Case Report: Imaging-Guided Localization for Surgical Retrieval of a Rare Complicated Retained Appendicolith
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- Category: Vol. 80, September 2012
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Case Report: Imaging-Guided Localization for Surgical Retrieval of a Rare Complicated Retained Appendicolith,YAHIA ASSIRI
Abstract
Background: Retained appendicolith related abscess formation is rare and carries challenging management options. We describe a unique case of a patient who presented with right upper quadrant pain tenderness that is clinically mim-icking acute cholecystitis which turned out to be a perihepatic abscess caused by a dropped migrated appendicolith two and half years following a laparoscopic appendectomy.
Aims: To report a case of a perihepatic abscess compli-cating migrated appendicolith after laparoscopic appendectomy and stress the importance of imaging-guided localization for surgical planning.
Case Report: On January 2012, a 34-year old male patient presented to Montreal General Hospital, Montreal, Quebec, Canada, with a right upper abdominal pain, fever and mild shortness of breath. On physical examination, he was hemo-dynamically stable, but febrile of 38.9º C. Abdominal exam-ination revealed right upper quadrant tenderness otherwise unremarkable. Blood tests resulted in elevated white blood cells count (16x103/μL). Abdominal ultrasound showed nor-mally appearing gallbladder with an unexplained perihepatic collection containing internally air locules and an 8 mm radiopaque appendicolith. Review of his previous imaging revealed a retained appendicolith at right subdiaphragmatic space. The abscess was immediately drained and the patient came back 6 months later for surgical retrieval of this appen-dicolith after ultrasound guided localisation.
Conclusion: Dropped appendicolith related complication has increased since the introduction of laparoscopic appen-dectomy. Therefore, it should be suspected in cases of unex-plained intraperitoneal abscess formation. Imaging guided localization can ease surgical retrieval.