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CASE REPORT   

Chirurgia 2021 August;34(4):181-4

DOI: 10.23736/S0394-9508.20.05151-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Retroperitoneal abscess and ileal ischemia: report of a complicated case of appendicitis

Andrea BIANCO , Stefania MUZIO, Enrica BERTOTTI, Giorgio BORELLO, Monica CARRERA, Valter MARTINO, Eraldo PERSONNETTAZ

Department of General Surgery, Hospital of Ciriè, ASL TO4, Ciriè, Italy



Acute appendicitis is a common surgical emergency worldwide, with diagnostic and therapeutic managements well established. However, in complicated presentations not only the correct diagnosis but also the choice of treatment still represents a matter of debate. A 54-year-old male, without comorbidities, was hospitalized for persisting abdominal pain. Clinical examination evidenced only mild epigastric tenderness. Laboratory tests revealed leukocytosis (WBC 17.8/mm3, neutrophils 80.3%) and elevated C-reactive protein (120 mg/L). A CT scan showed a massive fluid collection with air bubbles originating behind the pancreas with caudal extension until right iliac fossa, not dissociated from the terminal ileum. During surgery, a massive retroperitoneal abscess growing the entire mesenteric root and extending up to duodenum-pancreatic plane was identified and a perforated meso-celiac appendix was founded. Due to necrosis, a laceration of mesentery was developed with initial signs of ischemic sufferance of ileal loops. To avoid intestinal resection, a packing with open-abdomen technique was done and a second look laparotomy at distance of 48h was performed. The mesentery was less edematous and ileal loops well vascularized, then resection was not necessary. The patient stayed in intensive care unit for three days and discharged in seventh postoperative day. The pathologic examination showed a necrotic appendix without signs of malignity. Retroperitoneal abscess with mesenteric involvement may be a rare presentation of acute appendicitis. These cases have not a clear and unique treatment in literature and the better management still depends by surgeons’ experience.


KEY WORDS: Appendicitis; Retroperitoneal space; Abscess; Laparotomy

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