Presentation
Diffuse abdominal pain for two days more at the lower abdomen. suspected appendicitis.
Patient Data
A mildly enlarged appendix measures about 7mm in diameter, and shows intraluminal fluid density contents, thickened enhanced wall, and congested edematous peri appendiceal fat.
Signs of generalized peritonitis more at the lower abdominal and pelvic regions with markedly edematous fat, peritoneal thickening, and minimal free fluid. No pneumoperitoneum.
Focal anterior rectal wall perforation with fecal-like contents seen at the rectovesical pouch.
Case Discussion
The patient hid the incident of inserting a foreign body in the anus.
The CT picture was evident for peritonitis which is more than expected in a simple case of acute appendicitis. The possibility of rectal wall perforation was questionable, especially in the absence of any relative clinical history.
The patient was subjected to laparoscopic exploration which revealed severe peritonitis, inflamed appendix probably secondary, and free fecal contents in the para-rectal regions. Open laparotomy was done immediately and confirmed the anterior wall rectal perforation. Hartmann's procedure with colostomy was done.
It is an example of the degree of difficulties facing physicians and radiologists if the patient hid his clinical history, especially the traumatic one.
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