Aim: Intra-abdominal collection or abscess (IAA) is a dreaded complication post open or laparoscopic appendectomy for perforated appendicitis. There have been many discussions on the role of laparoscopic irrigation during laparoscopic appendectomy for perforated appendix but not its role for patients who subsequently developed IAA post-surgery. Methods: All patients who developed clinical symptoms and radiological evidence of IAA of more than 5 cm × 5 cm post appendectomy from January 2014 to May 2016 were subjected to delayed laparoscopic suction (DLS) of the IAA. Days to resolution of fever and improvement of symptoms post the DLS were recorded. Complications during DLS like bowel injury, bleeding and conversion to open surgery were documented and analysed. Patients were followed up for 1 month to a year to look for potential adhesive intestinal obstruction. Results: Seven patients who met the criteria of large IAA were subjected to DLS at post-operative day 3 to day 5 post appendectomy. Six of the cases were post laparoscopic appendectomy and one case was post open appendectomy from another institution. Ports were inserted via the same sites as used during the first surgery. Turbid intraperitoneal fluid and abscesses were laparoscopically sucked without irrigation. There was no bowel injury, bleeding or conversion in any of the cases. All patients were afebrile within 24 h post procedure and their associated symptoms improved significantly. All patients were discharged within three days of DLS and have not returned with adhesive obstruction. Conclusion: Early recognition of IAA is important and early attempt at DLS resulted in better outcome of patients and lesser hospital stay. DLS is a safe and feasible technique. ABSTRACTArticle history:

Benign tumor of the myelin sheath or schwannoma is not uncommon, especially when it involves the peripheral or cranial nerves. But adrenal schwannoma is very rare and commonly presented as an incidentaloma. Adrenal incidentaloma by itself is not uncommon as more imaging is now being performed and its incidence is estimated to be around 4 to 6%. Clinical and imaging studies are not able to differentiate adrenal schwannoma from other causes of incidentaloma, making its diagnosis difficult preoperatively. We report a 64-year-old man who underwent computed tomography (CT) abdomen as part of his health-screening program. An 80 × 70 mm right adrenal tumor was discovered from the CT with features suggestive of malignancy. He has neither apparent abdominal symptoms nor symptoms related to adrenal hypersecretion. Apart from chronic hypertension, he also suffered from morbid obesity with body mass index (BMI) of 38. There was no clinical feature to suggest Cushing disease, pheochromocytoma, or primary hyperaldosteronism. His laboratories evaluation including endocrinology studies consistent with a non-functioning adrenal mass. He underwent an uneventful standard transabdominal right adrenalectomy. Immunohistochemistry report showed the tumor has characteristic of Antoni A type and positive for S-100 immunochemistry stain. The diagnosis of adrenal schwannoma was made. This case report highlights the difficulty in the management of adrenal incidentaloma.