PMC2824631_01
CT Scan showing a necrotic appendix with a stercolith (long arrow) and anterior wall perforation (short arrow).
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F1
The abdominal CT scan with only IV contrast showed a perforation of the anterior rectal wall, 10 cm proximally from the anorectal border with multiple, partially confluent large abscesses located extra- and retroperitoneally (Figure 1). Due to a coprolith and local abscess formation, appendiceal perforation was also highly suspected (Figure 1).
Retroperitoneal phlegmon with some air bubbles.
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F2
A significant air collection ascended from the lower pelvis through the retroperitoneal space up to the left kidney (Figure 2).
Hepatic portal venous gas in several intrahepatic portal branches.
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F3
Finally, massive hepatic portal venous gas was detected (Figure 3).