COMPLICATED RETROILEAL APPENDICITIS WITH RETROPERITONEAL ABSCESS RESOLVED BY LAPAROSCOPY
EAES Academy. de-Alba Cruz I. 07/05/22; 362986; P029
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Abstract
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Aim:
Report the case since the presentation of retroileal appendicitis is rare as well as laparoscopic surgical management in these cases.
Methods:
36-year-old female with no significant history. She started 48 hours prior to admission with colicky diffuse abdominal pain of intensity 7/10, radiation to the lower quadrants, nausea, emesus and fever. EF: tender abdomen in lower quadrants, positive rovsing, positive mcburney, negative von blumberg. Laboratories: leucos 14.3, neutral 70. Surgical time is requested to perform laparoscopic appendectomy.
Results:
A laparoscopic approach was performed with 3 ports (10 mm umbilical, 5 mm supraubic, and 5 mm left flank) with pneumoperitoneum at 14 mmHg. Reaction-free liquid is found in 80 cc abdominal cavity, plastron made up of cecum, terminal ileum and cecal appendix which is retroilel adhered to terminal ileum mesentery. The plastron is dissected until finding a retroileal cecal appendix with necrotic patches as well as a perforation in the integral middle third base, which is firmly adhered to the mesentery. A 10 cc retoperitoneal abscess is found, which is drained, a mesoappendix dissection is performed at the appendicular base level, a seromuscular point is made at the appendicular base level with 2-0 silk, an intracorporeal knot is made, securing the appendicular stump. A cecal appendix cut is performed with harmonic and a meso-appendix cut is continued. The piece is extracted and sent to pathology, the surgical site is washed, penrose drainage is placed, ports are removed and the procedure is considered completed. Patient with adequate evolution is discharged on the third day.
Conclusions:
The laparoscopic approach remains the gold standard even for complicated appendicitis. The seromuscular point at the appendicular base is an efficient resource for stump management in complicated appendicitis
Report the case since the presentation of retroileal appendicitis is rare as well as laparoscopic surgical management in these cases.
Methods:
36-year-old female with no significant history. She started 48 hours prior to admission with colicky diffuse abdominal pain of intensity 7/10, radiation to the lower quadrants, nausea, emesus and fever. EF: tender abdomen in lower quadrants, positive rovsing, positive mcburney, negative von blumberg. Laboratories: leucos 14.3, neutral 70. Surgical time is requested to perform laparoscopic appendectomy.
Results:
A laparoscopic approach was performed with 3 ports (10 mm umbilical, 5 mm supraubic, and 5 mm left flank) with pneumoperitoneum at 14 mmHg. Reaction-free liquid is found in 80 cc abdominal cavity, plastron made up of cecum, terminal ileum and cecal appendix which is retroilel adhered to terminal ileum mesentery. The plastron is dissected until finding a retroileal cecal appendix with necrotic patches as well as a perforation in the integral middle third base, which is firmly adhered to the mesentery. A 10 cc retoperitoneal abscess is found, which is drained, a mesoappendix dissection is performed at the appendicular base level, a seromuscular point is made at the appendicular base level with 2-0 silk, an intracorporeal knot is made, securing the appendicular stump. A cecal appendix cut is performed with harmonic and a meso-appendix cut is continued. The piece is extracted and sent to pathology, the surgical site is washed, penrose drainage is placed, ports are removed and the procedure is considered completed. Patient with adequate evolution is discharged on the third day.
Conclusions:
The laparoscopic approach remains the gold standard even for complicated appendicitis. The seromuscular point at the appendicular base is an efficient resource for stump management in complicated appendicitis
Aim:
Report the case since the presentation of retroileal appendicitis is rare as well as laparoscopic surgical management in these cases.
Methods:
36-year-old female with no significant history. She started 48 hours prior to admission with colicky diffuse abdominal pain of intensity 7/10, radiation to the lower quadrants, nausea, emesus and fever. EF: tender abdomen in lower quadrants, positive rovsing, positive mcburney, negative von blumberg. Laboratories: leucos 14.3, neutral 70. Surgical time is requested to perform laparoscopic appendectomy.
Results:
A laparoscopic approach was performed with 3 ports (10 mm umbilical, 5 mm supraubic, and 5 mm left flank) with pneumoperitoneum at 14 mmHg. Reaction-free liquid is found in 80 cc abdominal cavity, plastron made up of cecum, terminal ileum and cecal appendix which is retroilel adhered to terminal ileum mesentery. The plastron is dissected until finding a retroileal cecal appendix with necrotic patches as well as a perforation in the integral middle third base, which is firmly adhered to the mesentery. A 10 cc retoperitoneal abscess is found, which is drained, a mesoappendix dissection is performed at the appendicular base level, a seromuscular point is made at the appendicular base level with 2-0 silk, an intracorporeal knot is made, securing the appendicular stump. A cecal appendix cut is performed with harmonic and a meso-appendix cut is continued. The piece is extracted and sent to pathology, the surgical site is washed, penrose drainage is placed, ports are removed and the procedure is considered completed. Patient with adequate evolution is discharged on the third day.
Conclusions:
The laparoscopic approach remains the gold standard even for complicated appendicitis. The seromuscular point at the appendicular base is an efficient resource for stump management in complicated appendicitis
Report the case since the presentation of retroileal appendicitis is rare as well as laparoscopic surgical management in these cases.
Methods:
36-year-old female with no significant history. She started 48 hours prior to admission with colicky diffuse abdominal pain of intensity 7/10, radiation to the lower quadrants, nausea, emesus and fever. EF: tender abdomen in lower quadrants, positive rovsing, positive mcburney, negative von blumberg. Laboratories: leucos 14.3, neutral 70. Surgical time is requested to perform laparoscopic appendectomy.
Results:
A laparoscopic approach was performed with 3 ports (10 mm umbilical, 5 mm supraubic, and 5 mm left flank) with pneumoperitoneum at 14 mmHg. Reaction-free liquid is found in 80 cc abdominal cavity, plastron made up of cecum, terminal ileum and cecal appendix which is retroilel adhered to terminal ileum mesentery. The plastron is dissected until finding a retroileal cecal appendix with necrotic patches as well as a perforation in the integral middle third base, which is firmly adhered to the mesentery. A 10 cc retoperitoneal abscess is found, which is drained, a mesoappendix dissection is performed at the appendicular base level, a seromuscular point is made at the appendicular base level with 2-0 silk, an intracorporeal knot is made, securing the appendicular stump. A cecal appendix cut is performed with harmonic and a meso-appendix cut is continued. The piece is extracted and sent to pathology, the surgical site is washed, penrose drainage is placed, ports are removed and the procedure is considered completed. Patient with adequate evolution is discharged on the third day.
Conclusions:
The laparoscopic approach remains the gold standard even for complicated appendicitis. The seromuscular point at the appendicular base is an efficient resource for stump management in complicated appendicitis
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