A 58-year-old Man with Abdominal Pain; Acute Appendicitis due to an Appendicolith
Case presentation: A 58-year-old man presented to the emergency department with abdominal pain, nausea and loss of appetite for the last 8 hours. He reported diffuse pain that had been localized to the right lower quadrant (RLQ). Physical examination revealed muscular defense and tenderness in the RLQ. Computed tomography (CT) of the abdomen and pelvis confirmed luminal distension with a thickened enhancing wall with an appendicolith.
Learning points: Appendicitis may be developed by an appendicolith, a calcified deposit within the appendix. It may be an incidental finding on an abdominal radiograph, ultrasound (US) examination or CT. It appears as echogenic focus and casts an acoustic shadow on US examination and manifests as a calcified mass on plain radiograph or CT. The incidence of appendicolith is higher among patients with a retrocaecal appendix. In our patient, a clinical diagnosis of acute appendicitis was made and the patient was immediately transferred to the operating room and an appendectomy was performed.
2. Aljefri A, Al-Nakshabandi N. The stranded stone: relationship between acute appendicitis and appendicolith. Saudi J Gastroenterol. 2009;15(4):258-60.
3. Lowe LH, Penney MW, Scheker LE, Perez R, Jr., Stein SM, Heller RM, et al. Appendicolith revealed on CT in children with suspected appendicitis: how specific is it in the diagnosis of appendicitis? AJR Am J Roentgenol. 2000;175(4):981-4.
4. Niknejad M, Jones J. Appendicolith [30/Mar/2013]. Available from: http://radiopaedia.org/articles/appendicolith.