Pelvic abscess masquerading as urachal malignancy-a rare presentation of retained appendicolith
Du Phan1, Ian Y Goh2, Geoffrey Muduioa2
1Department of General Surgery, Hervey Bay Hospital, Queensland, Australia.
Abstract:
Dropped or retained appendicoliths are uncommon complication of laparoscopic appendicectomies, and rarely they have been reported to cause complications such as pelvic abscesses or enterocutaneous fistulas. We reported on a rare presentation of a pelvic abscess masquerading as urachal malignancy in a 41-year-old male, 2 years after his laparoscopic appendicectomy. As urachal malignancy could not be unequivocally excluded on imaging findings alone, en bloc resection of this mass and partial cystectomy were performed. Histopathology study revealed pelvic abscess with no evidence of malignancy and a central calcification which corresponded to a faecolith identified on pre-appendicectomy imaging. We contributed this rare presentation to the limited existing literature about complications of retained appendicoliths. As laparoscopic appendicectomies are performed commonly as the standard of care of appendicitis, care should be taken to extract appendicoliths completely to prevent complications.
Insights
A retained appendicolith after laparoscopic appendectomy caused a pelvic abscess mimicking urachal cancer. Complete removal of appendicoliths is crucial to prevent rare but serious complications.
Area of Science:
- Surgical Complications
- Gastroenterology
- Urology
Background:
- Laparoscopic appendectomy is the standard treatment for appendicitis.
- Dropped or retained appendicoliths are uncommon but can lead to serious complications.
- Pelvic abscesses and enterocutaneous fistulas are known sequelae of retained appendicoliths.
Observation:
- A 41-year-old male presented with a pelvic abscess two years post-laparoscopic appendectomy.
- The abscess mimicked urachal malignancy on imaging, necessitating surgical resection.
- Histopathology confirmed a pelvic abscess with a calcified faecolith, not malignancy.
Findings:
- Retained appendicoliths can present years after surgery.
- A retained appendicolith can lead to a pelvic abscess that mimics other serious conditions.
- Complete intraoperative retrieval of appendicoliths is essential.
Implications:
- This case highlights a rare complication of retained appendicoliths.
- It underscores the importance of meticulous surgical technique during appendectomy.
- Awareness of such presentations is crucial for accurate diagnosis and management.
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