Perforation of a retrocaecal appendix presenting clinically as a right lumbar abscess

Perforated retrocecal appendicitis presenting with lung abscess—A case report

Retrocecal appendicitis usually presents with atypical signs and symptoms which may lead to delayed diagnosis, perforation and serious complications. Development of a large lung abscess secondary to perforation of retrocecal appendicitis in an adolescent patient is an extremely rare entity and to the best of our knowledge has not been described in literature. We present a 15-year-old boy with complaint of chest pain, cough, fever, vague abdominal pain and raised inflammatory markers who underwent CT examination. On CT, a collection with focal calcification was noted in the right iliac fossa that extended along the right retroperitoneum through the retrocrural space in the right lung base communicating with a cavitary pulmonary lesion with air-fluid level. A diagnosis of perforated retrocecal appendicitis with retroperitoneal and right lung abscesses was made. The patient underwent appendectomy and the entire retroperitoneal and lung abscesses were drained. A lung abscess as a complication of perforated retrocecal appendicitis should be in consideration in septic patients with thoracoabdominal infectious manifestations.

Complicated acute appendicitis presenting as a rapidly progressive soft tissue infection of the abdominal wall: a case report

Background

We report a case of a rare complication of acute appendicitis with perforation through the abdominal wall. The case points out that an intraabdominal origin should be considered in patients presenting with rapidly spreading soft tissue infections of the trunk.

Case presentation

A 58-year-old European woman presented to our hospital with a 1-week history of severe abdominal pain accompanied by rapidly spreading erythema and emphysema of the lower abdomen. On admission, the patient was in septic shock with leukocytosis and elevation of C-reactive protein. Among other diagnoses, necrotizing fasciitis was suspected. Computed tomography showed a large soft tissue infection with air-fluid levels spreading through the lower abdominal wall. During the operation, we found a perforated appendicitis breaking through the fascia and causing a rapidly progressive soft tissue infection of the abdominal wall. Appendicitis was the origin of the soft tissue infection. The abdominal wall was only secondarily involved.

Conclusions

Even though perforated appendicitis as an etiology of a rapidly progressive soft tissue infection of the abdominal wall is very rare, it should be considered in the differential diagnosis of abdominal wall cellulitis. The distinction between rapidly spreading subcutaneous infection with abscess formation and early onset of necrotizing fasciitis is often difficult and can be confirmed only by surgical intervention.

An Uncommon Course Of Acute Appendicitis With Sepsis--A Case Report

Authors report a case of 54-years-old patient, who presented to the hospital due to three-day history of weakness, abdominal pain and diarrhea. His general shape was severe, abdomen was tender at palpation in hypogastrium, peritoneal signs were positive, and blood tests showed highly elevated markers of inflammation, including procalcitonin, what suggested the sepsis. Despite unclear clinical picture, the presence sepsis was an argument to give the patient surgery. Intraoperatively, perforated appendix was found, being in mass with the omentum and small bowel. An appendectomy was performed. Postoperative course was complicated by the wound infection, but recovery progressed quickly and patient was dismissed at 5 days after operation. In the discussion the authors referred to the similar cases reported in the literature, concluding that acute appendicitis can be a life threatening event for - to date - healthy adult person. Although a tendency to treat conservatively an uncomplicated acute appendicitis and to delay operations is supported by scientific evidence, the cases may occur in which only prompt surgical intervention protects the patient from serious complications.