Complicated Appendicitis with Perforations

Clinical History

A 19-year old male presented with a 4-day history of abdominal pain radiating to the right iliac fossa, some fever, diarrhoea, and vomiting. Blood tests revealed elevated inflammatory markers.

Case Description

Ultrasound revealed a 98 x 43 x 58 mm heterogeneous hypoechoic area in the right iliac fossa posterolateral to the caecum and anterior to the psoas muscle fibres. Also, there was mesenteric fat stranding around it. These were all at the site of the patient’s maximum tenderness. The normal appendix tissue was not seen leading the sonographer to raise the suspicion of appendiceal perforation.

Diagnosis/ Discussion/ Treatment/ Follow up

The patient had an emergency appendectomy and the surgical specimen analysed histologically confirmed the diagnosis of perforated appendicitis.

Sonograms