Abstract

A 67-year-old Bahraini male patient, diabetic and hypertensive, presented to the Emergency department with complaints of 3-days history of shortness of breath, abdominal distension, and constipation without abdominal pain. Clinical evaluation and laboratory investigations revealed lower abdominal tenderness and rebound tenderness as well as status of septic shock. Contrast enhanced computed tomography revealed inflamed vermiform appendix with pneumoretroperitoneum and abdominal wall emphysema associated with abdominal wall edema. Surgical laparotomy was performed which revealed retroperitoneal perforation of the appendix associated with pus and air in the retroperitoneum and the abdominal wall. Appendectomy was performed along with drainage of retroperitoneal as well as abdominal wall pus. The case represents an uncommon complication of acute vermiform appendix inflammation with retroperitoneal perforation into the abdominal wall. This case indicates that a possibility of intra-abdominal pathology should be raised in patients with subcutaneous surgical emphysema of the chest and abdomen.

Keywords: Acute appendicitis, atypical, computed tomography, subcutaneous emphysema, retroperitoneal