case_images: PMC5131238_01
case_images: Abdominal X-ray on admission. Normal findings.
case_images: CRIGM2016-1378046.001.jpg
case_images: PMC5131238_01_CRIGM2016-1378046.001.jpg
case_images: fig1
case_images: The blood laboratory tests showed results within normal limits (WBC: 8.01 K/muL, with 76.3% neutrophils) and imaging control through abdominal X-ray (Figure 1) and ultrasound did not reveal any abnormalities.
case_images: Imaging through colonoscopy. No signs of inflammation until the point of 10 cm proximally to the ileocecal valve.
case_images: CRIGM2016-1378046.002.jpg
case_images: PMC5131238_01_CRIGM2016-1378046.002.jpg
case_images: fig2
case_images: The procedure was uneventful and examination up to 10 cm proximally to the ileocecal valve did not lead to any pathologic findings (Figure 2).
case_images: Abdominal X-ray after colonoscopy and clinical deterioration. Presence of free abdominal gas.
case_images: CRIGM2016-1378046.003.jpg
case_images: PMC5131238_01_CRIGM2016-1378046.003.jpg
case_images: fig3
case_images: A new abdominal X-ray was performed, presenting free abdominal gas (Figures 3(a) and 3(b)).
case_images: Abdominal CT scan. Perihepatic collection with free abdominal gas.
case_images: CRIGM2016-1378046.004.jpg
case_images: PMC5131238_01_CRIGM2016-1378046.004.jpg
case_images: fig4
case_images: The abdominal CT scan revealed diffuse inflammation not only in the area of the appendix and free gas in the peritoneal cavity, but also in the retroperitoneal space (Figure 4).
case_images: Intraoperative findings. Acute appendicitis with peritonitis. Presence of a fecalith.
case_images: CRIGM2016-1378046.005.jpg
case_images: PMC5131238_01_CRIGM2016-1378046.005.jpg
case_images: fig5
case_images: Based on the condition and the imaging findings, an exploratory laparotomy was performed, during which perforated appendicitis with peritonitis was revealed (Figures 5(a) and 5(b)).