Dirk Schaper, V. Hofmann (Halle/S.)  

Viewable for logged on visitors (Log on)  

11 Years  

Male  

GI-Other and unknown  

inflammatory or infectious  

11 year old boy with vomiting for 5 days. Stomach aches in the right lower quadrant for 3 days. Careful gait, abdominal resistance in the right lower quadrant. Leukocytosis, CRP inreased.  

N/A  

<- view Ultrasound

Ultrasound 1: Right lower quadrant, tubular structure without wall demarcation. Decreased echogenicity of the contents with a round echogenic structure. Homogenic, echogenic surroundings (suspected appendicitis with fecalith and omental patch closure.



<- view Ultrasound 2

Ultrasound 2: Right upper quadrant: subhepatic, echogenic structure with acoustic shadows.




<- view Ultrasound 3

Ultrasound 3: Right upper quadrant: subhepatic, echogenic structure with acoustic shadows, surrounded by an inhomogenic region which was partly free of echoes.

 

Surgery / Histo  

Gallstone, intrahepatic calcification  

Lapartomy, perforated appendicitis, postoperative antibiotic treatment. Condition improved. In the sonographic follow-up examinations showed the echogenic process subhepatically and to the right (Image 2). Patient was discharged. After some time, the patient developed stomach aches again, fever, CRP increase, and leucocytosis. Development of a subhepatic abscess with an echogenic structure. Laparotomy, abscess drainage, and removal of the suspicious fecalith.  

It is questionnable if - in a laparoscopy - the coprolith would have been detected already in the first surgery.  

N/A  

1. Medline:
Lin, B.H., M.A. Stull, T. Drant
Extraluminal appendicolith in perforating appendicitis
AJR 1996 Jun;166(6):1499

2. Medline:
Horst,M.,G.Eich,P.Sacher
Postappendectomy abscess - the role of fecoliths
Swiss Surg 2001;7(5):205-8

3. Medline:
Forel,F., D.Filiatrault, A.Grignon
Ultrasonic demonstration of appendicolith
J Can Assoc Radiol 1983 Mar;34(1):66-7  

appendicitis, fecolith, appendicolith, dispersed appendicolith, perforated appendicolith, abdominal pain, vomiting, leukocytosis, elevated CRP, appendix perforation, child, childhood, pediatric radiology  

Dirk Schaper, V Hofmann. Perforated appendicolith. PedRad [serial online] vol 3, no. 3.
URL: www.PedRad.info/?search=20030328111906