A case of Perforated Retroperitoneal Appendicitis Mimicking Pyelonephritis

Abstract

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.