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Perforated appendicitis causing thigh emphysema: a case report.

T Ushiyama1, R Nakajima, T Maeda

  • 1Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta, Otsu, Japan. usiyama@xj8.so-net.ne.jp

Journal of Orthopaedic Surgery (Hong Kong)
|May 6, 2005
PubMed
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A rare case of thigh emphysema occurred in an 83-year-old man due to perforated appendicitis. This unusual presentation mimicked a psoas abscess but was successfully treated with surgery and recovery.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Surgical Pathology

Background:

  • Appendicitis, a common surgical emergency, typically presents with abdominal pain.
  • Retroperitoneal perforation of the appendix is a rare complication, often presenting with atypical symptoms.
  • Thigh emphysema is an uncommon manifestation of intra-abdominal pathology.

Observation:

  • An 83-year-old male presented with symptoms initially misdiagnosed as a psoas abscess.
  • Pelvic MRI revealed appendicitis, and barium enema demonstrated contrast leakage into the thigh.
  • A retroperitoneal perforation of a retrocaecal appendix without generalized peritonitis was diagnosed.

Findings:

  • The patient underwent appendectomy and drainage of infected spaces, including the thigh.

Related Experiment Videos

  • The appendiceal abscess extended into the hip joint, causing osteomyelitis.
  • Surgical intervention included resection arthroplasty for the hip joint involvement.

    • Implications:

    • This case highlights the importance of considering unusual presentations of appendicitis, even in the absence of typical abdominal signs.
    • Retroperitoneal perforation can lead to extensive soft tissue infection and emphysema, requiring aggressive surgical management.
    • Prompt diagnosis and multidisciplinary treatment are crucial for favorable outcomes in complex appendiceal abscess cases.