Perihepatic abscesses due to dropped appendicolith following laparoscopic appendectomy

Case contributed by Dr Amina Aljasmi

Presentation

Fever and right side abdominal pain, and right shoulder pain since 2 weeks, had laparoscopic appendectomy 25 days back.

Patient Data

Age: 30 years
Gender: Male

Multiloculated marginally enhancing collection at the right subphrenic space; abutting the liver capsule. It is measuring about 5.3 x 3.7 x 3.5 cm and shows a calcific structure within (8 mm).

Associated with underlying right basal lung atelectasis.

A small localized pocket of collection at appendectomy bed. 

Mild hepatomegaly. 

Case Discussion

An appendicolith can be found in 30% of patients with appendicitis. Retained, or dropped, appendicolith is a rare complication that can occur as a consequence of stone expulsion from the appendix before or during an appendectomy.

Recognition of dropped appendicoliths is important, as these may act as a nidus for infection and result in the subsequent development of abscesses at the site of the dropped appendicolith at a later stage. 

Patients with retained appendicolith presenting with recurrent intra-abdominal sepsis and a history of appendectomy.

The typical imaging description of symptomatic dropped appendicolith is an abscess containing one or more high-attenuation foci, most commonly in the pelvis or the Morison pouch

The management of symptomatic dropped appendicolith is open or laparoscopic surgery with abscess drainage and extraction of the calculus. 

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