Flank Abscess After Perforated Acute Appendicitis

Year 2021, Volume: 4 Issue: 3, 106 - 109, 30.09.2021

Tolga Kalaycı

Abstract

Aim: Abscess after appendectomy is an important problem. However, there was no case of flank abscess after appendectomy in literature. In this case report, we wanted to present a case of flank abscess due to perforated appendicitis.

Case: A 65-year-old male patient presented to the emergency department with complaints of abdominal pain and fever. The patient was diagnosed with acute appendicitis during the evaluation in the emergency department, and emergency surgery was planned for the patient. During laparoscopic exploration, perforation was observed in the middle part of the appendix. The patient underwent laparoscopic appendectomy. Abdominal ultrasonography (USG) was performed on the patient since there was no regression in the patient's infective parameter values in the postoperative service follow-up. No pathology (abscess or fluid collection) was observed in the USG evaluation. Computed tomography (CT) was performed as the patient's infective blood parameters continued to increase. CT scan showed a 70*50 mm abscess in the right flank without intra-abdominal abscess. Abscess drainage was performed with a right flank incision under sedation. All laboratory parameters returned to normal on the 14th postoperative day, and the patient was discharged without complications.

Conclusion: Flank abscess after appendectomy is a very rare condition. The diagnosis of flank abscess should be kept in mind in patients who underwent appendectomy due to perforated appendicitis and whose infective blood parameters continue to be elevated in the follow-up.

Keywords

Abscess, appendectomy, drainage, laparoscopy

Perfore Akut Apandisit Sonrası Flank Apsesi

Abstract

Amaç: Apendektomi sonrası apse önemli bir problemdir. Ancak literatürde apendektomi sonrası flank apse vakasına rastlanılmamıştır. Bu olgu sunumunda perfore apandisit nedeniyle gelişen bir flank apse olgusunu sunmak istedik.

Olgu: 65 yaşında erkek hasta karın ağrısı ve ateş şikâyeti ile acil servise başvurdu. Acil serviste yapılan değerlendirmede hastaya akut apandisit tanısı konuldu ve acil cerrahi planlandı. Laparoskopik eksplorasyon sırasında apendiksin orta kısmında perforasyon izlendi. Hastaya laparoskopik apendektomi uygulandı. Postoperatif servis takibinde hastanın enfektif parametre değerlerinde gerileme olmadığı için hastaya karın ultrasonografisi (USG) yapıldı. USG değerlendirmesinde herhangi bir patoloji (apse veya sıvı toplanması) gözlenmedi. Hastanın enfektif kan parametrelerinin artmaya devam etmesi üzerine, bilgisayarlı tomografi (BT) çekildi. BT'de karın içi apsesi olmaksızın sağ flankta 70*50 mm apse görüldü. Sedasyon altında sağ flank insizyonu ile apse drenajı yapıldı. Ameliyat sonrası 14. günde tüm laboratuvar parametreleri normale dönen hasta komplikasyonsuz taburcu edildi.

Sonuç: Apendektomi sonrası flank apsesi çok nadir görülen bir durumdur. Perfore apandisit nedeniyle apendektomi yapılan ve takipte enfektif kan parametreleri yükselmeye devam eden hastalarda flank apse tanısı akılda tutulmalıdır.

Keywords

Abse, apendektomi, drenaj, laparoskopi

References

• Yeni M, Peksöz R, Dablan A, et al. A rare acute abdomen case: Acute appendicitis in the patient with situs inversus totalis. J Surg Med. 2019;3(10):766-8.
• Ahmed HO, Muhedin R, Boujan A, et al. A five-year longitudinal observational study in morbidity and mortality of negative appendectomy in Sulaimani teaching Hospital/Kurdistan Region/Iraq. Scientific reports. 2020;10(1):1-7.
• Ditillo MF, Dziura JD, Rabinovici R. Is it safe to delay appendectomy in adults with acute appendicitis? Annals of surgery. 2006;244(5):656.
• Busch M, Gutzwiller FS, Aellig S, et al. In-hospital delay increases the risk of perforation in adults with appendicitis. World journal of surgery. 2011;35(7):1626-33.
• Papandria D, Goldstein SD, Rhee D, et al. Risk of perforation increases with delay in recognition and surgery for acute appendicitis. Journal of Surgical research. 2013;184(2):723-9.
• Almström M, Svensson JF, Patkova B, et al. In-hospital surgical delay does not increase the risk for perforated appendicitis in children. Annals of surgery. 2017;265(3):616-21.
• Yardeni D, Hirschl RB, Drongowski RA, et al. Delayed versus immediate surgery in acute appendicitis: do we need to operate during the night? Journal of pediatric surgery. 2004;39(3):464-9.
• Mariage M, Sabbagh C, Grelpois G, et al. Surgeon's Definition of Complicated Appendicitis: A Prospective Video Survey Study. Euroasian journal of hepato-gastroenterology. 2019;9(1):1.
• Kotan Ç, Köseoğlu B, Barut İ, et al. The Comparison of Clinical Features of Acute Appendicitis in Childs, Adults and Elderly Population. Van Medical Journal.7(4):133-7.
• Moslemi S, Tahamtan M, Hosseini SV. A late-onset psoas abscess formation associated with previous appendectomy: a case report. Bulletin of Emergency & Trauma. 2014;2(1):55.
• Hsieh C-H, Wang Y-C, Yang H-R, et al. Retroperitoneal abscess resulting from perforated acute appendicitis: analysis of its management and outcome. Surgery today. 2007;37(9):762-7.
• Coelho A, Sousa C, Marinho A, et al. Post-appendectomy intra-abdominal abscesses: six years' experience in a Pediatric Surgery Department. Cirugia pediatrica: organo oficial de la Sociedad Espanola de Cirugia Pediatrica. 2017;30(3):152-5.
• Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database of Systematic Reviews. 2010(10).
• Levin DE, Pegoli W. Abscess after appendectomy: Predisposing factors. Advances in surgery. 2015;49(1):263-80.