Presentation
Last delivery two weeks ago now with severe lower abdominal tenderness to rule out endometritis.
Patient Data
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Unilaterally diffusely bulky and hypervascular right-sided fallopian tube with hypoechoic parenchymal reflectivity and a tortuous curvature that continues from the cornual to the terminal end is noted accompanied by perifocal echogenic omental fat stranding within the right adnexa. The right and the left ovary and the contralateral left oviduct as well as the puerperal, anteverted uterus are unremarkable. No significant lochia or features of retained non-viable products of conception.
The appendix (well applied at the cecal loop) is well visualized, demonstrates diffuse edematous change and resultant elongation towards the ipsilateral Mc Burney's point/right lateral lumbar region and is surrounded with echogenic reacted omental fats plus scattered peri-appendiceal hypoechoic mesenteric enlarged lymph nodes.
Minimal hypoechoic free fluid is visualized within the retro-uterus pouch and within the proximal hepato-renal space and these features advocate for coexisting postpartum appendicitis-salpingitis.
Case Discussion
Bulky unilateral right fallopian tube (measuring up to 3.2 cm in diameter) with hypervascularity and hypoechoic reflectivity coexisting with an ipsilateral edematous and elongated appendix (measuring up to 1.7 cm in diameter) with both structures wrapped around reactive echogenic omental fat consistent with appendicitis-salpingitis.
Clinical follow up revealed salpingitis secondary to appendicitis and the patient was managed conservatively with antibiotics instead of a surgical intervention owing to the fact that the patient was post-partum.