Right Psoas Abscess as a Consequence of Ruptured Appendix with Caecal Perforation and Presenting as Right Lumbar Swelling in a Toddler: A Rare Presentation of Appendicitis PD03-PD05
Dr. Umesh Kumar Gupta,
Type 4, Block-C, Room No-202, New Campus, Etawah, Uttar Pradesh, India.
Psoas Abscess (PA) is a very rare form of presentation of appendicular pathology, especially in a toddler. A three-year-old male child presented to the casualty with complaint of right lumbar swelling for 14 days. There was no other significant history. On clinical examination, there was 5×5 cm right lumbar swelling with a prominent bulge, which was non tender. USG and Contrast Enhanced Commuted Tomography (CECT) abdomen revealed PA which was drained by incision made on the bulge. There was feculent output noted from the incision and drainage site the following day. Child underwent exploratory laparotomy and was found to have ruptured partially sloughed of appendix along with perforated caecum going deep to the psoas muscle which in turn was communicating via tract to the incision and drainage site. Residual appendectomy along with caecal repair was done. Diverting proximal loop ileostomy was made and an abdominal drain was placed. Postoperatively, the child recovered well and was discharged on postoperative day 5 with a functioning ileostomy and on full oral feeds. In the follow-up distal cologram was done which revealed free flow of contrast along the entire colon up to rectum. The child has now been planned for stoma closure. Prompt diagnosis and prompt intervention was responsible for significantly reducing morbidity in the present case.