PMC10394468_01
(A) The white arrows depict the gas-filled sections of the iliopsoas abscess. The red arrow points to the inferior pole of the right kidney. (B-D) CT scans reveal the extent of the iliopsoas abscess, with the white arrows outlining the abscess borders, the green arrow pointing to the inferior pole of the left kidney, and the white dotted arrows indicating the gas-fluid levels in the upper part of the abscess. (E) The postsurgery image displays the extra-abdominal area. The white arrow shows the stoma of the terminal ileum, and the red arrow highlights the incision made on the lateral side of the groin. (F) The postoperative pathology report confirms gangrenous appendicitis. CT, computed tomography.
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F1
The abdominal enhanced computed tomography (CT) showed a large gas-containing irregular iliopsoas abscess between the right kidney, psoas major, and ascending colon, and the appendix with its root was almost completely decomposed (Figures 1A-C, Supplementary Figure S1A). The abscess originated from the inferior pole of the right kidney and descended to the deep right groin, and then extended into the inguinal lateral subcutaneous area to form a fluctuating mass (Figure 1D). On the second day after admission, the patient underwent open appendectomy (OA) with appendiceal root repair and closure, inguinal abscess incision and drainage, iliopsoas abscess debridement and drainage, and a terminal ileostomy (Figure 1E). Perforated gangrenous appendicitis was confirmed by the postoperative pathological examination (Figure 1F). Three months later, the follow-up abdominal enhanced CT scan suggested that the iliopsoas abscess was completely absorbed (Figure 2A), and the colonic barium enema showed no contrast medium spillage from the appendiceal stump (Figure 2B, Supplementary Figure S1B).
(A,B) Assessment of the baseline condition prior to reversal of ileal stoma: the white arrows indicate the cecum, and the red arrows represent the terminal ileal stoma. (C) The white arrows indicate the encapsulated abscess in the right iliac fossa, while the green arrow shows the titanium staples at the ileal anastomosis site. (D) Five titanium clips were clamped on the appendiceal orifice during colonoscopy. (E) On CT, the white dotted arrow indicates the titanium clips, and the white arrows display the J-catheter within the abdominal cavity. (F) Follow-up abdominal CT shows that the abscess has completely resolved. The white dotted arrow indicates the titanium clips. CT, computed tomography.
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F2
Three months later, the follow-up abdominal enhanced CT scan suggested that the iliopsoas abscess was completely absorbed (Figure 2A), and the colonic barium enema showed no contrast medium spillage from the appendiceal stump (Figure 2B, Supplementary Figure S1B). ASL (Figure 2C, Supplementary Figure S2A). A percutaneous insertion of an ultrasound-guided 7F J-catheter was performed to drain approximately 60 ml of fecal-odorous fluid from the abscess. In order to ensure effective blockage, five titanium clips (ROCC-D-26-195, Mirco-Tech, Nanjing) were closely arranged in a straight line and the orifice was sealed lip-shaped (Figures 2D,E, Supplementary Figure S2B). The results were unexpected and encouraging, and the patient was subsequently discharged with normal results during the 3 months of regular follow-up (Figure 2F).