After the patient was assessed in the ER, he underwent a US examination that revealed a right iliac fossa and suprapubic mass-like appearance of amalgamated bowel loops. Intervening bowel loops are seen. The impression of an inflammatory lesion was suggested. After doing the plain CT an appendicolith is identified yet we could not see the appendix.

After IV contrast administration: The full blown appearance of multiloculated and marginated mass is identified with air/fluid level. The related mesentery and peritoneum show enhancement and stranding giving the possibility of perforated appendicitis with pelvic collection and abscess formation that was proven after immediate surgical intervention.