Ruiz SJO, Villalobos REJ

Language: Spanish
References: 6
Page: 78-83
PDF size: 321.48 Kb.

ABSTRACT

Introduction: The management of an appendicular mass is controversial in modern literature. Developed countries favor conservative measures followed by an interval or deferred appendectomy instead of a primary one. Even more; after the success of the conservative approach, there is doubt if an interval appendectomy is necessary. Case report: 40-year-old female; while traveling in Canada, she presented with acute appendicitis, misdiagnosed as irritable bowel syndrome. After four days, she developed fever and a right lower quadrant mass. She was sent to a hospital, where a laparoscopy was performed, with appendicular abscess drainage and peritoneal lavage, without drains. No appendectomy was done at the time. Ceftriaxone was prescribed, and an appendectomy was recommended in four to six weeks, once she came back to her country of origin. Once in Mexico, she was met in stable conditions; she was managed with ceftriaxone and metronidazole; six weeks later, a laparoscopic appendectomy was performed, with no complications. Discussion: The decision taken in the first surgical intervention raises important questions, since there are reasonable doubts about not performing an appendectomy in the first approach: Was it the ideal procedure?; after using only drainage and antibiotics, what is the follow-up that applies to patients with complicated appendicitis managed with a conservative approach, and what is the risk of recurrence? Conclusion: Deferred or interval appendectomy is a reality in developed countries. In this case report, due to the appendix location and the pathological findings (double lumen and mucocele in situ), the possibility of complications was always present. It is convenient to mention that the patient was treated surgically without an appendectomy, which is not described as interval appendectomy in strict terms.

REFERENCES

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