this case, are those of a calcified appendicolith and acute appendicitis, but the presence of marked mural thickening of the ileum, although probably reactive in nature, bring other differentials such as inflammatory bowel disease. Acute appendicitis has been confirmed at laparotomy with histological confirmation.