[Appendicitis necessitatis: appendicitis perforating the abdominal wall]

Complicated acute appendicitis presenting as an abscess in the abdominal wall in an elderly patient: A case report

INTRODUCTION

Appendicitis is a common cause of acute abdomen; however, the classic clinical signs are not often present, and it has unusual presentations. Thus, its diagnosis can be challenging.

PRESENTATION OF CASE

We describe the case of an elderly man who presented with right abdominal wall abscess with spontaneous drainage in the emergency department. Since we suspected a subjacent abdominal pathology, we performed surgery, and intraoperatively, we observed that the Appendix tip had invaded the abdominal wall.

DISCUSSION

This patient had a challenging diagnostic process and surgical visualization of the appendicular tip invading the abdominal wall was an important characteristic in proving the cause of the abdominal wall abscess.

CONCLUSION

The onset of an abdominal wall abscess without a known cause needs to be thoroughly investigated, with consideration of a subjacent abdominal cause and appendicitis necessitatis.

Atypical presentation of appendicitis

A woman aged 64 years presented as an emergency with a mass in the right iliac fossa, clinically within the abdominal wall, but an otherwise soft abdomen. Systemically, she was quite well with normal vital signs. Blood tests revealed raised inflammatory markers, and an abdominal CT scan demonstrated a perforated appendix with associated large subcutaneous abscess. This represents a rare presentation of a common condition, demonstrating how appendicitis can still be a challenging problem for the clinician. The patient underwent incision and drainage of the abscess, resulting in the formation of an enterocutaneous fistula (ECF). This was managed with enteral nutritional support, wound dressings and antibiotics. Following normal CT imaging, an ileocaecal resection was planned in the expectation that the ECF would persist. The operation was postponed due to intercurrent illness, during which time her symptoms and the ECF fully resolved.

Appendicitis and uterine abscess: presentation of an unusual fistula between the gynaecological and gastrointestinal tracts

The authors present the case of a 65-year-old woman with clinical and radiological evidence of pelvic sepsis and a medical history of endometrial ablation 20 years previously. She underwent laparotomy after failing to settle with a course of intravenous antibiotics and her appendix was found to have perforated into the uterus with abscess formation which had not discharged vaginally presumably due to widespread intrauterine synechia following her endometrial ablation. She underwent appendectomy and hysterectomy and made a full recovery with no complications. Macroscopic and microscopic examination suggested the appearances are those of an abscess of the uterine fundus with part of the appendix incorporating into the abscess mass.