Abdominal pain and fever for one week.
CT abdomen with contrast
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The neck of the appendix is seen obstructed by 10 x 6 x 16 mm appencolith with consequent ill definition of the tip which is seen continuous with irregular walled off fluid collection measuring 6.5 x 7 x 7.4cm containing multiple air foci and air fluid level. This is associated with multiple mildly enlarged locoregional mesenteric lymph nodes and stranding of the surrounding fat planes. Reactive thickness of small bowel loops. Another mesenteric abscess loculus is noted measuring 7 x 8.5 cm.
Non complicated diverticular disease at the sigmoid and descending colon.
Small 4 mm gravel seen in the lower calyx of the right kidney. Few bilateral cortical cysts , the largest on the right measuring 3 cm .
These findings described at the level of the right iliac fossa are compatible with complicated acute appendicitis with appendicular abscess. Appendicular abscess is the most common complication of acute appendicitis following rupture of the inflamed and distended appendix. An appendicolith is thought to be a predisposing factor for perforation. Perforation of the appendix is more common among the elderly population due to an increased frequency of late and atypical presentation of appendicitis, delay in diagnosis, delayed decision for surgery and to the age-specific physiological changes.
An appendicular abscess can be managed by either surgical drainage or by image guided percutaneous drainage. The appendix is subsequently removed at interval appendicectomy.