Appendicitis-perforated

This patient gave a fairly convincing story for appendicitis. POCUS revealed a “pocket o’ pus” around the caecum (now->perforated appendicitis). I couldn’t see the appendix and the CT showed it hiding underneath the caecum.

[Ed. note:  Free fluid around the bowels in the RLQ in someone with a history suspicious for appendicitis should always prompt further investigation.  While trace amounts of free fluid can be seen around the bowels of healthy male and female patients thanks to the newest generations of high resolution ultrasound, fluid found in a painful area is always a concern.]