Chronic Appendicitis-Induced Effusive-Constrictive Pericarditis and Hepatic Fibrosis: A Case Report

BACKGROUND Effusive-constrictive pericarditis (ECP) is a rare pediatric condition linked to infections, autoimmune disorders, or post-surgical complications. Appendicitis, a common abdominal emergency, rarely causes systemic inflammation affecting distant organs. We report a unique case of chronic appendicitis with an appendicolith leading to ECP and hepatic fibrosis, necessitating extensive diagnostic evaluation and surgical interventions. CASE REPORT A 14.5-year-old boy presented with progressive dyspnea, reduced exercise tolerance, low-grade fever, and intermittent abdominal pain. Examination revealed hepatomegaly and systemic inflammation. Laboratory tests showed leukocytosis, elevated inflammatory markers, and mild liver enzyme abnormalities. Transthoracic echocardiography revealed a large pericardial effusion with tamponade, prompting urgent pericardiocentesis. CT identified a calcified appendicolith, but appendectomy was deferred to prioritize pericardial management. Pericardiocentesis provided partial relief. Persistent symptoms and further imaging confirmed pericarditis, leading to a subtotal pericardiectomy. Histology revealed chronic fibrotic pericarditis without infection. The patient improved significantly postoperatively but returned 6 weeks later with acute abdominal pain and fever. Imaging confirmed a perforated appendix with an abscess. Appendectomy led to complete resolution of symptoms, normalization of inflammatory markers, and improvement in hepatic and cardiac function. CONCLUSIONS This case highlights the diagnostic complexity of atypical appendicitis with systemic involvement. Recognizing abdominal pathologies as potential sources of systemic inflammation is vital, especially in refractory cases. Early intervention in the primary source can prevent severe complications and improve outcomes.