右腰背部痛にて発症した虫垂炎続発筋膜後腔膿瘍の１例

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  • A CASE OF RETROFASCIAL ABSCESS SECONDARY TO APPENDICITIS PRESENTED WITH RIGHT LOW BACK PAIN

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A 71-year-old woman complaining of right low back pain and right thigh pain in walking had been followed with application of poultice and administration of an analgesic in the department of orthopedics in our hospital. About 3 months later, she developed fever and her low back pain was acutely aggravated. Abdominal CT scan showed a right dorsolumber abscess, so that the patient was referred to our department of surgery and admitted on that day. Incision drainage for the right dorsolumber abscess was performed under local anesthesia, when brown pus with fecal odor gushed out, suggesting a possibility of communication with the intestine. When gastrographin fluoroscopy was conducted through the anterior portion of appendiceal opening at colonoscopy, communication between the appendix and abscess cavity was identified. Thus retrofascial abscess secondary to appendicitis was diagnosed, and an appendectomy was performed. During surgery the appendix was adherent to the retroperitoneum to form a fistula.<br> The disease secondary to appendicitis lacks abdominal findings and we often have difficulty in making the diagnosis. In this case, however, sbscess drainage resulted in symptomatic remission with which the definite diagnosis was able to make before surgery. We present the case, especially for clinical course and treatments, together with a review of the literature.

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