Post-Appendectomy Complication: Peritonitis and Abscess Due to Partial Obstructive Ileus in a Patient with Neglected Appendicitis

Christiny Christiny; I  Putu Rangga Rasnadea Tama; Anak  Agung Gede; Agung Budhi Kusuma

doi:10.59188/jcs.v3i12.2938

Authors

Christiny Christiny Wangaya Regional General Hospital Denpasar, Bali, Indonesia
I Putu Rangga Rasnadea Tama Wangaya Regional General Hospital Denpasar, Bali, Indonesia
Anak Agung Gede Wangaya Regional General Hospital Denpasar, Bali, Indonesia
Agung Budhi Kusuma Wangaya Regional General Hospital Denpasar, Bali, Indonesia

DOI:

https://doi.org/10.59188/jcs.v3i12.2938

Keywords:

complications, partial obstructive ileus, patient

Abstract

A 13-year-old male presented with abdominal pain, fever, and vomiting two weeks after open appendectomy for neglected appendicitis. Examination revealed peritonitis signs, including diffuse tenderness. Laboratory findings showed leukocytosis and elevated C-reactive protein (CRP), indicating inflammation. Abdominal X-rays suggested dynamic ileus, while contrast-enhanced CT revealed pelvic fluid collections, gas-forming abscesses, partial ileus, and pneumoperitoneum, consistent with peritonitis complications. Complications such as adhesive small bowel obstruction (SBO), abscess formation, and peritonitis can arise after appendectomy. Adhesions from surgery may cause partial ileus, obstructing bowel motility, while infection can lead to abscesses. Imaging, particularly contrast-enhanced CT, is vital for accurate diagnosis and intervention. Treatment involves surgical drainage of abscesses, adhesiolysis, and broad-spectrum antibiotics to control infection. In this case, timely surgical and medical management resulted in a successful outcome. Peritonitis following appendectomy for neglected appendicitis can result in partial obstructive ileus and abscess formation, underscoring the need for vigilance during postoperative follow-up. Early imaging and intervention are critical to prevent severe outcomes. Prompt surgical and medical treatment enables full recovery, emphasizing the importance of recognizing post-appendectomy complications.

References

Anupam, S., Goel, S., Mehta, D. K., & Das, R. (2024). Comprehensing the role of serum GGT in colorectal carcinoma: cancer risk, prognostic and diagnostic significance. Clinical and Translational Oncology, 1–8.

Clements, T. W., Tolonen, M., Ball, C. G., & Kirkpatrick, A. W. (2021). Secondary peritonitis and intra-abdominal sepsis: an increasingly global disease in search of better systemic therapies. Scandinavian Journal of Surgery, 110(2), 139–149.

Collard, M. K., Benoist, S., Maggiori, L., Zerbib, P., Lefevre, J. H., Denost, Q., Germain, A., Cotte, E., Beyer-Berjot, L., & Corté, H. (2021). A reappraisal of outcome of elective surgery after successful non-operative management of an intra-abdominal abscess complicating ileocolonic Crohn’s disease: a subgroup analysis of a nationwide prospective cohort. Journal of Crohn’s and Colitis, 15(3), 409–418.

De Simone, B., Chouillard, E., Borzellino, G., Sartelli, M., Ansaloni, L., & Catena, F. (2021). Diagnostic Imaging in Surgery. Emergency Surgery for Low Resource Regions, 37–47.

Detz, D. J., Podrat, J. L., Castro, J. C. M., Lee, Y. K., Zheng, F., Purnell, S., & Pei, K. Y. (2021). Small bowel obstruction. Current Problems in Surgery, 58(7), 100893.

Evans, R., Bhagani, S., Haque, T., & Harber, M. (2022). Infectious complications of transplantation. In Primer on Nephrology (pp. 1627–1661). Springer.

Fikri, E., Alnaz, A. R. M., & Alnaz, F. M. (2023). Endothelial dysfunction in appendicitis. In Endothelial Dysfunction-A Novel Paradigm. IntechOpen.

Healy, J. M., Olgun, L. F., Hittelman, A. B., Ozgediz, D., & Caty, M. G. (2016). Pediatric incidental appendectomy: a systematic review. Pediatric Surgery International, 32, 321–335.

Kaplan, U. (2023). Management of Bariatric Surgery Early and Delayed Complications. In Mini-invasive Approach in Acute Care Surgery (pp. 281–299). Springer.

Koltsidopoulos, P., Papageorgiou, E., & Skoulakis, C. (2020). Pott’s puffy tumor in children: a review of the literature. The Laryngoscope, 130(1), 225–231.

Li, J. (2021). Revisiting delayed appendectomy in patients with acute appendicitis. World Journal of Clinical Cases, 9(20), 5372.

Moody, M., Chilukuri, N., Khalil, S., McLaren, G., Shebrain, S., & Timmons, J. (2023). Acute gastrointestinal and general surgical conditions in children and adolescents. Journal of Pain Management, 16(2).

Ogbuanya, A. U.-O., Ugwu, N. B., Enemuo, V. C., Nnadozie, U. U., Eni, U. E., Ewah, R. L., Ajuluchuku, U. E., Umezurike, D. A., & Onah, L. N. (2023). Emergency laparotomy for peritonitis in the elderly: A Multicentre observational study of outcomes in Sub-Saharan Africa. African Journal of Emergency Medicine, 13(4), 265–273.

Paspatis, G. A., Arvanitakis, M., Dumonceau, J.-M., Barthet, M., Saunders, B., Turino, S. Y., Dhillon, A., Fragaki, M., Gonzalez, J.-M., & Repici, A. (2020). Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) position statement–update 2020. Endoscopy, 52(09), 792–810.

Ross, J. T., Matthay, M. A., & Harris, H. W. (2018). Secondary peritonitis: principles of diagnosis and intervention. Bmj, 361.

Sabzghabaei, A., Shojaei, M., & Chavoshzadeh, M. (2022). Diagnostic Accuracy of Ultrasonography by Emergency Medicine Resident in Detecting Intestinal Obstruction; a Pilot Study. Archives of Academic Emergency Medicine, 10(1).

Virdis, F., Podda, M., Reccia, I., Gallo, G., Khan, M., Martin, M., & Di Saverio, S. (2021). Laparoscopy and minimally invasive surgery techniques in acute care surgery. Trauma Centers and Acute Care Surgery: A Novel Organizational and Cultural Model, 235–248.