Gastroenterology image challenge: A 57-year-old woman presented with a four-day history of migratory right iliac fossa pain and abdominal distension. Her past medical history consisted of a deep vein thrombosis, uterine fibroids and cholecystectomy for gallstone disease. Family history was positive for colon cancer. She was not peritonitic, and there were no palpable abdominal masses on examination. The patient was afebrile on admission, with a neutrophilia of 8.2 × 10^9/L and an elevated C-reactive protein of 85 nmol/L. A computed tomography scan found a distended appendix measuring 28 mm in caliber with a 13 mm appendicolith at the base. Intravenous ciprofloxacin and metronidazole were commenced (due to penicillin allergy) for a presumed complicated appendicitis, and the patient proceeded to a laparoscopic appendicectomy.
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