Key Clinical Message
Post appendicectomy abscess formation is uncommon in patients with
non-perforated appendicitis. Diagnosis via imaging is essential to
provide swift treatment and resolution of underlying infection, which we
demonstrate in our case.
An 8 year old female presented 7 days post open appendicectomy for acute
uncomplicated appendicitis. Initial procedure was unremarkable, with no
perforation seen macroscopically or microscopically. She appeared
acutely unwell and was pyrexial and vomiting with severe lower abdominal
pain. Examination of the abdomen revealed guarding and rigidity in the
right iliac fossa and suprapubic regions. C reactive protein was raised
at 282g/L, white cell count was 24X10^9/L. Computed tomography of the
abdomen revealed a 7x5cm multiseptated and multiloculated abscess in the
right iliac fossa with compression of the urinary bladder(Figure 1, Figure 2). The patient was transferred to a regional
paediatric facility for laparotomy and washout.
Post open appendicectomy intrabdominal abscess incidence has previously
been reported at around 2.5% in acute appendicitis, rising to 4.2% in
perforated appendicitis(1). Indeed overall incidence of post
appendicectomy abscess has been reported as higher in laparoscopic
appendicectomy rather than open with figures as high as 6.4% for simple
appendicitis and 24% for perforated appendicitis(1). These images
convey the importance of considering early imaging in paediatric
patients presenting post appendicectomy, as even in cases where
contamination was minimal, there is a chance of deep seated abscess
leading to intrabdominal sepsis and potential need for laparotomy.