Appendectomy and Resection of the Terminal Ileum with Secondary Severe Necrotic Changes in Acute Perforated Appendicitis

Abstract

Patient: Female, 19Final Diagnosis: Acute perforated appendicitis • appendiceal abscess • secondary necrosis of the ileal wallSymptoms: Right lower quadrant abdominal pain • feverMedication: —Clinical Procedure: Diagnostic laparoscopy • open drainage of an appendiceal abscess • appendectomy • ileal resectionSpecialty: SurgeryObjective:Management of emergency careBackground:Resectional procedures for advanced and complicated appendicitis are performed infrequently. Their extent can vary: cecal resection, ileocecectomy, and even right hemicolectomy. We present a very rare case of appendectomy that was combined with partial ileal resection for severe necrotic changes and small perforation of the ileum.Case Report:A 19-year-old female patient was hospitalized with right iliac fossa pain and fever 10 days after the onset of symptoms. On laparoscopy, a large mass in a right iliac fossa was found. The ultrasound-guided drainage of the suspected appendiceal abscess was unavailable. After conversion using McBurney’s incision, acute perforated appendicitis was diagnosed. It was characterized by extension of severe necrotic changes onto the ileal wall and complicated by right iliac fossa abscess. A mass was bluntly divided, and a large amount of pus with fecaliths was discharged and evacuated. Removal of necrotic tissues from the ileal wall led to the appearance of a small defect in the bowel. A standard closure of this defect was considered as very unsafe due to a high risk of suture leakage or bowel stenosis. We perform a resection of the involved ileum combined with appendectomy and drainage/tamponade of an abscess cavity. Postoperative recovery was uneventful. The patient was discharged on the 15th day.Conclusions:In advanced appendicitis, the involved bowel resection can prevent possible complications (e.g., ileus, intestinal fistula, peritonitis, and intra-abdominal abscess). Our case may be the first report of an appendectomy combined with an ileal resection for advanced and complicated appendicitis.

Abdomen hostil: complicación quirúrgica ulterior a 9 intervenciones

“…Al presentarse una apendicitis complicada de larga evolución con posterior formación de un absceso peri apendicular severo, el manejo de la base apendicular se dificulta como consecuencia del proceso inflamatorio, necrosis de pared cecal y el posible compromiso de órganos vecinos; la apendicetomía por si sola es insuficiente, siendo en ocasiones necesaria la resección ileocecal o hemicolectomía derecha, para prevenir complicaciones sépticas como fístula intestinal, peritonitis, abscesos intrabdominales y obstrucción intestinal aguda 5 .…”