Page Contents
OVERVIEW
This page is dedicated to covering a very important call case: appendicitis complicated by abscess. This page will specifically cover this diagnosis in the setting of making the finding on abdomen/pelvis CT imaging.
Many of the cases presented here will be CT scans of the abdomen/pelvis with contrast however certain cases may present non-contrast imaging (which can have overlapping findings). This page assumes that you are familiar with acute uncomplicated appendicitis and perforated appendicitis (each of which have a separate linked page).
WHAT IS IT EXACTLY?
Appendicitis complicated by abscess is a fairly self descriptive condition: it is acute appendicitis that has often perforated (sometimes a partially contained perforation), which has resulted in the formation of a discrete fluid collection (abscess).
WHY IS IT AN IMPORTANT CALL CASE?
As discussed on the acute uncomplicated appendicitis, appendicitis is generally a condition that has immediate surgical considerations (as many patients get an emergent appendectomy as well as antibiotics).
These considerations get a bit more nuanced in the setting of perforated appendicitis. In the setting of an abscess (with or without the evidence of perforation) percutaneous drainage of the fluid collection becomes a serious consideration (prior to considering surgery).
WHAT CLINICAL CONTEXT HELPS RAISE SUSPICION FOR THIS DIAGNOSIS?
Patients may present in a manner very similar to those that have acute uncomplicated appendicitis. Additionally patients who previously had a known perforated appendicitis that was treated nonoperatively may present again with an abscess.
WHAT IS THE KEY TO MAKING THIS DIAGNOSIS ON CALL?
The initial step is to identify if the patient has acute appendicitis which is covered in detail on the separate page on acute uncomplicated appendicitis.
Onc an appendicitis is identified, it is important to evaluate for clues to suggest perforation as discussed here.
Additionally clues that might suggest the presence of an abscess should be assessed as well. Mainly the presence of a focal fluid collection really makes this diagnosis. It can be near the appendix, however may also be in a remote location. There can also be more than one!
WHAT HAPPENS NEXT AFTER THE DIAGNOSIS IS MADE?
Once appendicitis with an abscess is identified, the care team will generally assess to see if it can be drained via a percutaneous approach. Then (depending upon this, and a few other clinical variables) the patient will get some combination of antibiotics, percutaneous drainage, surgery (with or without a temporary drain placement).
CASE ARCHIVE
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Page Updated: 02.16.23