Appendicitis in the Deep Pelvis

Sonography is an excellent tool to identify the appendix in patients with abdominal pain. If a normal appendix is identified, then a search for alternative pathology can be pursued. Identifying the appendix can be challenging: the location varies, overlying bowel gas interferes, and patient size can affect the resolution. Specific sonographic findings can help identify when an appendix is inflamed. A positive appendicitis may present with varying sonographic characteristics, and the tip of the appendix may present in atypical locations. The classic location of the appendix originates off the cecum with the tip draping over the iliac vessels in the right lower quadrant. This case report describes a case of appendicitis in the deep pelvis. Sonography of the appendix bears enormous responsibility and, when done correctly, may still require clinical corroboration.