A snake in the grass: retroperitoneal abscess due to perforated appendicitis—management, approach and recommendations

A perforated retrocecal appendix resulting in a retroperitoneal abscess is a rare complication of a common disease. The first description of this condition was published in 1948. We present a case involving a 50-year-old woman who presented with abdominal pain inconsistent with the typical presentation of acute appendicitis and was eventually found to have a perforated retrocecal appendix accompanied by a retroperitoneal abscess. The patient was diagnosed using CT and operated upon but unfortunately had a resistant inflammatory process that led to persistent pus drainage from the abdomen despite multiple evacuation attempts and a prolonged hospital stay. In such cases, if the source of this type of inflammatory process has not yet been controlled or even identified, we recommend a second surgical examination, with additional surgical examinations as needed, and offer other suggestions.