Acute appendicitis is the most common abdominal emergency
worldwide, with an incidence of approximately 7% in the
Western world; it can usually be managed smoothly even if the
appendix is perforated
3. Currently, there is no test or
objective physical finding that can rule out the presence of
appendicitis with acceptable accuracy. Suppuration following
acute appendicitis is well known and occurs in 3-9% of cases
of acute appendicitis
4. The causes of abscess formation are
typically unclear before surgery and patients are usually critical on presentation. Abscess formation commonly occurs in the
pelvis, between intestinal loops, and in the subphrenic space.
Clinching the diagnosis of perforated appendicitis and
iliac fossa abscess often depends on a high degree of
suspicion and the timely acquisition of appropriate imaging
studies. CT scan is a major adjunct to prompt diagnosis and
should, therefore, be considered in all cases of abdominal
wall/lumbar region sepsis to detect an intra-peritoneal source.
CT scan of the abdomen not only helps in the establishment
of the diagnosis, but also in the evaluation of the extent of
involvement and in its treatment5.
Iliac fossa and psoas abscess are generally considered
primary when they are the result of hematogenous spread and
when the most frequent agent is S. Aureus6. Iliac fossa
abscess is considered secondary when it is related to infection
in adjacent organs, such as the colon, jejunum, ureters,
kidneys, pancreas, appendix, spine, and lymph nodes, and the
microorganisms most frequently involved are enterobacteria6,7.
The abscess in this report can be explained by the direct
contamination of the right anterior abdominal wall and groin
by an inflamed phlegmenous appendix. The spread of
resultant sepsis along the abdominal wall muscles,
preperitoneal space, and downward behind the inguinal
ligament into the thigh presented clinically as an abscess8.
In this case, bacterial examination revealed the organism
Escherichia coli, which suggested an intestinal involvement.
Early recognition of an abdominal source of sepsis with
appropriate treatment can improve survival. The treatment of
appendiceal abscesses is still a matter of discussion and many
different approaches are currently adopted. Expectant
management, consisting of intravenous antibiotics, percutaneous
drainage, and interval appendectomy at a later date, is gaining
general acceptance as it seems to be associated with less
morbidity and a shorter overall hospital stay9,10.
We conclude that a search for the presence of
intraabdominal pathology by a thorough clinical and
radiological evaluation should be conducted in all patients
presenting with painful groin and lower extremity in order to
improve survival by early recognition of an underlying
intraabdominal inflammatory pathology.
Acknowledgements: There is no acknowledgement to declare.