A clinical case of surgical treatment of appendiceal stump abscess

Abstract

In Ukraine, the share of patients with acute appendicitis is 89.1% of the total number of patients with acute surgical pathology. In modern surgical practice, early and late complications occupy the first place in the structure of acute surgical diseases of the abdominal organs, regardless of the age and gender of the patients, and the postoperative mortality is on average 0.15%. In the remote period after an appendectomy, despite the progress of modern surgery, a very rare complication known as inflammation of the stump of the appendix can occur.

The patient, 25 years old, turned to the department of purulent surgery with complaints of a «small wound» at the site of the postoperative scar in the right inguinal area and minor purulent discharge from it. Four months ago, in July, he was operated on for acute phlegmonous appendicitis. On November 1, after physical exertion, the wound reappeared, and on November 3, the patient independently sought a consultation at the reception department of the Clinical City Hospital No3. He was examined by a surgeon and hospitalized. During the revision of the wound, a tumor‑like formation measuring 2.5x3.0x2.5 cm, as well as the parietal peritoneum, was revealed. Appendectomy was performed by the method of pouch ligation with drainage of the abdominal cavity through a separate contraperture with polyvinyl chloride drainage. After the operation, a diagnosis was established: abscess of the stump of the appendix, and external fistula of the anterior abdominal wall. The postoperative wound healed with primary tension, and the sutures were removed.

The diagnosis of appendicitis may be mistakenly excluded from the clinical search due to the presence of a postoperative scar after appendectomy. A clear clinical picture of acute appendicitis or the opening of a fistula at the site of a postoperative scar in the right iliac region indicates the need for a computer tomography of the abdominal organs with contrast to establish an accurate diagnosis and choose the correct treatment tactics. The only treatment for inflammation of the appendiceal stump is a complete appendectomy with appendix removal either by open or laparoscopic surgery, which should be performed urgently to avoid further complications.