Complicated acute appendicitis presenting as an abscess in the abdominal wall in an elderly patient: A case report

Abstract

Introduction: Appendicitis is a common cause of acute abdomen; however, the classic clinical signs are not often present, and it has unusual presentations. Thus, its diagnosis can be challenging.

Presentation of case: We describe the case of an elderly man who presented with right abdominal wall abscess with spontaneous drainage in the emergency department. Since we suspected a subjacent abdominal pathology, we performed surgery, and intraoperatively, we observed that the Appendix tip had invaded the abdominal wall.

Discussion: This patient had a challenging diagnostic process and surgical visualization of the appendicular tip invading the abdominal wall was an important characteristic in proving the cause of the abdominal wall abscess.

Conclusion: The onset of an abdominal wall abscess without a known cause needs to be thoroughly investigated, with consideration of a subjacent abdominal cause and appendicitis necessitatis.

Keywords: Abdominal abscess; Appendicitis; Appendicitis necessitatis; Case report.

Fig. 1

Photograph showing the large wound with sloughing of the skin in the lateral abdominal and thigh regions.

Fig. 2

CT-Scan showing gas and fluid collection extending from his retroperitoneal space to the subcutaneous layer of his right groin and abdominal wall, without identification of the appendix.

Fig. 3

Photograph showing the tip of the Appendix entering the retroperitoneal space in the region of the necrotic wound in the abdominal wall.