Right Hydronephrosis as a Complication of Acute Appendicitis

Abstract

Introduction. Acute appendicitis is the most common cause of acute abdomen, but atypical appendicitis may lead to delayed diagnosis and related complications. In this report, we present a very rare case of acute appendicitis causing right hydronephrosis. Case Report. A 54-year-old male patient who had been receiving antibiotic therapy due to the diagnosis of urinary tract infection for the last one week but had no clinical improvement was admitted to the emergency service. Abdominal computed tomography (CT) showed right hydronephrosis and a pelvic abscess. After appendectomy and abscess drainage had been performed, hydronephrosis was completely recovered. Discussion. The use of appendicitis scoring systems, abdominal ultrasonography (USG), abdominal CT, and diagnostic laparoscopy can be useful for the diagnostic process in patients presenting with acute abdomen. In our patient, we considered that the surgical treatment was delayed since the symptoms of acute appendicitis were suppressed by the antibiotic therapy that was being administered due to the complaints including symptoms of urinary tract infections. Conclusion. Atypical appendicitis may cause a delay in the diagnosis of acute appendicitis and thus may lead to serious complications such as right hydronephrosis, prolonged hospital stay, increased morbidity and mortality, and increased antibiotic resistance.

Acute Perforated Appendicitis Complicated by Necrotizing Fasciitis and Bladder Perforation

“…It has an estimated mortality rate that widely varies between 6%-76% [4]. According to our search of the literature, there have been 15 reported cases associated with acute appendicitis, with a mortality rate of 33.3% (5/15) [5]. An even rarer complication is perforation of the bladder wall, of which we found three similar cases in the literature [6].…”

“…Complications from acute appendicitis vary widely, many of which are secondary to the effects of visceral perforation. They include bowel obstruction, abscess formation, uropathy, and gastrointestinal bleeding among others [ 15 ]. Our patient had a perforation of the appendix and subsequent periappendiceal abscess formation with gas-forming bacteria that caused necrotizing fasciitis of the abdominal wall.…”

A pictorial essay of the most atypical variants of the vermiform appendix position in computed tomography with their possible clinical implications

“…In cases of atypically located tip of the appendix the pain is localised in areas of the abdomen typical for other diseases and leads to a clinical dilemma [3,4,8,14,15]. A possible misdiagnosis may lead to complications including perforation, abscess, and peritonitis [3,7,16].…”

“…Inflammation of the tip of the appendix situated near the wall of the duodenum may produce symptoms of duodenitis or a duodenal ulcer. A long appendix crossing the right ureter can cause hydronephrosis with renal colic symptoms due to inflammation or the development of an abscess pressing the ureter [16]. When the appendix crosses the ileum or is situated in the midline, appendicitis may be indistinguishable from enteritis [3].…”

Retro-psoas appendicitis

“…Variations in morphology and location have been reported extensively with the most frequently encountered positional variant being retrocecal, followed by pelvic and ileal locations (figure 1). 1–7 It has been postulated that appendiceal variation in some cases can arise from embryological development during midgut rotation and descensus of the cecum in the 6th–10th weeks of gestation. Additionally, a history of prior abdominal surgery can result in less common positioning 8.…”