# Complicated appendicitis presenting as anterior abdominal wall abscess in a diabetic patient: A case report

## TL;DR

A diabetic patient developed a rare abdominal wall abscess from perforated appendicitis, highlighting the need for early diagnosis and imaging in high-risk individuals.

## Contribution

This case report highlights the rare complication of anterior abdominal wall abscess in diabetic patients with perforated appendicitis.

## Key findings

- Diabetic patients have a higher risk of appendicular perforation (38.9%) compared to non-diabetics (18.5%).
- Anterior abdominal wall abscesses from perforated appendicitis are rare but significant, especially in immunocompromised individuals.
- Early imaging and timely surgical intervention are critical to prevent severe complications in high-risk patients.

## Abstract

Acute appendicitis is one of the most common surgical emergencies (8.6 % in men and 6.4 % in women), with varying presentations, including complications such as appendicular abscess. While the typical clinical course involves right lower quadrant pain and fever, rare complications can present with atypical symptoms, particularly in high-risk patients such as those with diabetes.

A 55-year-old diabetic female presented with a 10-day history of worsening abdominal pain, foul-smelling discharge at the anterior abdominal wall below the umbilicus, and fever. Imaging revealed an appendicular abscess extending into the anterior abdominal wall. Emergency exploratory laparotomy showed a perforated appendix with a purulent collection in the peritoneal cavity extending to the anterior abdominal wall, requiring drainage and right hemicolectomy.

Perforated appendicitis (incidence of 20–30 %), particularly in diabetic patients, can lead to localized abscesses or soft tissue infections in atypical locations such as the abdominal wall. These rare complications are more likely in immunocompromised individuals, including those with diabetes, where the incidence of perforated appendicitis is notably higher. Early imaging with ultrasonography or Contrast Enhanced Computed Tomography is critical for identifying complicated appendicitis and guiding surgical intervention.

Anterior abdominal wall abscesses as a complication of perforated appendicitis are rare but significant. This case underscores the importance of early and accurate diagnosis, supported by imaging, to guide appropriate surgical management. Timely intervention can help prevent life-threatening conditions such as necrotizing fasciitis, improve patient outcomes, and reduce the risk of postoperative complications, particularly in high-risk populations.

•Acute appendicitis is one of the common surgical cases with lifetime incidences of 8.6% of men and 6.4% of women.•Anterior abdominal wall abscess due to perforated appendicitis is rare; common in diabetics and with impaired immunity.•Appendicular perforation is more common in diabetics (38.9%) than non-diabetics (18.5%), showing higher complication risk.•Ultrasonography and Contrast-enhanced computed tomography are crucial for diagnosis and guiding the surgical approach.•Early diagnosis and timely surgical intervention are crucial to prevent severe complications, improving patient outcomes.

Acute appendicitis is one of the common surgical cases with lifetime incidences of 8.6% of men and 6.4% of women.

Anterior abdominal wall abscess due to perforated appendicitis is rare; common in diabetics and with impaired immunity.

Appendicular perforation is more common in diabetics (38.9%) than non-diabetics (18.5%), showing higher complication risk.

Ultrasonography and Contrast-enhanced computed tomography are crucial for diagnosis and guiding the surgical approach.

Early diagnosis and timely surgical intervention are crucial to prevent severe complications, improving patient outcomes.