Osteomyelitis of the body of the iliac bone as a late complication of perforated appendicitis with abscess formation

BACKGROUND: Osteomyelitis adjacent to an abscess is difficult to diagnose because both disorders can present with the same symptoms. Early recognition and start of treatment are essential because osteomyelitis can have severe consequences. We present a man with osteomyelitis by direct contamination of an adjacent abscess after a perforated appendicitis. METHODS: Case report. RESULTS: A 66-year-old man was treated conservatively for appendicitis with a large appendiceal mass. After perforation for which a resection of the affected coecum was performed, treatment was complicated by abscess formation. A small abscess deep in the pelvic cavity could not be reached for percutaneous drainage. After several weeks the patient's recovery stroked and he developed complaints of pain with weight-bearing and movement of the hip. Computed Tomography showed an osteolytic lesion of the body of the iliac bone adjacent to the former abscess. After long-term antibiotic treatment the patient recovered completely. RESULTS AND CONCLUSIONS: Osteomyelitis due to direct contamination from an adjacent abscess after a perforated appendicitis is rare. Diagnosis can be difficult because both disorders can present with the same complaints.