Post-appendectomy Resistent Pain and Pathology

26 yrs old male, presented with acute abdomen 2 days ago, pain in right iliac, lumbar, and loin. Vomiting once, no urinary symptoms, no other GIT symptoms, no fever. Examination revealed tenderness in right iliac and lumbar areas. TLC was 13,000. Sonographic assessment of the abdomen and pelvis revealed a superficial blind ended tubular structure distended and tender under the probe mostly represented the inflamed appendix, echogenic omentum and thick bowel loops in the same area. Laparoscopic assessment revealed the picture you see in the video; the appendix was inflamed, but the mesentery of the terminal ileum was thickened, oedematous, and firm. The small intestine was thoroughly examined from the iliocaecal junction up to the DJ junction but no other pathology was detected.

Histopathological examination of the appendix revealed acute follicular appendicitis.

But the patient still has a pain and tenderness in the same areas as preoperative.

Follow up sonar revealed echogenic omentum, mesentery and small bowel loops in right iliac fossa.

What’s your opinion??