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Perforated retrocaecal appendix presenting as right lumbar abscess.

D M Fanning1, M Barry, G C O'Brien

  • 1Department of Surgery, Beaumont Hospital, Dublin 9, Ireland.

Irish Journal of Medical Science
|May 23, 2007
PubMed
Summary
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Acute appendicitis in elderly patients can present unusually, mimicking a lumbar abscess. Computed tomography (CT) is crucial for diagnosing this condition and identifying the source of sepsis.

Area of Science:

  • Gastroenterology
  • Radiology
  • Geriatrics

Background:

  • Acute appendicitis is a frequent condition in elderly individuals.
  • Presentation in older adults often differs from younger populations, complicated by comorbidities and delayed diagnosis.

Observation:

  • This case report details an atypical presentation of acute appendicitis in an elderly male.
  • The patient, a 66-year-old male, presented with a right lumbar abscess and cellulitis, later diagnosed with asymptomatic retrocaecal perforated appendicitis.
  • The presentation was complicated by a new diagnosis of type 2 diabetes mellitus.

Findings:

  • The case highlights a unique anatomical pathway of disease extension in acute appendicitis.
  • Computed tomography (CT) proved advantageous in the preoperative evaluation and management of this unusual presentation.

Related Experiment Videos

  • CT imaging identified an intraperitoneal source of sepsis.

    • Implications:

    • Elderly or immunocompromised patients with abdominal wall or lumbar cutaneous abscesses may benefit from abdominal CT.
    • CT imaging can reveal underlying intraperitoneal sources of sepsis, aiding in timely and appropriate management.
    • This case underscores the importance of considering atypical presentations of common conditions in specific patient populations.