Dilated appendix

Case contributed by Dr John Li

Presentation

Migratory right iliac fossa pain. Febrile with localised peritonism.

Patient Data

Age: 40 years
Gender: Male
CT

The appendix is distended and thickened, up to 19 mm in maximal axial dimension, with adjacent fat stranding and a 18 mm fecolith at its proximal lumen.  No evidence of perforation or paraappendiceal collection.

Case Discussion

This patient proceeded to a laparoscopic appendectomy. The tip of the appendix was gangrenous but not perforated. The fecolith seen on CT was seen operatively and carefully removed to avoid contamination/spillage which could result in abscess formation.

The histology showed acute appendicitis with early necrosis and no evidence of malignancy.

Special note: Two tubular strictures arise from the cecum: the appendix and the terminal ileum. Size of the stricture should not be used to distinguish the two as seen in this case with an appendix dilated up to 19 mm. However the appendix is the only one that is blind-ended.

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Case information

rID: 59332
Published: 11th Apr 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Gold Coast University Hospital

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