A pathologist examined the resected specimen of the appendix, and a definite diagnosis was made as normal appendix, inflammatory defined as infiltration of inflammatory cells, suppurative defined as infiltration of inflammatory cells with destruction of the appendiceal wall, with no evidence of abscess or perforation, and gangrenous and/or perforated appendicitis defined as infiltration of inflammatory cells, necrotic appendiceal wall, and macroscopic periappendiceal abscess
The margins of the appendix were thickened concerning for a possible acute on chronic appendicitis with periappendiceal abscess
We present two cases where the initial diagnosis was periappendiceal abscess due to acute appendicitis and a drain was inserted.
In cases of periappendiceal abscess due to underlying malignancy, there can be recurrent or persistent collections despite drainage .
This could represent a phlegmon, which consists of matted loops of bowel adherent to the adjacent inflamed appendix or a periappendiceal abscess.
Initial nonoperative management for periappendiceal abscess. Dis Colon Rectum 2001; 44:936-41.
The preoperative computed tomography (CT) of abdomen would show the presence of periappendiceal abscess, indicating a perforated appendicitis [4, 5].
In the absence of periappendiceal abscess on preoperative CT of abdomen, as in an uncomplicated appendicitis, appendectomy is considered to be preferable to the nonsurgical antibiotic treatment .
A pathology report confirmed acute stump appendicitis with rupture and periappendiceal abscess formation (Figure 3).
In men, older patients, and when periappendiceal abscess is suspected, CT is the imaging method of choice for diagnosis of acute appendicitis.2 Definitive CT diagnosis of acute appendicitis is based on finding: 1) an abnormally dilated (>6 mm) enhancing appendix; 2) enhancing appendix surrounded by inflammatory stranding or abscess; or 3) pericecal abscess or inflammatory mass with a calcified appendicolith.
A periappendiceal abscess
may be treated immediately by surgery or by nonoperative management.
In preoperative diagnosis, acute appendicitis was detected in eight patients, perforated appendicitis and periappendiceal abscess
in two patients, and suspicious cecal mass in two patients.