Abstract
We report a rare case of perforated appendicitis with an appendiceal calculus. An 18-year-old man was introduced to our department for pan-peritonitis due to acute appendicitis, because antibiotic therapy was not effective to treat in the previous hospital. He had right lower abdominal pain, rebound tenderness and muscular defense. Abdominal X-ray photograph (X-P) showed a large amount of intestinal gas. Abdominal computed tomography (CT) showed the swelling of appendix and a calculus at lower right abdomen. Appendectomy and abdominal drainage were performed. Appendix was perforated and a calculus was found in the lumen of appendix. Although most appendiceal calculi could be found by using abdominal X-P, it was not found by abdominal X-P in this case. Several reports showed that gangrenous and perforated appendicitis were frequent in patients who had appendicitis with appendiceal calculus. Therefore, appendiceal calculus is one of the important findings suggesting perforation in patients with acute appendicitis. In order to confirm an appendiceal calculus, abdominal CT should be performed in patients with acute appendicitis before surgery.
