The patient fully recovered, and was finally discharged after 21 days. Restoration of the bowel continuity was performed after 3 months. During follow-up of one year, the long-term course was uneventful. Histopathology showed a perforated appendicitis with severe peritonitis, as well as large necrosis formation of sigmoid mesenteric adipose tissue and a necrotic ulcer measuring 1 cm square on the anterior wall of the rectum. Since no diverticular disease could be detected, EPZ-6438 cell line it was strongly assumed that necrotizing appendicitis being the trigger of this massive inflammatory process that also facilitated

rectal wall necrosis and stercoral perforation, respectively. Discussion and review of the literature Retroperitoneal abscess and acute appendicitis Large retroperitoneal selleck compound abscess represents a potentially life-threatening complication of hollow viscus organ perforation, e.g. appendicitis [4, 5], diverticulitis [6], as well as inflammatory diseases of the

pancreas [7] and kidneys [8]. Often its starts as a retroperitoneal phlegmon with few clinical symptoms, hence its timely diagnosis may not be always achieved. Once abscess formation has started, it may spread from the pelvis along the spine and psoas muscle up to the diaphragm and laterally to the abdominal wall since there are no anatomical barriers limiting its penetration. Perforation of the appendix into the retroperitoneal space probably represents one of the commonest reason for large retroperitoneal abscess formation but there are only few reported series in the literature [4]. While its real incidence remains unknown, several risk factors have been AR-13324 identified to promote large abscess formation, such as diabetes, alcohol abuse, liver cirrhosis,

malignancy, chronic renal failure, and immunosuppressive therapy [9]. Hsieh et al. recently reported two cases and summarized the literature, whereby they found only additional 22 cases [4]. The main clinical features are the delayed diagnosis (mean time until diagnosis of 16 days), symptoms are dependent on the localization of the abscess and often unspecific, extension of abscess formation into the thigh and perinephritic space, and an increased disease-related ifenprodil mortality of 19%. Similar to our case, final diagnosis of retroperitoneal perforation originating from acute perforated appendicitis is often only achieved during surgical exploration. However, it remains unclear, who an otherwise healthy young patient can develop such a major abscess without having more clinical symptoms. Hepatic portal venous gas and acute appendicitis The presence of air bubbles in the extrahepatic and/or intrahepatic portal venous system is primarily a radiological finding that is detected by performing an abdominal CT scan for various reasons.