Foreign body induced acute perforated appendicitis: an unusual case presentation from a tertiary care centre

Foreign body-induced appendicitis is an uncommon cause of acute appendicitis and may rarely result in perforation and localized peritonitis. Diagnosis can be challenging when there is no definite history of foreign body ingestion. We present a case of acute perforated appendicitis secondary to an impacted appendiceal foreign body in an adult patient. Clinical evaluation, laboratory investigations, contrast-enhanced computed tomography (CT), operative findings, and postoperative outcome were assessed. A 45-year-old male presented with a 2-day history of abdominal pain that localized to the right iliac fossa, associated with low-grade fever, nausea, vomiting, and anorexia. Examination revealed right iliac fossa tenderness, guarding, and rebound tenderness, with positive McBurney's and Rovsing's signs. Leukocytosis with neutrophilic predominance was present, and the Alvarado score was 8/10. CT demonstrated an inflamed appendix containing a hyperdense linear foreign body with focal appendiceal wall disruption, suggestive of perforation. Emergency appendectomy revealed a perforated appendix with localized peritonitis and an impacted foreign body within the appendiceal lumen. The foreign body and appendix were removed, and postoperative recovery was uneventful. Foreign body-induced perforated appendicitis is a rare but important cause of complicated appendicitis. CT is valuable for identifying an intraluminal foreign body and associated complications. Early surgical intervention with appendectomy and foreign body removal is effective when perforation or localized peritonitis is present.