The tip of the appendix is typically the first site of inflammation and appendiceal perforation. 

Modalities:

• NECT:  sometimes adequate if patient has ample intraperitoneal fat

• CECT: Can visualize early appendicitis via increased mural enhancement. Helps to diagnose perforation w nonenhancement of necrotic portion of appendiceal wall as well as inflammed bowel and abscesses.

• Oral contrast: can be helpful in identifying the appendix

Complications:

• Gangrene and perforation, abscess formation. 

• Peritonitis, septiciemia

• Pyelophlebitis or superior mesenteric or portal vein +/- hepatic abscess 

• Dropped appendicolith w associated abscess. 

TX

• Surgery: nonperforated or minimal perforation. 

• Percutaneous drainage: well-localized abscess >3 cm

• Abx therapy: periappendiceal ST inflammation, no abscess.