Kauffman Zachary S, Stuart David L
Department of Research, DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN, USA.
Department of Surgery, Beckley Appalachian Regional Hospital, Beckley, WV, USA.
Am J Case Rep. 2025 Mar 18;26:e946543. doi: 10.12659/AJCR.946543.
BACKGROUND Acute appendicitis is a common surgical emergency, and perforated appendix is one potential complication. Acute appendicitis can be complicated by perforation and peritonitis, but chronic abscess formation is less common. This report presents the case of a 45-year-old woman with a 7-day history of right lower-abdominal pain and swelling due to perforated acute appendicitis and abdominal wall abscess that required laparotomy and drainage. The presentation of this particular case is unique in that a fistulous tract formed subsequent to perforation of the appendix, with the resultant abscess forming in the abdominal wall. The current case study serves to showcase the diagnostic challenges associated with such a presentation. CASE REPORT A 45-year-old woman presented to the emergency department with a 7-day history of right lower-quadrant and midline lower-abdominal pain and swelling. Computed tomography (CT) scans with intravenous (IV) and rectal contrast showed an abdominal wall abscess with no signs of obstruction, perforation, or appendicitis. Incision and drainage of the abdominal wall abscess with debridement of the abdominal wall was complicated by peritoneal adhesions, and open laparotomy was thus performed. Upon entry into the abdominal cavity, the appendix was found to be adherent to the abdominal wall. It was noted that the appendix had perforated, allowing for fistula formation with the abdominal wall. CONCLUSIONS Clinicians should maintain a high index of suspicion for perforated appendicitis in cases of abdominal wall abscesses with leukocytosis and right lower-quadrant pain, even when initial imaging does not show obvious appendicitis.
急性阑尾炎是一种常见的外科急症，阑尾穿孔是一种潜在并发症。急性阑尾炎可并发穿孔和腹膜炎，但慢性脓肿形成较少见。本报告介绍了一例45岁女性病例，因急性阑尾炎穿孔和腹壁脓肿导致右下腹痛和肿胀7天，需要进行剖腹手术和引流。该特殊病例的表现独特之处在于阑尾穿孔后形成了瘘管，导致腹壁形成脓肿。本病例研究旨在展示与此类表现相关的诊断挑战。病例报告：一名45岁女性因右下象限和下腹部中线疼痛及肿胀7天就诊于急诊科。静脉内（IV）和直肠造影剂增强计算机断层扫描（CT）显示腹壁脓肿，无梗阻、穿孔或阑尾炎迹象。腹壁脓肿切开引流并清创腹壁时因腹膜粘连而复杂化，因此进行了开放剖腹手术。进入腹腔后，发现阑尾与腹壁粘连。注意到阑尾已穿孔，形成了与腹壁的瘘管。结论：即使初始影像学检查未显示明显阑尾炎，临床医生对于白细胞增多和右下象限疼痛的腹壁脓肿病例，也应高度怀疑阑尾穿孔。
