A ten year old boy came with history of pain abdomen since 1 week and features of generalized peritonitis. CT scan of the abdomen was suggestive of ruptured appendicitis with presence of an unusually large appendicolith. Exploratory laparotomy was done and the appendix was found to be perforated just distal to the base with the appendicolith lying outside of the appendicular lumen. Postoperative recovery was uneventful.
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