A case report on surgeon’s perseverance: post ileal type appendicular perforation with concealed abscess-laparoscopic appendectomy

Abstract

In humans, the vermiform appendix is not a vestigial organ, but rather a lymphoid structure that, when inflamed, causes major problems. Acute appendicitis is characterized by pain and soreness in the right iliac fossa, along with nausea and anorexia. Depending on the location of the appendix, it may appear in an unusual manner. In post-ileal type appendicitis, pain is more concentrated around the umbilicus, and pain shifting may be absent. In this scenario, an ultrasound of the abdomen may not be particularly useful, but a CT scan of the abdomen may aid in the diagnosis. A delay in diagnosing and treating acute appendicitis can have disastrous consequences. We now present the case report of a 20-year-old male patient with chief complaints of sudden onset of abdominal pain over umbilical region, squeezing type radiating to right lumbar region, for 3 days. On clinical examination, the patient had presence of tenderness at McBurney’s point over the right iliac fossa and periumbilical area. The diagnostic investigations of GI endoscopy report showed grade A esophagitis and hemorrhagic gastropathy. CT report shows acute appendicitis with contained perforation and appendiceal abscess. Post ileal appendicular perforation with concealed abscess was treated with laparoscopic appendectomy under general anesthesia.