Appendicular abscess

Case contributed by Fakhry Mahmoud Ebouda
Diagnosis certain


Severe persistent lower abdominal pain and fever.

Patient Data

Age: 16 years
Gender: Male

Large suprapubic and right iliac fossa complex heterogenous mass lesion. Appearances as if formed by amalgamated bowel loops with an intervening fluid. Proximal small bowel dilatation is seen with peristaltic movements.

Unremarable other abdominal organs.


A calcified lesion is seen within a mass-like appearance in the pelvis likely an appendicolith. An associated air/fluid level can be depicted.

After post-contrast series, it shows multiloculated and marginated enhancement in the right iliac fossa and in the suprapubic regions. Following administration of transrectal contrast in delayed phase, the adjacent large bowel loops can be assessed.

Case Discussion

After the patient was assessed in the ER, he underwent a US examination that revealed a right iliac fossa and suprapubic mass-like appearance of amalgamated bowel loops. Intervening bowel loops are seen. The impression of an inflammatory lesion was suggested. After doing the plain CT an appendicolith is identified yet we could not see the appendix.

After IV contrast administration: The full blown appearance of multiloculated and marginated mass is identified with air/fluid level. The related mesentery and peritoneum show enhancement and stranding giving the possibility of perforated appendicitis with pelvic collection and abscess formation that was proven after immediate surgical intervention.

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