Migratory right iliac fossa pain. Febrile with localised peritonism.
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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.
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.