Answer of April 2006

Clinical History:

A 69-year-old woman presented with a few days' history of fever and right upper quadrant pain.  Physical examination revealed some suprapubic tenderness and right flank tenderness.  Bowel sounds were present.  Urinalysis at the bedside showed pyuria.

Diagnosis:

Appendicitis with periappendicular abscess.

Discussion:

Computed tomography showed right hydroureteronephrosis consequent to obstruction caused by an inflammatory bowel mass involving the distal right ureter. The appendix is swollen and its tip is inseparable from the mass. There are some prominent small bowel loops and small amount of free intraperitoneal fluid. Laparoscopy revealed a perforated appendix with an abscess obstructing the right ureter.