Fig. 6.

A 22-year-old male with AA preoperatively diagnosed with unenhanced MDCT (a) revealing a distended, thickened appendix (arrow) with a small calcified appendicolith, surrounded by right-sided fascial fluid and perivisceral fat stranding. Intraoperative and pathological findings diagnosed phlegmonous AA. Two weeks after LA, persistent fever, leukocytosis (13,500/mmc) and increased lipase and C-reactive protein values (380 mg/l) led to repeated contrast-enhanced MDCT. Imaging showed subphrenic (thin arrows in b) and infrahepatic (arrowheads in b and c) collections: the former with enhancing serosa, the latter with thickened enhancing borders abutting the lateroconal fascia. Laparoscopic exploration confirmed subhepatic and right subphrenic abscesses; conversion to laparotomy was necessary to drain collections and clean the peritoneal cavity. The subsequent postoperative course was further complicated by right-sided pneumonia and pleural effusion