AN UNCOMMON INSTANCE OF APPENDICULAR ABSCESS, BOWEL NECROSIS AND CALCULUS CHOLECYSTITIS: A RARE CASE PRESENTATION

Abstract

This text discusses a rare case of coexisting appendicitis and cholecystitis, which is a condition where both diseases occur simultaneously. The theory for the origin of this condition suggests that bacterial contamination of the gallbladder bile and impaired bile salt excretion can result in acute cholecystitis due to a direct bacterial invasion or translocation from the muscularis propria of a gangrenous appendix. The prevalence of hyperbilirubinemia in acute appendicitis supports this theory. The patient in this case presented with abdominal pain that started from the Para umbilical region and shifted to the right iliac fossa, with progressive lack of intestinal transit for faeces and flatulence for four days and continuous vomiting for one day. An ultrasound of the whole abdomen revealed the presence of a distended gallbladder with a calculus of 1.4 cm, representing cholelithiasis, and an initial provisional diagnosis of cholelithiasis with cholecystitis was made. However, a contrast CT abdomen revealed peripheral enhancement in the right iliac fossa beneath the ileocecal junction and associated mural thickening of the cecum and ascending colon with adjacent fat stranding, which were consistent with those of an infective aetiology, raising the possibility of an appendicular lump formation. The patient was treated with antispasmodic drugs, pain management, and fluid resuscitation. This case report emphasizes the need to recognize coexisting appendicitis and cholecystitis in patients with abdominal pain, especially when conservative treatments are unsuccessful. Rapid diagnosis and treatment are essential to prevent complications and achieve a positive outcome.