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      Management of retroperitoneal appendiceal perforation: a case report

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          Abstract

          Retroperitoneal appendiceal perforation presents unique challenges in surgical management due to the complex nature of the retroperitoneal space. We present a case of a 57-year-old male with retroperitoneal appendiceal perforation, characterized by the presence of a large amount of gas in the retroperitoneal space. Emergent laparoscopic surgery was performed to address the retroperitoneal involvement. In retroperitoneal appendiceal perforation, surgical intervention and postoperative drainage are of great significance to prevent septic shock. The interconnectedness of the retroperitoneal space with other body regions is highlighted, underscoring the potential for severe complications. This case emphasizes the need for a tailored approach to managing retroperitoneal appendiceal perforation, preventing potential complications associated with this condition.

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          Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis.

          H. Kørner, K Söndenaa, J. Søreide … (2015)
          This prospective study was performed to investigate epidemiological characteristics in terms of the age- and sex-specific incidence in patients with perforated and nonperforated appendicitis. The study population comprised 1486 consecutive patients who underwent appendectomy for suspected acute appendicitis between 1989 and 1993. Two patient cohorts [n = 544 (37%)] were analyzed with regard to prehospitalization duration of symptoms and in-hospital observation time. The crude incidence of acute appendicitis was 86 per 100,000 per year. Although the incidence of nonperforated appendicitis was highest among adolescents and young adults (13-40 years of age), perforated appendicitis occurred at almost the same incidence in all sex and age groups. The diagnostic accuracy was 76%. Perforated appendicitis occurred in 19%, with higher rates in small children and the elderly, irrespective of gender. A high diagnostic accuracy was not associated with an increased rate of perforation. In small children and the elderly, the diagnostic accuracy was low and the perforation rate high. Patients with perforation had a significantly longer duration of symptoms as well as in-hospital observation time than did patients with nonperforated appendicitis. Perforated appendicitis showed a different incidence pattern than nonperforated appendicitis and was associated with a significantly longer duration of symptoms and in-hospital observation time, probably due to patient-related factors. We suggest this observation deserves attention regarding clinical diagnosis and treatment decision-making for patients with suspected acute appendicitis.
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            Diagnosis of acute appendicitis.

            Andy Petroianu (2012)
            Appendicitis is the most common abdominal emergency. While the clinical diagnosis may be straightforward in patients who present with classic signs and symptoms, atypical presentations may result in diagnostic confusion and delay in treatment. Abdominal pain is the primary presenting complaint of patients with acute appendicitis. Nausea, vomiting, and anorexia occur in varying degrees. Abdominal examination reveals localised tenderness and muscular rigidity after localisation of the pain to the right iliac fossa. Laboratory data upon presentation usually reveal an elevated leukocytosis with a left shift. Measurement of C-reactive protein is most likely to be elevated. The advances in imaginology trend to diminish the false positive or negative diagnosis. Radiographic image of faecal loading image in the caecum has a sensitivity of 97% and a negative predictive value that is 98%. In experienced hands, ultrasound may have a sensitivity of 90% and specificity higher than 90%. Helical CT has reported a sensitivity that may reach 95% and specificity higher than 95%. Despite all medical advances, the diagnosis of acute appendicitis continues to be a medical challenge. Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
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              Acute appendicitis: review and update.

              Jeffrey D. Hardin (1999)
              Appendicitis is common, with a lifetime occurrence of 7 percent. Abdominal pain and anorexia are the predominant symptoms. The most important physical examination finding is right lower quadrant tenderness to palpation. A complete blood count and urinalysis are sometimes helpful in determining the diagnosis and supporting the presence or absence of appendicitis, while appendiceal computed tomographic scans and ultrasonography can be helpful in equivocal cases. Delay in diagnosing appendicitis increases the risk of perforation and complications. Complication and mortality rates are much higher in children and the elderly.
              Article 0 comments Cited 42 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jinliang Li:
                ORCID: https://orcid.org/0000-0002-0707-0525
                Feng Li
                Jun Li
                Chunlei Wang
                Yubao Sun
                Xiaowei Bian
                Journal
                Journal ID (nlm-ta): J Surg Case Rep
                Journal ID (iso-abbrev): J Surg Case Rep
                Journal ID (publisher-id): jscr
                Title: Journal of Surgical Case Reports
                Publisher: Oxford University Press
                ISSN (Electronic): 2042-8812
                Publication date Collection: February 2024
                Publication date (Electronic): 13 February 2024
                Publication date PMC-release: 13 February 2024
                Volume: 2024
                Issue: 2
                Electronic Location Identifier: rjae069
                Affiliations
                Department of Emergency Surgery , Weifang People’s Hospital , Weifang, Shandong 261000, China
                Department of Emergency Surgery , Weifang People’s Hospital , Weifang, Shandong 261000, China
                Department of Emergency Surgery , Weifang People’s Hospital , Weifang, Shandong 261000, China
                Department of Emergency Surgery , Weifang People’s Hospital , Weifang, Shandong 261000, China
                Department of Emergency Surgery , Weifang People’s Hospital , Weifang, Shandong 261000, China
                Department of Emergency Surgery , Weifang People’s Hospital , Weifang, Shandong 261000, China
                Author notes
                Corresponding author. Department of Emergency Surgery, Weifang People’s Hospital, Weifang, Shandong 261000, China. E-mail: lijinliang1993@ 123456hotmail.com
                Author information
                https://orcid.org/0000-0002-0707-0525
                Article
                Publisher ID: rjae069
                DOI: 10.1093/jscr/rjae069
                PMC ID: 10871770
                SO-VID: e08091b2-f0c6-45a6-9374-59114468d3d3
                Copyright © Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 28 December 2023
                Date accepted : 25 January 2024
                Page count
                Pages: 3
                Categories
                Subject: Case Report
                Subject: AcademicSubjects/MED00910
                Subject: jscrep/040

                Keywords: appendix,retroperitoneum,perforation
                Data availability:
                Keywords: appendix, retroperitoneum, perforation

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