A Case of Abdominal Wall Abscess Due to Perforated Appendicitis

Yutaka Nakata, Michiki Narushima and Noriaki Tomioka

Department of Surgery, Kitaishikai Hospital

We report a rare case of appendicitis forming an abdominal wall abscess. A 32-year-old man referred for high fever and a reddish induration in the right lower abdominal wall was found on physical examination to have a fist-sized induration with slight tenderness at the medial right iliac crest, but showed no finding in other parts of the abdomen. Laboratory studies showed inflammation. Ultrasonography and computed tomography showed a spindle-shaped abscess in subcutaneous tissue and an intraabdominal inflammatory tumor. A barium enema did not show vermiform appendix, so we surmised that the abscess had formed due to a perforated appendicitis. On entering the peritoneal cavity, we found the tip of the vermiform appendix surrounded by the omentum was buried in the anterior abdominal wall. We conducted an appendectomy and opened the abscess after closing the abdominal wound. We completely drained the abscess and cleaned it, leaving it open because anaerobic bacterium infection was suspected. Pus cultures were positive for Bacteroides fragilis. The postoperative course was uneventful.

Key words
appendicitis, abscess, anaerobic infection

Reprint requests
Yutaka Nakata Department of Surgery, Kitaishikai Hospital 2633-3 Tokunomori, Ozu, 795-0061 JAPAN

Accepted
January 22, 2003

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