Pelvic Appendicitis (Complications)

Drawing of an appendix (citis) lying low in the pelvis (M. Bettex). In perforated appendicitis the periappendical abscess impresses on the rectum (dent) or may expand in both directions in the lower abdomen (arrows). A pelvic appendicitis may be difficult to diagnose due to the hidden site. Without or with perforation, evacuation of mucus by the anus or urgency and signs of lower urinary tract infection may be caused by irritation or pressure of/on the rectum or the bladder; therefore, the signs are interpreted as enterocolitis or cystourethritis. An abscess may expand on both sides of the abdomen. An encapsulated abscess in perforated appendicitis is difficult to diagnose except for the palpation of a typical local finding in the Douglas' cul-de-sac.