Perforated pelvic appendicitis

Case contributed by Ammar Haouimi


Right lower abdominal pain with fever, tenderness, and leukocytosis.

Patient Data

Age: 60 years
Gender: Female

The MRI sequences demonstrate:

  • a pelvic appendix, dilated (10 mm) with thick enhanced wall and focal defect at the appendiceal tip (see annotated images)
  • pelvic free intraperitoneal fluid with small floating internal hypointense structures on T2 sequences, representing certainly the extraluminal appendicoliths (see annotated images)
  • regular thickening with enhanced peritoneal reflections (pelvic peritonitis)
  • note artifact within the cecum
Annotated image

Annotated images:

  • red arrows: inflamed appendix
  • yellow arrow: perforated appendiceal tip
  • blue arrow: extraluminal appendicoliths

Case Discussion

MRI features of perforated pelvic appendicitis with secondary pelvic peritonitis.

Perforation of the appendix is more common with advanced age (as in this case), due to an increased frequency of late and atypical presentation of appendicitis, Perforated appendicitis within the pelvis is seen in around 30% of cases.

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