Chronic abscess due to "dropped" appendicoliths following appendectomy for perforated appendix

Case contributed by Chris O'Donnell
Diagnosis certain


Multiple episodes of RUQ pain and sepsis (requiring several percutaneous drainages) over more than 5 years. Previous perforated appendix many years ago as a teenager.

Patient Data

Age: 30
Gender: Female

Irregular hypoechoic "mass" in the hepato-renal pouch consistent with fluid containing an echogenic focus (arrow) indicative of a "lithe"

Non-contrast CT shows 3 small radio-opaque stones in the irregular fluid collection contained within the hepato-renal pouch,  Wall of this collection enhances indicative of a chronic inflammatory process.

Case Discussion

Dropped appendicoliths at the time of surgery (usually at laparoscopic removal) can act as a nidus for recurrent infection and will often require on-going drainage and sometimes surgical removal.  Occasionally percutaneous image-guided removal with a nitinol basket can be successful.  In this case the stones could have been dropped at appendicetomy or possibly spontaneously extruded from the appendiceal perforation.  The key to diagnosis is the finding of echogenic or radio-opaque lithes in the fluid collection.

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