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CT Scan showing a necrotic appendix with a stercolith (long arrow) and anterior wall perforation (short arrow).
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Figure 1: CT Scan showing a necrotic appendix with a stercolith (long arrow) and anterior wall perforation (short arrow).

Mentions: The abdominal CT scan with only IV contrast showed a perforation of the anterior rectal wall, 10 cm proximally from the anorectal border with multiple, partially confluent large abscesses located extra- and retroperitoneally (Figure 1). A significant air collection ascended from the lower pelvis through the retroperitoneal space up to the left kidney (Figure 2). Finally, massive hepatic portal venous gas was detected (Figure 3). Due to a coprolith and local abscess formation, appendiceal perforation was also highly suspected (Figure 1).

Retroperitoneal abscess with concomitant hepatic portal venous gas and rectal perforation: a rare triad of complications of acute appendicitis. A case report

Diana M, Paroz A, Demartines N, Schäfer M - World J Emerg Surg (2010)

Bottom Line: Here we report a case of a patient with a perforated appendicitis that was associated with these triad of complications.There was one case having hepatic portal venous gas, and one further case with a rectal perforation associated with acute appendicitis.Hence, delayed diagnosis and treatment are not uncommon.

Affiliation: Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, University Hospital, Lausanne, Switzerland. demartines@chuv.ch.

ABSTRACT

Background: While retroperitoneal abscess is a known complication, hepatic portal venous gas and rectal perforation have not been reported as a concomitant sequelae of acute appendicitis. Here we report a case of a patient with a perforated appendicitis that was associated with these triad of complications.

Materials and methods: In addition to report our case, we carefully reviewed the literature in order to detect similar cases and the causes of such rare conditions.

Results: Only 26 cases (including our patient) of acute appendicitis complicated by retroperitoneal abscesses have been published in the English literature between 1955 and 2008. There was one case having hepatic portal venous gas, and one further case with a rectal perforation associated with acute appendicitis. All patients with retroperitoneal abscess presented with non specific clinic symptoms that not revealed any suspicion for such a complicated disease. Hence, delayed diagnosis and treatment are not uncommon.

Conclusions: So far, no patient has been described with such a triad of rare complications related to acute appendicitis. We want to emphasize the insidious onset of retroperitoneal abscess formation, and the need of prompt recognition and adequate treatment to avoid deleterious outcome.

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