A Case of Pelvic Abscess with Appendicitis in which Interval Appendectomy was Performed following Preoperative Endoscopic Ultrasonography-guided Transrectal Drainage

Abstract

A 31-year-old man presented to the emergency department with complaints of right lower abdominal pain and vomiting. Laboratory data showed elevated levels of inflammatory markers, and contrast-enhanced computed tomography showed ascitic fluid in the pelvis and an inflamed appendix with a stone. The patient was hospitalized for antibiotic treatment. Seven days after admission, CT showed a pelvic abscess. Antibiotic treatment was continued, but the pelvic abscess did not improve. Endoscopic ultrasonography-guided transrectal drainage was performed on the 21st day after admission. On laboratory examination, the inflammatory reaction improved the next day. The patient was discharged on the 9th day after drainage therapy (30th day after admission). Four months later, laparoscopic interval appendectomy was performed, and the patient was discharged without any complications. This case shows that endoscopic ultrasonography-guided transrectal drainage is effective for preoperative treatment of a pelvic abscess with appendicitis.