Complicated appendicitis presenting as anterior abdominal wall abscess in a diabetic patient: A case report

Abstract

Introduction: Acute appendicitis is one of the most common surgical emergencies (8.6 % in men and 6.4 % in women), with varying presentations, including complications such as appendicular abscess. While the typical clinical course involves right lower quadrant pain and fever, rare complications can present with atypical symptoms, particularly in high-risk patients such as those with diabetes.

Presentation of case: A 55-year-old diabetic female presented with a 10-day history of worsening abdominal pain, foul-smelling discharge at the anterior abdominal wall below the umbilicus, and fever. Imaging revealed an appendicular abscess extending into the anterior abdominal wall. Emergency exploratory laparotomy showed a perforated appendix with a purulent collection in the peritoneal cavity extending to the anterior abdominal wall, requiring drainage and right hemicolectomy.

Discussion: Perforated appendicitis (incidence of 20-30 %), particularly in diabetic patients, can lead to localized abscesses or soft tissue infections in atypical locations such as the abdominal wall. These rare complications are more likely in immunocompromised individuals, including those with diabetes, where the incidence of perforated appendicitis is notably higher. Early imaging with ultrasonography or Contrast Enhanced Computed Tomography is critical for identifying complicated appendicitis and guiding surgical intervention.

Conclusion: Anterior abdominal wall abscesses as a complication of perforated appendicitis are rare but significant. This case underscores the importance of early and accurate diagnosis, supported by imaging, to guide appropriate surgical management. Timely intervention can help prevent life-threatening conditions such as necrotizing fasciitis, improve patient outcomes, and reduce the risk of postoperative complications, particularly in high-risk populations.

Keywords: Abdominal wall abscess; Case report; Complicated appendicitis; Diabetes; Laparotomy; Perforated appendix.

Fig. 1

Indurated erythematous swelling in hypogastrium with an ulcerative lesion at the center.

Fig. 2

CECT of abdomen and pelvis axial view shows a peripherally enhancing lesion with a thick, irregular wall and a central collection in the right lower abdomen (yellow arrow), extending into the right anterior abdominal wall (red circle). CECT: Contrast-Enhanced Computed Tomography. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

CECT abdomen and pelvis coronal section showing hyperechoic lesion in the right lower quadrant of the abdomen (yellow arrow) extending into the anterior abdominal wall (red circle). CECT: Contrast-Enhanced Computed Tomography. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 4

Intraoperative picture showing a lump formed by the cecum (asterisk), appendix (yellow arrow), ileum (white arrow), and omentum. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)