Recurrent appendicitis following successful conservative management of an appendicular mass in association with a foreign body: a case report

Abstract

Introduction: Interval appendicectomy is not routinely indicated after successful resolution of an appendix mass. Whether this policy can also be applied to patients with appendicular foreign body presenting with an appendix mass remains a matter of debate. We report here a patient who presented with recurrent symptoms following conservative management of an appendicular mass associated with a foreign body in the appendix. We also review the available literature briefly.

Case presentation: A 70 year old gentleman was admitted with right iliac fossa pain, tenderness, and raised inflammatory markers. A computed tomography scan of his abdomen showed an appendix mass with a small abscess and a linear opaque foreign body. His symptoms resolved completely on conservative management with intravenous antibiotics. A colonoscopy few weeks later was unremarkable. He presented with recurrent symptoms a few months later. A repeat computed tomography scan showed persistent appendicular abscess with the same foreign body in it. A laparotomy with appendicectomy, abscess drainage and removal of the foreign body was carried out with satisfactory outcome.

Conclusion: Surgeons should be aware of appendicular foreign body as a cause of persistent/recurrent symptoms after conservative management of appendicular mass. These patients require prompt surgery and formal appendicectomy. Interval appendicectomy should be considered.

Figure 1.

CT scan of the abdomen showing an appendix mass with a small abscess and a linear opaque foreign body.

Figure 2.

Repeat CT scan of the abdomen a few months later showing the same foreign body embedded in iliopsoas muscle with an abscess in the area.

Figure 3.

The foreign body removed from the abscess cavity at the time of surgery.