Appendicular Rupture Leading to Laparoscopic Appendectomy: Report of a Case 2932

• Published in: The American journal of gastroenterology Vol. 113; no. Supplement; p. S1615
• Main Authors: Qureshi, Zaheer A., Thomas, Stacey E., Bodepudi, Sri Lekha, Reyes, Sherry, Biswas, Sharmi, Altaf, Faryal
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.10.2018
• Subjects: Abdomen; Appendectomy; Appendicitis; Appendix; Gastroenterology; Laparoscopy
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/00000434-201810001-02931

Acute appendicitis is characterized by inflammation of the inner lining of vermiform appendix caused by obstruction of the lumen of the appendix. Despite advances in medical imaging and diagnostic methods, clinical assessment is still the mainstay of diagnosis. Similarities in clinical presentation of Appendicitis to more common illnesses can lead to misdiagnosis with studies showing a 23% misdiagnosis rate in women and 9% in men. Studies in the US demonstrated that utilization rate of Laparoscopic Appendectomy for perforated appendicitis increased from 45.0% in 2006 to 50.5% in 2008 for adults. Early identification and treatment can prevent fatal complications, therefore, emphasizing the importance of physicians keen eye for diagnosis. We present a case of 20-year-old male presented to the ER with severe lower abdominal pain associated with nausea, vomiting, and low-grade fever for 1 week. The patient had similar symptoms 4 days prior and was treated conservatively for acute gastritis. Vitals in the ER showed BP 90/60 mm Hg, HR 120 bpm, RR 22/min and Temperature 100 F. Physical exam showed patient in a hypovolemic state with low-grade pyrexia and severe tenderness noted in the right iliac fossa along with guarding and rebound tenderness. Further examination revealed a positive Pointing sign and Rovsing sign along with absent of bowel sounds on auscultation. Laboratory investigations presented WBC count of 15,000 cells/uL, platelets of 200,000/mm3, Hb of 11 g/ dl, and BMP within normal limits. Alvarado score was 8/10 making acute appendicitis a differential. The FAST scan showed free fluid in the abdomen but was inconclusive. Comprehensive CT showed a perforated appendix with fluid collection in the abdomen. Laparoscopic Appendectomy was done immediately which showed an inflamed, gangrenous appendix. There were no complications postoperatively and the patient was discharged home in a stable condition. This case is pathognomonic for a life-threatening perforated appendix requiring laparoscopic. A laparoscopic appendectomy is required immediately to reduce the risk for septicemia, peritonitis, small bowel obstructions, and pylephlebitis. As opposed to open appendectomies, laparoscopic appendectomies require tiny, keyhole incisions for scope visualization and appendix extraction. Decreased length of hospital stay, less postoperative pain, and lower rates of wound infection were deduced after laparoscopy and is the preferred method in obese and older patients.