Hepatic Abscess Secondary to a Retained Appendicolith Following Perforated Appendicitis: A Case Report

In rare cases, intra-abdominal abscesses can be caused by retained appendicoliths. Additionally, hepatic abscesses can also occur after dropped appendicoliths and are exceptionally rare. This report showcases a case of a 75-year-old man who developed a right subhepatic abscess five months after undergoing an appendectomy for perforated appendicitis. It was revealed through imaging that there was a peripherally enhancing fluid collection adjacent to the right lobe of the liver that contained a calcified appendicolith. Additionally, retrospective review of prior scans confirmed the presence of an appendicolith that was left intraperitoneally, which likely occurred after the appendix perforation or intraoperative spillage. After confirming the presence of the abscess, the patient was successfully treated with broad-spectrum antibiotics along with percutaneous drainage of the abscess. This case demonstrates the importance of understanding that dropped appendicoliths are a rare but potential etiology for abscesses in patients undergoing appendectomy. It also shows the importance of proper radiological and intraoperative evaluation to identify and remove these fragments. Early identification and removal of a retained appendicolith can prevent persistent infection, recurrent abscess formation, and severe complications such as sepsis.