Perforated Appendicitis

Abstract

Background: Globally, nearly 100 in 100,000 adults develop appendicitis every year. When the wall of the inflamed appendix gets compromised, this leads to perforation, abscess, and peritonitis, which if left unmanaged can cause sepsis and potentially death.The Case: This is a case of a 51-year old male that presented to the Surgical Triage Unit with right lower quadrant pain ongoing for four days, and some intermittent sharp pain. Ultrasound revealed an inflamed appendix in the right iliac fossa measuring 18mm in AP dimension with an irregular wall outline, loss of wall stratification, and a heterogeneous luminal content. Furthermore, a small amount of fluid was seen close to the compromised wall of the appendix near its fundal tip in keeping with complicated appendicitis with possible perforation. Computed tomography (CT) revealed a dilated and fluid-filled appendix measuring 17mm in AP dimension with a tiny appendicolith at the tip of the appendix. However, there was no evidence of free gas or periappendiceal abscess seen on CT to suggest perforation. The patient underwent laparoscopic appendectomy the following day and this revealed perforated appendicitis (PAp) with four quadrants peritonitis. Histopathology revealed a transmural acute inflammation with an overlying serosal reaction, ulcerated epithelium, and loss of the muscularis propria layer. Conclusion:This case report highlights the features of PAp seen on ultrasound imaging and also discusses the role of ultrasound, CT, and haematology in the diagnosis of PAp based on recent works of literature.