Acute appendicitis presenting with abdominal wall and right groin abscess: A case report

Abstract

We report a case of right lower abdominal wall and groin abscess resulting from acute appendicitis. The patient was an 27-year-old man who had no apparent abdominal signs and was brought to the hospital due to progressive painful swelling of right lower abdomen and the groin for 10 d. Significant inflammatory changes of soft tissue involving the right lower trunk were noted without any apparent signs of peritonitis. Laboratory results revealed leukocytosis. Abdominal ultrasonography described the presence of abscess at right inguinal site also communicating with the intraabdominal region. Right inguinal exploration and laparotomy were performed and about 250 mL of pus was drained from the subcutaneous tissue and preperitoneal space. No collection of pus was found intraabdominally and subserous acute appendicitis was the cause of the abscess. The patient fully recovered at the end of the second post-operation week. This case reminds us that acute appendicitis may have an atypical clinical presentation and should be treated carefully on an emergency basis to avoid serious complications.

Atypical presentation of appendicitis

“…Rarely, an appendico-cutaneous fistula may form, presenting as an open wound, with reports predominantly from countries where delayed presentation is more common 10 11. Other reports have described appendico-cutaneous fistulae in the right lumbar region, and an appendiceal rupture presenting as necrotising fasciisitis of the right groin after spread beneath the inguinal ligament 12 13. An ECF is more likely to form following surgical drainage of an abscess, as in this case.…”

Aislamientos bacterianos en apendicitis aguda

“…Ocho artículos están enfocados al estudio de apendicitis aguda, cuatro informes de casos y cuatro estudios clínicos. [21][22][23][24][25][26][27][28] En estos análisis se incluyeron 8.005 pacientes, describen la toma de cultivos en 3.218, lográndose el aislamiento bacteriano en 1.444 casos (44.7%). No describen la proporción específica por germen bacteriano y tipo aerobio o anaerobio, pero la frecuencia de aislamientos fue similar al grupo de publicaciones de infecciones intraabdominales, siendo la E.coli la principal 23,26 , seguida por K. pneumoniae.…”

“…No describen la proporción específica por germen bacteriano y tipo aerobio o anaerobio, pero la frecuencia de aislamientos fue similar al grupo de publicaciones de infecciones intraabdominales, siendo la E.coli la principal 23,26 , seguida por K. pneumoniae. 21,22 Otros gérmenes hallados fueron Strepcoccus sp de varios tipos (Tabla 2). 23,24,26 El aislamiento de anaerobios se informó en dos de estas ultimas publicaciones, las que describen el crecimiento de Bacteroides fragilis como la bacteria más frecuente.…”

“…Igual que en el grupo de infecciones intraabdominales, el aerobio más frecuente fue E. coli seguido por K. pneumoniae y en cuanto a los gérmenes anaerobios el más común fue B. fragilis, sin que se describa la proporción entre los cultivos. 23,26 En dos de los estudios 22 Haemophilus segnis y Streptococcus pneumoniae. 12,24. En ninguno de estos artículos se mencionó el perfil de sensibilidad/resistencia antibiótica de los gérmenes aislados.…”

Perforated Retroperitoneal Appendicitis Presenting as Extensive Subcutaneous Emphysema of Abdominal and Chest Wall: An Unusual Presentation

“…Retroperitoneal abscess because of acute appendicitis is relatively rare but serious surgical complication associated with significant morbidity and mortality. Review of literature surprise us that, there is lot of abdominal pathology like diverticulitis, perforated appendicitis, colorectal carcinoma, crohn's diseases, abdominal trauma and rarely suppurative iliac lymphadenitis, pyelonephritis and abdominal tuberculosis are causing retroperitoneal abscess formation with extension to abdominal wall, thigh, groin, psoas muscle and perinephric space, but acute appendicitis has rarely been discussed with extensive subcutaneous emphysema of abdominal and chest wall [4][5][6][7]. The complicated acute appendicitis represents here a retroperitoneal abscess which has extravasated in the subcutaneous space of the abdominal wall and the chest wall through medial side of the internal oblique muscle.…”