Introduction
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Retrocecal appendicitis often presents with atypical signs and symptoms that can lead to delayed diagnosis, perforation, and serious complications. The occurrence of lung abscess secondary to retrocecal perforation of appendicitis in adolescent patients is an extremely rare case, which has been rarely mentioned in the literature before, and today we will learn about it.
document description
A 15-year-old male patient with a history of chest pain, cough, fever, and abdominal pain. Physical examination revealed decreased breath sounds with moist rales at the base of the right lung, and mild tenderness in the right abdomen. Laboratory findings showed elevated erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and leukocytosis.
The patient underwent contrast-enhanced CT scans of the chest and abdomen. A faint circular shadow was observed in the lower right area, with well-defined upper and lateral margins, but not well-defined lower margins. No clear liquid level was observed inside it. Multiple microscopic bubbles were seen protruding from the liver (Figure 1).
lower chest and upper abdomen location The image shows a faint circular shadow in the lower right area, with clear upper and lateral borders, and multiple tiny air bubbles (arrows) can be seen on the liver.
CT showed retrocecal effusion with focal calcification, consistent with appendix abscess with appendiceal calculi (Fig. 2). This effusion extends along the right retroperitoneal space to the subdiaphragmatic position (Figure 3).
Axial view of the iliac fossa (Fig. Black arrows) with focal calcification, representing appendiceal stones (white arrows).
cut view of the abdomen on the right side A ring-enhancing effusion followed by bubbles.
A large, well-circumscribed, thick-walled cavitary lesion with air and fluid was seen in the posterior basal segment of the right lung The plane, consistent with the appearance of a lung abscess, was approximately 8 cm x 7 cm x 6.5 cm (CC x AP x TR) (Figure 4). The lung abscess communicates with the retroperitoneal abscess through the space behind the diaphragmatic crura (Figure 5-7).
Figure 4. Axial section of lower chest showing thick-walled cavity lesions in the basal segment of the right lung The air-liquid level is consistent with the appearance of a lung abscess.
retrosagittal area of abdomen and lower chest The fluid was accompanied by focal calcifications extending to the subphrenic location that communicated with the lung abscess.
Figure 6. Sagittal view of the abdomen and lower chest showing a lung abscess< communicating with the retroperitoneal abscess through the posterior space of the diaphragm. /span>
Figure 7. Coronal section of abdomen and lower chest showing lung abscess and retroperitoneal abscess.
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The patient underwent appendectomy, and the retroperitoneal abscess and lung abscess were completely drained. The patient’s condition improved and the patient was discharged.
Analysis and discussionAcute appendicitis is the most common cause of pediatric emergency abdominal surgery, requiring Timely diagnosis and early treatment. The typical clinical manifestation of acute appendicitis is pain around the umbilicus, which gradually transfers to the right iliac fossa, accompanied by nausea and vomiting. Mild fever, leukocytosis and tenderness of the right iliac fossa are often present.< /p>
Retrocecal appendicitis accounts for 26%-65% of cases. It may occur in theabdominal cavityor peritoneum Posterior location. 81% of patients with retrocecal appendicitis present with atypical signs and symptoms. The atypical clinical presentation of retrocecal appendicitis may lead to delayed diagnosis, leading to higher perforation rates and serious complications.
Retroperitoneal abscess is a rare and serious complication of retrocecal appendicitis, usually due to delayed diagnosis and treatment. Retroperitoneal abscesses can also occur as a complication of other conditions, such as colon cancer perforation, inflammatory bowel disease, diverticulitis, pancreatitis, cholecystitis, pyelonephritis, renal abscess , trauma, adverse reactions after radiotherapy, tuberculosis and thoracolumbar osteomyelitis. In this case, appendicitis in the right iliac fossa with appendix calculi can be diagnosed as perforated appendicitis in the posterior cecum.
Pulmonary abscesses are cavitary lesions caused by necrosis or infection of lung tissue, most often caused by lung parenchymal disease. Rarely, it can develop from intra-abdominal lesions. Lung abscess is an extremely rare complication of perforated retrocecal appendicitis.
In terms of auxiliary examinations, ultrasonography has a sensitivity of 70% in the detection of retroperitoneal abscesses, and is the preferred imaging method for children. However, this method is more dependent on the technique of the operator, and small abscesses may also be missed. In addition, ultrasonography may not provide information on the etiology and spread of a retroperitoneal abscess. Computed tomography is the gold standard for diagnosing retroperitoneal abscess location, contour, relationship to adjacent structures, origin, and preoperative planning. Surgical intervention is the treatment of choice for retroperitoneal and lung abscesses.
Summary
Retrocecal appendicitis is often clinically atypical and can lead to delayed diagnosis, perforation, and serious complications. Lung abscess is an extremely rare complication of perforated retrocecal appendicitis. This also suggests that an intra-abdominal cause should be considered when a lung abscess without an intrathoracic cause is present and the patient presents with a septic thoracoabdominal infection.
References: Fazel RF,Farhad F.Perforated lung appendic case report with retrocecal appendicitis present. Case Reports 17(2022):2754–2758.
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