Abdominal wall abscess in a diabetic patient with ruptured appendicitis.

A62-year-old obese man presented to the emergency department because of poor appetite and right-sided abdominal pain for 1 week. He had a history of poorly controlled type 2 diabetes and denied having any recent trauma. On arrival, his blood pressure was 96/46 mm Hg; pulse rate, 129 beats per minute; and body temperature, 37.7°C. Physical examination disclosed hypoactivity of bowel sounds and rebound tenderness over the right upper and lower quadrants of the abdomen. There was no crepitus or palpable mass. Laboratory data showed leukocytosis (24,200/ L), elevated C-reactive protein (16.95 mg/ dL), and hyperglycemia (307 mg/dL). A plain abdominal roentgenogram revealed an amorphous subcutaneous air accumulation over the right side of the abdomen (Fig. 1, arrows). Contrastenhanced computed tomography (CECT) of the abdomen disclosed fecaliths (arrowhead) within the ruptured appendix with