Perforated appendicitis shows asymmetric wall thickening, free fluid, intramural air and often decreased tenderness. Phlegmon refers to inflammatory changes causing matting of cecum, appendix and ileum with no fluid usually. Finally, frank abscesses are marked by focal fluid collections. Typical cases require no imaging. Positive cases should go to surgery, and clearly negative cases may be observed for a few days.
Inadequate studies require further imaging.
The detection of abscess or phlegmon should be noted, as antibiotic therapy and or percutaneous drainage followed by operation are standard treatment. Clinicians could not exclude gynecologic or vascular etiologies, and so US was performed. 1 are the supine and upright plain films, initially read as negative. While initially interpreted as probable abscess, as appendiceal layers and wall are not definitely demonstrated, pathology showed acute appendicitis with surrounding hemorrhage and fatty necrosis, without definite evidence of perforation. The differential is long, particularly so in females.