Tip appendicitis

Case contributed by Dr Fakhry Mahmoud Ebouda

Presentation

Suprapubic tenderness and right iliac fossa pain, afebrile. Elevated WBC.

Patient Data

Age: 20 years
Gender: Female
CT

Normal CT appearance of the vermiform appendix except towards the tip. The distal end of the appendix appears abnormally swollen and edematous measuring 12 mm in caliber. It has no air loculi or contrast inside but is surrounded by perilumnal fat stranding. A minimal amount of paravesical and pelvic fluid is seen.

There is an incidental small left ovarian cyst, 3.1 cm in diameter.

Case Discussion

Although rare, acute tip (or distal) appendicitis is more frequently diagnosed following the widespread adoption of CT imaging. Tip appendicitis does not carry the same degree of morbidity but is, nevertheless, an important diagnosis to make in order to avoid complications.

Surgical correlation in this case demonstrated distal appendicitis.

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