Presentation
Fever and abdominal pain in right lower quadrant. Evaluate for appendicitis.
Patient Data
There is a complex thick-walled retrovesical fluid collection with a large central air-fluid level. Within the fluid collection, there is a 1.3 cm calcification/appendicolith. There are adjacent inflammatory changes and trace fluid predominantly to the right of the rectum. There is bowel wall thickening and/or incomplete distention of the rectosigmoid colon with the sigmoid colon being deviated to the left, secondary to a large complex inflammatory retrovesical fluid collection.
Case Discussion
This is a case of a perforated appendix with subsequent formation of an abscess. Within the abscess, there is a relatively large calcification which suggests an appendicolith (the likely etiology of the initial appendicitis).
The patient underwent a laparoscopic appendectomy, which was notable for a perforated appendix. The pelvic abscess was drained and the appendicolith was removed. The patient's post-operative course was uncomplicated.
Co-author:
Morgan Zhao, MD
Travis Bevington, MD
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