Acute Appendicitis and Its Complications: Diagnostic Challenge and Treatment, Literature Review

Abstract

We present the clinical case of a 54-year-old female patient, who came to the emergency department for abdominal pain of 2 days of evolution, predominantly mesogastric and radiating to the right iliac fossa, accompanied by nausea and vomiting, does not refer fever. The clinical and paraclinical symptoms are suggestive of acute appendicitis. With Alvarado’s criteria with a high probability of acute appendicitis, she motivates herself and prepares for appendectomy, finding retroileal appendicular plastron. In the immediate postoperative period, complications inherent to the procedure arise: medically managed retroileal hematoma x 72 hours, decrease in hemoglobin levels, which requires a transfusion of compatible packed red blood cells, significant retroileal hematoma drainage is performed with infiltration in the ileum walls Cecal, bizarre evolution, torpid, with vomiting, abdominal distention, absence of stools and flatus on postoperative day 10, an Abdomen Rx is performed where they report air-fluid levels, Contrasting Computerized Axial Tomography of the abdomen reports narrow ileus cecal union, which is why it is motivated for Laparotomy explorer, finding stenosis of the ileo cecal segment due to stenosis, distortion of the segment, performing a right hemicolectomy and ileotransverse anastomosis, good evolution in the Intensive Care Unit until the 8th day when she presented leakage of intestinal contents through the penrose drain, quantifying m As of 500 cc a day, classifying high-output fistula, signs of abdominal sepsis, it is motivated for exploratory relaparotomy, with a frozen abdominal cavity, by multiple peritoneal adhesions, peritonitis, managing to identify the fistula of the anastomosis, friable tissue, performing drainage of localized peritonitis of the right hemiabdomen, ileostomy plus transverse colostomy, subsequently suffers alkaline burn at the operative site, despite handling with the colotomy kit isolating the ostomy from the skin, enters into hydro-electrolyte imbalance with severe hypokalemia, managing it with Parenteral replacement of potassium, until stabilizing and overcoming abdominal sepsis, being discharged after the 2nd month of hospitalization.