Perforated appendicitis secondary to a ruptured pyosalpinx managed by laparoscopic appendectomy and salpingectomy: a case report

Pyosalpinx, the accumulation of pus within the fallopian tube, rarely causes acute appendicitis. We report a 38-year-old woman who presented with a 10-day history of right lower quadrant pain and low-grade fever and was diagnosed radiologically with a perforated appendix. At laparoscopy, intraperitoneal pus, an appendix perforated at its tip, and a perforated right fallopian tube near the utero-tubal junction were found. Laparoscopic appendectomy with right salpingectomy was performed. Histopathology confirmed acute appendicitis and acute salpingitis; cultures showed no growth and GeneXpert was negative. She recovered uneventfully over six months of follow-up. To our knowledge, this is the first documented perforated appendix caused by ascending infection from a perforated pyosalpinx managed laparoscopically. The case highlights the importance of considering gynaecological pathology in atypical appendicitis and the value of a laparoscopic, interdisciplinary approach.