A Case of Perforated Appendicitis Caused by a Small Appendiceal Calculus Found During Laparoscopic Surgery

Abstract

Appendicolithiasis is a relatively rare condition, but it has been reported that appendicitis accompa-nied by an appendiceal calculus tends to be severe. We report a case of perforated appendicitis with a rapid course caused by an appendiceal calculus found during laparoscopic surgery. A 43-year-old woman presented with right lower abdominal pain and epigastralgia at our hospital. Blood analysis indicated a slight inflammatory response, and plain abdominal computed tomography (CT) revealed bilateral renal calculi and in the Pouch of Douglasʼ but no swollen appendix. The patient was suspected to have pelveoperitonitis and was admitted to the Department of Gynecology. However, her abdominal pain and inflammatory response became worse, and therefore, she was re-ferred to the Department of Surgery. The appendix did not appear swollen on CT, but appendicitis was not excluded because of an inflammatory change observed near the cecum, we performed laparoscopic appendectomy, and found a 5-mm diameter perforation at the appendiceal root and a 5-mm diameter calculus falling through the perforated site of the appendix. The patient underwent an ap-pendectomy and abdominal drainage, and was discharged from our hospital 9 days after surgery. We conclude that the perforation of the appendix was caused by a pointed appendiceal calculus.