Presentation
Abdominal pain.
Patient Data
The appendix is dilated measuring 11 mm with wall stratification due to submucosal oedema (target-like sign) with minimal fat stranding. It shows appendico-caecal invagination (appendiceal intussusception) of proximal part of the appendix with dilated intra-caecal part measuring 22 mm surrounded by encysted intracaecal fluid. No suspicious caecal wall thickening or masses.
Bilateral inguinal hernias transmitting omental fat, larger on right side.
Basal lung zones show multiple calcific foci at both lower lobes.
Chest radiograph shows diffuse centrilobular emphysema, predominately affecting both upper lobes and multiple calcific foci at both lower lobes, mostly representing calcified granuloma.
Classification system for appendiceal intussusception by Forshall et al. 2.
appendicectomy is sufficient in types 1.a, 1.c, and 1.d as the lesion does not include appendiceal base
ileocaecectomy may be required in types 1.b and 1.e
Author: Ahmed K. Ali et al
Original files: https://www.sciencedirect.com/science/article/pii/S2213576622003621#bib14
Modifications: none
License: This file is licensed under Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
Case Discussion
CT features of appendico-caecal invagination of proximal part of the appendix, suggestive of appendiceal intussusception. It's a very rare diagnosis accounting for 0.01% of appendicectomies. It is considered as type 1.b according to Forshall et al. classification system.