Chronic Appendicular Abscess Presenting as a Complex Adnexal Mass: A Case Report

Authors

  • Micah Wright, DO Oklahoma State University Center for Health Sciences College of Osteopathic Medicine (OSU-COM)
  • Kent Abernathy, DO Department of Obstetrics and Gynecology, Oklahoma State University Center Medical Center
  • Darren Street, MD Department of Gynecologic Oncology Oklahoma Cancer Specialists and Research Institute
  • Lance Frye, MD Department of Obstetrics and Gynecology, Oklahoma State University Center Medical Center
  • William Po, MD Department of Obstetrics and Gynecology, Oklahoma State University Center Medical Center

Keywords:

Abscess, Appendix, Chronic, Exploratory, Laparoscopy, Surgery

Abstract

We present an unusual presentation of a chronic appendicular abscess. A 57-year-old presented to the emergency department with acute on chronic abdominal pain, worsening discomfort, abdominal distention and decreased appetite. Abdominal imaging revealed the presence of multiseptated cystic right adnexal mass, concerning for metastatic ovarian carcinoma. Intra-operatively the diagnosis of a likely chronic ruptured appendix at the base of the colon was confirmed.

References

References

Bouzari Z, Yazdani S, Ahmadi MH, et al. Comparison of three malignancy risk indices and CA-125 in the preoperative evaluation of patients with pelvic masses. BMC Res Notes 2011;4:206–16.

Li Qiu, MD, Fan Yang, MD, PhD, Hong Luo, MD, PhD The sequential use of the risk malignancy index and contrast-enhanced ultrasonography in differential diagnosis of adnexal masses Medicine (Baltimore). 2018 Jul;97(29):e11536

CDC - National Center for Health Statistics https://www.cdc.gov/cancer/ovarian/healthcare/index.htm https://www.cdc.gov/cancer/ovarian/statistics/index.htm August 12, 2018

Kothadia JP, Katz S, Ginzburg L. Chronic appendicitis: uncommon cause of chronic abdominal pain. Therapeutic Advances in Gastroenterology. 2015;8(3):160-162. doi:10.1177/1756283X15576438.

Shah, S., Gaffney, R., Dykes, T. and Goldstein, J. (2013) Chronic appendicitis: an often forgotten cause of recurrent abdominal pain. Am J Med 126: e7–e8.

Mussack, T., Schmidbauer, S., Nerlich, A., Schmidt, W. and Hallfeldt, K. (2002) [Chronic appendicitis as an independent clinical entity.] Chirurg 73: 710–715.

See TC, Watson CJ, Arends MJ, Ng CS Atypical appendicitis: the impact of CT and its management. J Med Imaging Radiat Oncol. 2008 Apr;52(2):140-7. doi: 10.1111/j.1440-1673.2008.01932.x.

Rao, P., Rhea, J., Novelline, R. and Mccabe, C. (1998) The computed tomography appearance of recurrent and chronic appendicitis. Am J Emerg Med 16: 26–33.

Niwa H, Hiramatsu T. A rare presentation of appendiceal diverticulitis associated with pelvic pseudocyst. World J Gastroenterol. 2008 Feb 28;14(8):1293-5.

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Published

2019-04-17

Issue

Vol. 3 No. 1 (2019)

Section

Medical

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