Perforated acute appendicitis with abscess formation
Two weeks history of periumbilical and pelvic pain with fever. The ultrasound exam was inconclusive.
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Enlarged fluid-filled appendix with thickened enhancing wall, containing an appendicolith. It has a pelvic location with an ascending course of the distal segment, the tip is visible anterior to the IVC bifurcation. Periappendiceal and mesenteric inflammatory changes with adjacent reactive enlarged lymph nodes are noted.
Multiple abscess formations are seen in the pelvic region, extending to the left anterior pelvic wall with signs of pelvic peritonitis. Free peritoneal gas locules are also seen.
Ultrasound remains the initial investigation of choice for any suspicion of acute appendicitis in young patients in many centers. CT is highly sensitive and specific for the diagnosis.