Presentation
Right iliac fossa pain for two weeks.
Patient Data
intraluminal filling defects are seen in the left portal vein division and multiple intrahepatic portal venules more at the right hepatic lobe (pylephlebitis)
intraluminal filling defect is seen in the distal superior mesenteric vein and venous confluence (thrombophlebitis)
marked fat blurring and edema are seen at the right iliac fossa with internal small locule measures about 20 mm suggestive of necrosis with a small abscess formation
the appendix shows mildly increased diameter with associated thickened hyper-enhanced wall
Case Discussion
This patient gave a history of right iliac fossa pain, inadequately treated as acute gastroenteritis with oral medications however, the pain persists for two weeks. Lab assessment revealed leukocytosis. The CT study showed a picture of complicated acute appendicitis with a small abscess, superior mesenteric vein thrombophlebitis, and pylephlebitis.
The patient was admitted for conservative treatment and discharged in good condition with a planned elective appendectomy after complete recovery.