Right lower quadrant pain.
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Dilated, fluid-filled, appendix with irregular enhancement and focal discontinuity along the anterior margin. There area of discontinuity is associated with a small amount of unorganized extraluminal fluid which tracks into the pelvis, likely developing abscess. Reactive inflammation of the terminal ileum with mild upstream dilation of small bowel likely reflecting ileus.
Classic case of perforated appendicitis: dilated, fluid filled appendix with focal wall discontinuity, indicating the site of perforation. There is periappediceal fluid which tracks into the pelvis, consistent with developing abscess.
See this companion case.