Phlegmonous appendicitis with reactive ileal wall thickening

Case contributed by Dr Yair Glick

Presentation

Right lower quadrant pain, elevated inflammatory markers.

Patient Data

Age: 65 years
Gender: Male

Intravenous contrast material not administered due to renal failure.

NGT in stomach.
Abdominal aorta of normal diameter, shows mural calcifications.
The appendix is thickened up to 11.5 mm in diameter and does not fill up with contrast material except for its origin. Minute amount of dense fluid contiguous with the appendix. Marked surrounding fat stranding and non-enlarged reactive lymph nodes. 7 cm-long segment of terminal ileum with thickened wall and narrowed lumen in close proximity to appendix.

Case Discussion

Radiographic picture most compatible with phlegmonous appendicitis with reactive ileal wall thickening; however, primary pathology of the terminal ileum (e.g. IBD) with reactive appendicitis should also be considered.

The patient was taken to surgery, where the former was confirmed.

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Case information

rID: 62880
Published: 3rd Sep 2018
Last edited: 25th Jun 2019
Inclusion in quiz mode: Included

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