Perforated hollow viscus with abscess

Case contributed by Frank Gaillard

Presentation

Acute abdominal pain.

Patient Data

Age: 50 years
Gender: Male

CT abdomen / pelvis

ct

A collection containing fluid and gas and measuring 8.1cm (trans) x 4.3cm (AP) x 7.9cm (SI) is demonstrated medial to the cecum. Fat stranding surrounds this collection. The appendix is not clearly identified. Locules of free gas are seen within the peritoneum.

The liver, gallbladder, spleen, pancreas, kidneys and adrenal glands appear normal. A small amount of free fluid surrounds the liver and spleen. Gastric lap band in situ. There is uncomplicated colonic diverticular disease.

Atelectasis is seen in the lung bases bilaterally.

Marked degenerative change of the lumbar spine and bony pelvis identified.

Conclusion:

Pneumoperitoneum. The collection adjacent to the cecum is most likely due to a perforated appendix. Diverticulitis, carcinoma and even a Meckle's diverticulum are less likely possibilities. 

Case Discussion

Unfortunately follow-up is unavailable and the surgical cause is not known. *sigh* 

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