Liver Abscess Due to Dropped Appendicolith after Laparoscopic Appendectomy

Abstract

The lifetime risk of appendicitis is 6 to 7 % [1]. When appendicitis is clinically suspected, an appendicolith can be found in 30% of the patients [2]. An appendicolith may be retained post-operatively ('dropped appendicolith') due to previous perforation, non-recognition during surgery or the impossibility to remove it. Abscesses that result from ectopic appendicoliths tend to occur paraceacally in the vicinity of Morrison's pouch and should be removed to prevent abscess development and possible overt sepsis [3]. As far as we know, we describe the first documented case of an intrahepatic localization of a dropped appendicolith causing a liver abscess.

Keywords: Liver abscess; appendicolith.

Figure 1A,B

Coronal and axial reconstruction of the non-contrast enhanced CT-scan performed at readmission. Intrahepatic localization of the former seen appendicolith surrounded by a hypodense zone with air bubbles, indicating pus.

Figure 2

Coronal reconstruction of the initial contrast-enhanced CT performed at the acute onset of appendicitis. The appendix shows a thickened wall, fat stranding, free fluid and the embedded appendicolith. No obvious signs of a macroscopic interruption of the appendiceal wall was noted.