Presentation
Known case of sickle cell trait with severe colicky right lower abdominal pain for 4 days. No fever or change in bowel/urinary habits.
Patient Data
Enlarged retrocaecal appendix measuring 13 mm in diameter with its tip lying in the sub hepatic location. Marked fat stranding/inflammatory changes seen around the appendix. Minimal free fluid seen in the right iliac fossa and pelvis. Multiple sub centimetre reactive loco-regional mesenteric lymph nodes noted in the right lower abdomen. No radiopaque appendicolith, abscess formation or pneumoperitoneum is seen. Small follicular cyst measuring 17 x 18 mm seen in the right ovary. Enlarged liver measuring approximately 20 cm. Incidental finding of a small transient intussusception in the proximal jejunum, appreciable only on the portovenous phase of the scan.
Case Discussion
Leucocytosis {WBC=13.57 x 109 (normal range:4.00-11.00 x 109/L)} and elevated c-reactive protein {CRP=62.80 (normal:≤1.20 mg/L)} were the positive laboratory findings.
The patient underwent laparoscopic appendicectomy and histopathology showed acute suppurative appendicitis and peri appendicitis.