Tip appendicitis

Case contributed by RMH Core Conditions

Presentation

Abdominal pain.

Patient Data

Age: 36
Gender: Female
CT

Dilated (11 mm) 11 cm long thick walled appendix, with extensive surrounding inflammatory fat stranding, a focal mucosal defect, and small adjacent low density fluid collection. Very mild adjacent distal ileal wall thickening. Mildly dilated (7 cm max calibre) caecum and proximal ascending colon with heterogenous internal density, likely a combination of fluid and oral contrast. Moderate volume dependent free intraperitoneal fluid. No pneumoperitoneum.

Multiple bilateral ovarian cysts. Mild splenomegaly (14.5 cm craniocaudal length). Ureteric and bladder contrast due to double phase contrast administration related to IV line malfunction. IDC in situ. Minor dependent bibasal subsegmental atelectasis.

Conclusion

Acute appendicitis with (tiny) focal perforation and a small amount of free peritoneal fluid. Surrounding secondary inflammatory changes in adjacent structures.

Case Discussion

Key learning points:

  • appendicitis does not have to grossly involve the entire appendix, most often it will affect the tip and this is referred to as "tip appendicitis"
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Case information

rID: 30306
Case created: 1st Aug 2014
Last edited: 11th May 2017
Inclusion in quiz mode: Included

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