Perinephric abscess caused by ruptured retrocecal appendix: MDCT demonstration

Area of Science:

• Gastroenterology
• Surgical Pathology
• Diagnostic Imaging

Background:

• Acute appendicitis, though common, can present with rare and severe complications.
• Diagnosis can be challenging, especially in atypical presentations involving deep anatomical spaces.

Observation:

• A 60-year-old male presented with 15 days of right lumbar pain and fever.
• Initial ultrasonography revealed a right perinephric gas and fluid collection.
• Multidetector-row CT (MDCT) demonstrated a gas-containing retroperitoneal abscess near the kidney and liver.

Findings:

• MDCT identified an inflamed retrocecal appendix as the source of the abscess.
• Laparotomy confirmed a ruptured appendix and allowed for drainage of a large volume of pus.
• The abscess extended from the right kidney's lower pole to the liver's bare area.

Implications:

• This case highlights the importance of considering appendicitis in complex retroperitoneal infections.
• Advanced imaging like MDCT is vital for diagnosing obscure abdominal pathologies.
• Early surgical exploration and drainage are critical for managing ruptured appendicitis with abscess formation.