A case of Perforated Retroperitoneal Appendicitis Mimicking Pyelonephritis

Yıl 2024, , 32 - 34, 28.06.2024

Levent Cankorkmaz , İsmail Şalk , Mehmet Atalar , Gökhan Köylüoğlu

https://doi.org/10.33706/jemcr.1383925

Öz

Introduction: Appendicitis is one of the most commonly diagnosed surgical diseases in childhood with emergency abdominal pain. Retrocecal retroperitoneal appendicitis is uncommon and potentially difficult to diagnose. This condition might present with atypical clinical, and radiological signs. Here, we present a patient with perforated retrocecal appendicitis in whom the clinical findings mimicked acute pyelonephritis.
Case Report: A 3-year-old boy presented with right flank pain, fever, and vomiting since a two days. The abdomen was soft but right costovertebral angle tenderness positive. There was pyuria. The clinical impression was pyelonephritis. Ultrasonography showed perirenal fluid collection but did not show any collections pericecal area. In the Multi-detector CT (MDCT) MDCT a long inflamed retrocecal retroperitoneal appendix was seen with surrounding inflammation that extended to anterior pararenal space, and retroperitoneal air. At surgery, there was retrocecal retroperitoneal appendicitis with perforation and retroperitoneal collection. Appendectomy and drainage were performed.
Conclusions: Patients with retroperitoneal appendicitis is that these patients often present with atypical and less severe abdominal complaints. In this situation, MDCT could be a rapid and efficient tool for localizing the appendix and for the differential diagnosis.

Anahtar Kelimeler

Retrocecal retroperitoneal appendicitis, perinephric collection, child

Kaynakça

• 1. Dönder Y, Baykan M, Güney B. Malrotation Anomaly Left Lower Quadrant Appendicitis. Journal of Emergency Medicine Case Reports. 2018; 9(3): 44-46.
• 2. Nahhas A, Abderahman A, Kharaba A. A snake in the grass: retroperitoneal abscess due to perforated appendicitis-management, approach and recommendations. J Surg Case Rep. 2019 May 28;2019(5):rjz163. doi: 10.1093/jscr/rjz163. PMID: 31186833; PMCID: PMC6537909.
• 3. C. T. Kao, J. D. Tsai, H.C. Lee et al. “Right perinephric abscess: a rare presentation of ruptured retrocecal appendicitis,” Pediatric Nephrology, vol. 17, no. 3, pp. 177–180, 2002.
• 4. Kim S, Lim HK, Lee JY, Lee J, Kim MJ, Lee AS Ascending retrocecal appendicitis: clinical and computed tomographic findings. J Comput Assist Tomogr 2006;30:772-6.
• 5. Sosnowska-Sienkiewicz P, Bućko E, Mańkowski P. The Rare Case of Perirenal Abscess in a Child-Possible Mechanisms and Methods of Treatment: A Case Report and Literature Review. Medicina (Kaunas). 2021 Feb 9;57(2):154. doi: 10.3390/medicina57020154. PMID: 33572093; PMCID: PMC7914655.
• 6. Wani NA, Farooq M, Gojwari T, Kosar T. Perinephric abscess caused by ruptured retrocecal appendix: MDCT demonstration. Urol Ann. 2010 Jan;2(1):29-31. doi: 10.4103/0974-7796.62923. PMID: 20842255; PMCID: PMC2934582.