Complicated Periappendiceal Abscess Diagnosed on Colonoscopy

Abstract

Purpose: Appendicitis with its complications like periappendiceal abscess is diagnosed with 93% to 98% accuracy using CT. In several reported cases, appendicitis with atypical symptoms and/or nondiagnostic imaging was diagnosed during colonoscopy. We present a case of complicated periappendiceal abscess diagnosed on colonoscopy. Case Report: A 37 yr old female presented to our clinic being referred for an abnormal CT scan showing mass extending into the cecum. She had intermittent right lower quadrant pain for past 2–3 months, increasing in intensity with menstruation. She had no change in bowel movements, no urinary symptoms, no nausea or vomiting. CT abdomen showed right pelvic cystic mass attached to the uterus, adnexa, cecum and sigmoid colon with no visualization of appendix (Fig. 1). Colonoscopy showed edematous cecum with clear pus extruding from the appendiceal orifice confirming appendicitis (Fig. 2). Laparotomy showed large mass in the pelvis covered with omentum and small bowel. Pus was expressing from necrotic base of the appendix and from the right ovarian cyst. Appendectomy and hysterectomy with bilateral salphingo-oophorectomy were performed. Pathology confirmed appendicitis with abscess formation along with the ovarian abscesses on both sides. The culture from the pus was positive for Bacteroides fragilis indicating bowel as the source of infection. Our patient had appendicitis with abscess that disseminated causing infection of the ovarian cysts. The infection was walled off by omentum causing atypical symptoms, thus misleading physicians till colonoscopy. Conclusion: This unusual case illustrates a key role played by colonoscopy in diagnosing a complicated periappendiceal abscess presenting with atypical symptoms and non diagnostic radiologic workup.[figure1][figure2]FigureFigure