[Abscesses after appendectomy due to intraoperative retaining of fecalith].
OBJECTIVE
Fecaliths appear to predispose a patient to acute appendicitis, abscess formation, and perforation. The number of preoperative radiological evaluations is increasing, although children with suspected perforation still undergo surgery immediately. We report and discuss imaging findings and implications in children with acute appendicitis and fecaliths.


METHODS
Four children (3 girls, 1 boy; mean age 9 years) underwent surgery for acute appendicitis. Three children underwent sonography and plain radiography before surgery, 1 child was operated without radiological evaluation. After readmission, all 4 children underwent sonography and plain radiography before surgery.


RESULTS
In 3 patients a fecalith was diagnosed initially. After uneventful recovery all 4 patients had acute abdominal pain and readmission was necessary. In all 4 patients the escaped fecalith was demonstrated with sonography and plain radiography confirmed surgically.


CONCLUSIONS
Discussion about the role of imaging in acute appendicities has concentrated on the diagnostic yield of cross-section techniques. The importance of demonstrating a fecalith, prompting a more thorough intraoperative search has found little attention. The radiologist should also detect and localize a fecalith and should be aware of retained fecaliths as a cause of abscess formation after appendectomy.
Hörmann
M
M
Universitätsklinik für Radiodiagnostik, Abteilung chirurgische Facher, AKH Wien, Osterreich. marcus.hoermann@akh-wien.ac.at
Kreuzer
S
S
Sacher
P
P
Eich
G F
GF
D018784:Abdominal Abscess / Q000000981:diagnostic imaging / Q000209:etiology*; D000208:Acute Disease; D000293:Adolescent; D000367:Age Factors; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D005244:Fecal Impaction / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011859:Radiography; D013997:Time Factors; D014463:Ultrasonography