A 20-year-old man has 2 days of low-grade fever, vague lower abdominal discomfort, diarrhoea, and urinary frequency. Right iliac fossa guarding is minimal, but digital rectal examination reveals marked tenderness over an anterior boggy swelling. Which anatomical variant of the appendix best explains this presentation?

• A Retrocaecal appendix
• B Pelvic appendix lying over the pelvic brim ✓
• C Subhepatic appendix
• D Preileal appendix

Explanation

A pelvic appendix hangs into the pelvis, so inflammation irritates the rectum and bladder, producing diarrhoea, tenesmus, and urinary frequency, while right iliac fossa signs stay minimal. Rectal examination elicits tenderness of a palpable pelvic mass. A retrocaecal appendix instead causes flank pain, positive psoas testing, and often a silent abdomen with minimal anterior wall signs.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.