Acute Appendicitis with Perinephric Abscess - A Rare Occurrence

Vermiform appendix previously thought to be a vestigial organ, has a variable length of 2 - 20 cms. It arises from posteromedial wall of cecum, around 2 cms lower than the ileocecal valve. The tip of appendix can be in different directions like retrocecal, pelvic, subcecal, retroileal, preileal, subhepatic and ectopic.1 The appendix is supplied by the appendicular artery, anterior and posterior cecal arteries. Ileocolic and right colic veins drain venous blood of appendix. Ileocolic lymph nodes adjacent to the superior mesenteric artery drains the lymphatics.2 Acute appendicitis remains the commonest cause of acute abdominal pain requiring surgical intervention.3 Acute appendicitis may present as loss of appetite, periumbilical pain, nausea and few episodes of vomiting, associated with low grade fever (38˚ C), there is also signs of peritoneal inflammation in lower abdomen.4 Acute appendicitis is actually a clinical diagnosis and confirmed by laboratory investigations like neutrophilia and radiological studies like ultrasonography abdomen.5 Appendicular perforation, cecal perforation, gangrene, periappendicular abscess, peritonitis, bowel obstruction, septic seeding of mesenteric vessels, and very rarely perinephric abscess are the complications of acute appendicitis.6 Purulent collection between the kidney and Gerota’s fascia is called as perinephric abscess, mostly occurs due to rupture of intrarenal abscess into the space between kidney and Gerota’s fascia, few other causes of perinephric abscess include haematogenous spreading from other sites of infection and direct spread from adjacent viscera, perforated colon carcinoma, diverticulitis and osteomyelitis of adjacent ribs or vertebrae.7