Piloluminal Appendicitis

Case Presentation

An 8-year-old Caucasian female was admitted with 2-day history of abdominal pain, fever, and vomiting. She has no developmental delay. On examination, the patient was febrile and rebound tenderness was present in the right iliac fossa. The laboratory investigations revealed C-reactive protein of 183 mg/L and white blood cell count of 29.4 × 10⁹/L.

Diagnosis of acute appendicitis was made and she underwent open appendicectomy. Acute suppurative appendicitis with perforation at the tip was noted along with pus in the pelvis. When resecting, a tuft of hair was found protruding from the base of the appendix. Care was taken to remove all the hair in the appendicular stump in cecum. She had liberal washout with warm saline and wound was closed in layers. She was treated with antibiotics postoperatively.

Macroscopic examination revealed strands of hair at the neck and distal luminal dilatation with pus ([Figs. 1] and [2]). Microscopic examination showed acute suppurative inflammation involving full thickness of the wall and perforation 17 mm from the tip.

Figure 1 Cut section of appendix showing pus and hair in lumen.

Figure 2 Appendix with tuft of hair at its base.

Her mother highlighted the fact that she would regularly play with her hair and ingest the long strands of hair which were in close proximity to her mouth.

The patient made good postoperative recovery and was discharged home with oral antibiotics. She was readmitted a week later with mild wound infection and small pelvic collection which were managed conservatively with antibiotics.

• References

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