Perihepatic abscesses caused by dropped appendicoliths in a child

Abstract

A dropped appendicolith is a well-known complication of laparoscopic appendectomy that may occur because of stone expulsion from the appendix, before or during surgery, and typically manifests as a focal, subcentimeter area of high attenuation with or without associated abscess. Dropped appendicoliths may act as niduses for infection and may result in the future development of abscess formation. We report the case of a 10-year-old pediatric patient who developed 2 perihepatic abscesses caused by 2 appendicoliths that were inadvertently dropped during laparoscopic surgery.

Keywords: Abscess; Appendicitis; CT; Dropped appendicolith.

Fig. 1

A 10-year-old boy with acute appendicitis. a, b. Initial, contrast-enhanced axial CT images of the pelvis demonstrate 2 calcified appendicoliths (arrows) within an enlarged, fluid-filled appendix with surrounding inflammatory changes.

Fig. 2

Repeat contrast-enhanced CT images of the abdomen obtained 18 days later at readmission. (a) Axial CT image shows a complex collection in the periphery of the right hepatic lobe containing a focal calcification in dependent position representing the “dropped” appendicolith (arrow). (b) Axial CT image obtained at a lower level than b shows an additional complex collection with a dropped appendicolith (arrow) in dependent location.

Fig. 3

Additional CT and US studies performed after failure to retrieve one of the appendicoliths. (a) Axial CT image corresponding to the level of Figure 2a, shows expected postoperative seroma and no retained appendicolith. (b) Axial CT image corresponding to the level of Figure 2b redemonstrates a smaller fluid collection with a retained appendicolith (arrow). (c) US image of the right flank shows a hypoechoic perihepatic abscess containing a calcified focus with posterior acoustic shadowing representing the retained appendicolith (arrow).

Fig. 4

(a, b) Photographs of the removed appendicolith.