Acute contact appendicitis due to a migrated pericardial drain: a case report

Area of Science:

• Gastroenterology
• Surgical Pathology
• Diagnostic Imaging

Background:

• Foreign-body appendicitis is uncommon, with few documented cases of extraintestinal foreign bodies causing contact appendicitis.
• This case presents a diagnostic challenge due to a foreign body originating from a distant surgical intervention.

Observation:

• A 47-year-old woman with systemic lupus erythematosus presented with acute right iliac fossa pain, fever, and a palpable mass.
• Computed tomography revealed a radio-opaque foreign body in the right iliac fossa, mimicking acute appendicitis.
• Exploratory laparotomy identified a retained pericardial drain within an abscess.

Findings:

• The foreign body was a pericardial drain, leading to Salmonella-infected abscess formation and acute appendicitis.
• Microbiologic analysis of the abscess confirmed Salmonella infection.
• The patient recovered fully after surgical removal of the drain and abscess drainage.

Implications:

• This case underscores the diagnostic dilemma posed by foreign bodies causing acute appendicitis, especially without a clear history of surgery or injury.
• Computed tomography findings can be misleading, necessitating exploratory laparotomy in complex cases.
• The possibility of foreign bodies causing acute abdominal conditions must be considered even when the initial intervention was remote from the abdominal cavity.