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Appendectomy and resection of the terminal ileum with secondary severe necrotic changes in acute perforated appendicitis.
Am J Case Rep. 2015 Jan 25; 16:37-40.AJ

Abstract

BACKGROUND

Resectional procedures for advanced and complicated appendicitis are performed infrequently. Their extent can vary: cecal resection, ileocecectomy, and even right hemicolectomy. We present a very rare case of appendectomy that was combined with partial ileal resection for severe necrotic changes and small perforation of the ileum.

CASE REPORT

A 19-year-old female patient was hospitalized with right iliac fossa pain and fever 10 days after the onset of symptoms. On laparoscopy, a large mass in a right iliac fossa was found. The ultrasound-guided drainage of the suspected appendiceal abscess was unavailable. After conversion using McBurney's incision, acute perforated appendicitis was diagnosed. It was characterized by extension of severe necrotic changes onto the ileal wall and complicated by right iliac fossa abscess. A mass was bluntly divided, and a large amount of pus with fecaliths was discharged and evacuated. Removal of necrotic tissues from the ileal wall led to the appearance of a small defect in the bowel. A standard closure of this defect was considered as very unsafe due to a high risk of suture leakage or bowel stenosis. We perform a resection of the involved ileum combined with appendectomy and drainage/tamponade of an abscess cavity. Postoperative recovery was uneventful. The patient was discharged on the 15th day.

CONCLUSIONS

In advanced appendicitis, the involved bowel resection can prevent possible complications (e.g., ileus, intestinal fistula, peritonitis, and intra-abdominal abscess). Our case may be the first report of an appendectomy combined with an ileal resection for advanced and complicated appendicitis.

Authors+Show Affiliations

Department of Faculty Surgery named after Prof. A.A. Rusanov, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russian Federation.Department of Gynecology, Mariinsky Hospital, Saint-Petersburg, Russian Federation.Department of Faculty Surgery named after Prof. A.A. Rusanov, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russian Federation.Department of Faculty Surgery named after Prof. A.A. Rusanov, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russian Federation.Department of Faculty Surgery named after Prof. A.A. Rusanov, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russian Federation.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

25618525

Citation

Shiryajev, Yuri N., et al. "Appendectomy and Resection of the Terminal Ileum With Secondary Severe Necrotic Changes in Acute Perforated Appendicitis." The American Journal of Case Reports, vol. 16, 2015, pp. 37-40.
Shiryajev YN, Volkov NN, Kashintsev AA, et al. Appendectomy and resection of the terminal ileum with secondary severe necrotic changes in acute perforated appendicitis. Am J Case Rep. 2015;16:37-40.
Shiryajev, Y. N., Volkov, N. N., Kashintsev, A. A., Chalenko, M. V., & Radionov, Y. V. (2015). Appendectomy and resection of the terminal ileum with secondary severe necrotic changes in acute perforated appendicitis. The American Journal of Case Reports, 16, 37-40. https://doi.org/10.12659/AJCR.892471
Shiryajev YN, et al. Appendectomy and Resection of the Terminal Ileum With Secondary Severe Necrotic Changes in Acute Perforated Appendicitis. Am J Case Rep. 2015 Jan 25;16:37-40. PubMed PMID: 25618525.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Appendectomy and resection of the terminal ileum with secondary severe necrotic changes in acute perforated appendicitis. AU - Shiryajev,Yuri N, AU - Volkov,Nikolay N, AU - Kashintsev,Alexey A, AU - Chalenko,Marina V, AU - Radionov,Yuri V, Y1 - 2015/01/25/ PY - 2015/1/26/entrez PY - 2015/1/27/pubmed PY - 2015/10/2/medline SP - 37 EP - 40 JF - The American journal of case reports JO - Am J Case Rep VL - 16 N2 - BACKGROUND: Resectional procedures for advanced and complicated appendicitis are performed infrequently. Their extent can vary: cecal resection, ileocecectomy, and even right hemicolectomy. We present a very rare case of appendectomy that was combined with partial ileal resection for severe necrotic changes and small perforation of the ileum. CASE REPORT: A 19-year-old female patient was hospitalized with right iliac fossa pain and fever 10 days after the onset of symptoms. On laparoscopy, a large mass in a right iliac fossa was found. The ultrasound-guided drainage of the suspected appendiceal abscess was unavailable. After conversion using McBurney's incision, acute perforated appendicitis was diagnosed. It was characterized by extension of severe necrotic changes onto the ileal wall and complicated by right iliac fossa abscess. A mass was bluntly divided, and a large amount of pus with fecaliths was discharged and evacuated. Removal of necrotic tissues from the ileal wall led to the appearance of a small defect in the bowel. A standard closure of this defect was considered as very unsafe due to a high risk of suture leakage or bowel stenosis. We perform a resection of the involved ileum combined with appendectomy and drainage/tamponade of an abscess cavity. Postoperative recovery was uneventful. The patient was discharged on the 15th day. CONCLUSIONS: In advanced appendicitis, the involved bowel resection can prevent possible complications (e.g., ileus, intestinal fistula, peritonitis, and intra-abdominal abscess). Our case may be the first report of an appendectomy combined with an ileal resection for advanced and complicated appendicitis. SN - 1941-5923 UR - https://www.unboundmedicine.com/medline/citation/25618525/Appendectomy_and_resection_of_the_terminal_ileum_with_secondary_severe_necrotic_changes_in_acute_perforated_appendicitis_ L2 - https://www.amjcaserep.com/download/index/idArt/892471 DB - PRIME DP - Unbound Medicine ER -