Presentation
Severe right iliac pain, fever, abdominal rigidity, and vomiting.
Patient Data
Right iliac fossa amalgamated thickened wall bowel loops involving the terminal ileum and cecum, seen forming mass-like lesions with blurred surrounding fat planes. Marginally enhanced locule/abscess is seen intervening these bowel lobes contain fluid-like contents. The appendix shows thickened enhanced wall that is likely interrupted at its fundus. Surrounding multiple lymph nodes are seen at the right iliac fossa.
These changes are seen extending to the pelvis with associated mild thickening of the bladder walls more prominent at the right lateral wall and blurred perivesical fat planes
Right renal pelvis large stone with associated dilatation of the renal collecting system and wall thickening of the renal pelvis and proximal ureter with blurred surrounding fat planes.
Right iliac fossa sizable localized collection showing air-fluid levels associated with nearby amalgamated thickened wall bowel loops involving the terminal ileum and cecum, seen forming mass-like lesion with blurred surrounding fat planes. other adjacent minute locules are also noted as well as small gases foci suggesting a perforated appendix that appears thickened with enhanced wall and interrupted at its fundus. Surrounding multiple lymph nodes are seen at the right iliac fossa
Slightly blurred fat planes with misty mesentery.
Relatively distended small bowel loops with edematous walls showing air-fluid levels
Right renal pelvis stone with back pressure changes as well as urinary inflammatory reactions are once again noted.
Case Discussion
Untreated acute complicated appendicitis presented by a small abscess and mass-like formation not improved by medical treatment presented 5 days later with large appendicular abscess.
The appendicular abscess is the most common complication of acute appendicitis following perforation of the inflamed appendix.
An appendicular abscess can be managed by either surgical drainage or better by image-guided percutaneous drainage as in this case with ultrasound-guided pig-tail drainage.