The patient presented with an elevated white blood cell count and right upper quadrant pain.
Appendicitis fluid in paracolic gutter.
Appendix in the right paracolic gutter.
Anterior segment arrow is partially compressed with flattened oval shape and normal diameter of 5 mm but posterior segment arrowhead is rounded with diameter of 7 mm.
Abdominal pelvic computed tomography showed abnormal fluid collection in the subdiaphragmatic lateral subhepatic and capsular regions extending into the right paracolic gutter see accompanying.
Fluid from an infected appendix can track up the right paracolic gutter to the hepatorenal recess.
Trace periappendiceal hypoechoic fluid is seen which is nonspecific and may relate to edema or trace dependent fluid in paracolic gutter.
Bile pus or blood released from viscera anywhere along its length may run along the gutter and collect in sites quite remote from the organ of origin.
In addition symptoms resembling those of gastroenteritis may result from colonic irritation.
Location of the inflamed appendix in the right paracolic gutter typically results in flank pain mimicking acute pyelonephritis or ureteral calculus.