Computer tomography imaging of an unusual cause of appendicitis: a case report

Introduction

Foreign body occlusion of appendices lumen is a quite rare cause of appendicitis due to foreign body (1,2)

Case report

A 63-year-old male presented to our department with a complaint of right lower quadrant pain of 1-day duration. The patient denied diarrhea, vomiting, hematuria and dysuria. Three weeks before, he says to have eaten heavy meal with a game and alcohol. The patient past medical history included, coronary artery disease, hypertension, hypercholesterolemia. Physical examination reveals shiver but no fever, a cardiac rhythm of 98 bpm and right lower quadrant pain tenderness. Laboratory tests showed a slight increase of white blood cell count at 10.6×10⁹/L and C-reactive protein at 22.9 mg/L. The urine analysis was normal. Contrast enhanced computed tomography (CT) of pelvis demonstrated a thickened and inflamed appendix of 17 mm of diameter. The lumen was occluded by a metallic foreign body (Figure 1). The patient underwent laparoscopic appendicectomy. A histopathologic examination revealed acute necrosis appendicitis due to a weapon bullet.

Figure 1 Enhanced CT with bullet (small dashed arrow) at the neck of inflamed appendix (long dashed arrow). (A) Axial vue; (B) coronal vue. CT, computed tomography.

Disclosure: The authors declare no conflict of interest.

References

1. Asad S, Bae K, Jeon KN, Cho JM, Shin TB, Joo YT, Kim HJ. Appendicitis caused by a foreign body of dental origin: diagnosis with ultrasonography. J Ultrasound Med 2007;26:967-70. [PubMed]
2. Karegoudar JS, Prabhakar PJ, Anitha MR, Vijayanah V. Foreign body appendicitis in children: Case report. New Indian J Surg 2011;2:153.