Presentation
Severe abdominal pain, vomiting, fever and nausea for 2 days.
Patient Data
Small bowel loops dilatation. No pneumoperitoneum. No large bowel loops dilatation.
Erect chest radiograph: no air under diaphragm.
A blind-ending tubular structure seen at the right iliac fossa, measuring 1.6cm in diameter. It represents dilated appendix. Focal discontinuity of the enhancing mucosa at the base of appendix. It is associated with significant amount of periappendiceal fat streakiness.
Pneumoperitoneum at the right sided abdomen.
Focal bowel wall thickening noted at the adjacent cecum, near to the base of appendix.
The terminal ileal wall is not thickened. The small bowel loops are diffusely dilated including jejunum and ileum. No intramural gas or portal venous gas.
Minimal ascites at both paracolic gutters, interloop region and pelvis.
Case Discussion
CT findings are in keeping with acute appendicitis complicated with perforation.
Intraoperative findings:
-Grossly purulent contamination at right paracolic gutter, pelvis, perihepatic and inter bowel loops
- Perforated appendicitis (perforation at the tip and base, base: unhealthy; edematous with 1cm perforation)
-Limited right hemicolectomy with double barrel stoma created at RIF
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