Perforated appendicitis with large abscess

Case contributed by Michael P Hartung

Presentation

Right lower quadrant pain for 5 days.

Patient Data

Age: 35 years
Gender: Male

Large enhancing collection in the right lower quadrant with air, fluid, and debris centered on the appendix, with an ill-defined tubular structure with pneumatosis within the collection. There is a small density in the collection that probably is the obstructing appendicolith. 

Right lower quadrant peritonitis with inflammation of the terminal ileum, cecum, and sigmoid colon. 

Case Discussion

Perforated appendicitis resulting in a large right lower quadrant and peritonitis. In this case, the perforation has walled off into a well-defined abscess cavity containing air, fluid, and likely a small appendicolith, with the "ghost" of the perforated appendix within the collection as a tubular structure with pneumatosis. The reactive inflammation of the surrounding structures (cecum, terminal ileum, sigmoid colon, and fat) help to characterize the localized peritonitis. This was treated with percutaneous drainage followed by delayed surgery. 

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