Case report
A 45 years male presented to the emergency department of Dadeldhura hospital, Nepal with pain in right iliac fossa for 4 days associated with low grade fever, nausea, vomiting and anorexia. His bowel and bladder habits were normal. On examination, the patient was febrile with tenderness and guarding in right iliac fossa. His hernial orifices were intact and bowel sounds were present.
Ultrasonography of abdomen showed acutely inflamed appendix with early lump formation and his total white blood cell count was 16000 mm3. Emergency open appendectomy was done which revealed an inflamed retrocecal appendix with lump measuring approximately 18 cm in length with perforation at the shaft of appendix (Figure 1). Histopathological examination of the specimen showed acutely inflamed appendix. His postoperative hospital stay was uneventful and discharged on third postoperative day.