Retroperitoneal, Abdominal, and Pelvic Abscess in Appendicitis: The Limitation of Diagnostic Modalities

Abstract

Acute appendicitis is a common and well-recognized condition that can be easily managed. However, at times it can become significantly complicated and thus life-threatening. Acute appendicitis can present atypically with findings such as peritonitis and even abdominal abscesses. During laparotomy it is highly unusual to find signs of peritonitis that were not initially visualized by abdominal imaging studies consisting of retroperitoneal and pelvic abscesses. In this case report, we describe the diagnosis and management of a 62-year-old female discovered to have several retroperitoneal abdominal and pelvic abscesses complicated by peritonitis discovered during exploratory laparotomy at the time of appendectomy. The presentation of appendicitis has been associated with abdominal abscesses and peritonitis; however, these findings may at times not be seen using CT imaging. Furthermore, retroperitoneal abscess is a relatively uncommon finding associated with appendicitis. Through this report, we plan to illustrate the importance of not neglecting the possibility of particular intra-abdominal and extra-abdominal inflammatory conditions which may arise during the surgical management of appendicitis.