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An Alarming Mimicry of Intra-Abdominal Infections: Acute Appendiceal Diverticulitis
Youseung Kim1, Varun Kesar2, Douglas Grider1,3,4
1Virginia Tech Carilion School of Medicine, Department of Internal Medicine, Roanoke, VA, USA.
Abstract:
A 65-year-old woman presented with three days of colicky abdominal pain. Abdominal imaging illustrated small bowel enteritis, ascites in both paracolic gutters, and incidental hepatic steatosis. Although ascites fluid demonstrated high neutrophil count consistent with peritonitis and the patient received adequate antibiotics, she clinically deteriorated. Subsequent exploratory laparotomy revealed necrotic appendix and multiple intra-abdominal abscesses. Histopathology showed acute suppurative appendicitis with multiple other intact small diverticula, indicating likely perforation of inflamed appendiceal diverticula with subsequent abscess formation and abdominal peritonitis. This case highlights the importance of ascites fluid analysis and continued clinical correlation, especially in cases of rare entities with atypical presentations.
Insights
A rare case of appendiceal diverticulitis perforation caused abdominal peritonitis and abscesses. Prompt ascites fluid analysis and clinical correlation are crucial for diagnosing atypical abdominal emergencies.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Appendicitis is a common surgical emergency, but atypical presentations can pose diagnostic challenges.
- Appendiceal diverticula are rare and their perforation can lead to severe intra-abdominal complications.
Observation:
- A 65-year-old woman presented with colicky abdominal pain, enteritis, and ascites.
- Ascites fluid analysis revealed a high neutrophil count, suggesting peritonitis, despite which the patient's condition worsened.
- Exploratory laparotomy identified a necrotic appendix with multiple intra-abdominal abscesses.
Findings:
- Histopathology confirmed acute suppurative appendicitis with perforation of inflamed appendiceal diverticula.
- This led to abscess formation, abdominal peritonitis, and clinical deterioration.
- Hepatic steatosis was an incidental finding on imaging.
Implications:
- This case underscores the importance of thorough ascites fluid analysis in diagnosing intra-abdominal sepsis.
- It highlights the need for continued clinical correlation, especially when faced with rare conditions and atypical symptoms.
- Early recognition and surgical intervention are critical for managing complications of appendiceal diverticular perforation.
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