Case 11 -  Appendicitis with abscess.

This patient also has appendicitis.  The appendix is distended to greater than 6 mm.  There is no contrast within the appendix despite excellent filling of the cecum.  Instead there are air and fluid levels in the appendix.  Notice the fat stranding and thickening of the adjacent fascia.  You can see the appendix lies right against the fascia. There is also thickening of the cecum at the base of the appendix.  Notice that the cecum has flopped and that the terminal ileum and ileocecal valve are located laterally. 

Inferior to the appendix is an air and fluid collection not connected to the rest of the bowel.  This is consistent with a perforated appendix and small peri-appendiceal abcess.  The air in the appendix is from perforation and probably also gas forming bacteria.  Abnormal findings include the fluid levels, distention, stranding, cecal thickening, and abscess.