PMC6083383_01
CT abdomen and pelvis with IV and PO contrast. The patient was found to have a large amount of inflammation in the right lower quadrant with phlegmon, as well as marked inflammatory changes including the colon, appendix and terminal ileum.
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The patient underwent a CT scan, which revealed a dilated appendix with severe inflammatory stranding centered around the ileocecal valve, inflammatory changes involving the terminal ileum and intraluminal narrowing (Fig. 1).
CT Scan on readmission 20 days after second encounter, repeat imaging demonstrated mass-like phlegmon and appendiceal thickening with surrounding inflammatory change and prominent adjacent lymph nodes.
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CT scan of the abdomen and pelvis with intravenous and oral contrast was again performed, showing diffuse inflammation and an abnormal cecal region with worsening peri-appendiceal phlegmon, significant RLQ mesenteric lymphadenopathy and adjacent free fluid (Fig. 2, Fig. 3).
Large amount of inflammatory changes in the right lower quadrant centered around the terminal ileum, cecum (colon) and the appendix. Prominent mass-like phlegmon noted in this area with diffusely abnormal cecal region.
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At surgery, a perforated, necrotic appendix was encountered with a large phlegmon and extensive adhesions involving the colon, the small bowel, and the abdominal wall (Fig. 4).
Mass-like thickening of the appendix and piecemeal removal of the inflamed mass/appendix laparoscopically. The inflamed mass-like appendix is seen to be a part of a larger phlegmon in this area. On the bottom right lower side of the photo the remaining inflamed colon is seen where perforation of the colon was found and repaired with the stapler laparoscopically.
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A perforation of the cecum near the site of appendiceal perforation was also found, and primary closure was achieved (Fig. 5).