Incidental Finding of Acute Appendicitis During Laparoscopic Cholecystectomy for an Acute Calculous Cholecystitis.

Mansour Alkhurmudi,Abdullah Alzaharani,Bandar Ali

doi:10.7759/cureus.21973

Abstract

Acute cholecystitis and appendicitis are among the most common conditions encountered by general surgeons; however, they are rarely described simultaneously. We are reporting a rare incidental finding of early acute appendicitis during laparoscopic cholecystectomy for a 36-year-old lady who presented to our emergency department with signs and symptoms of acute calculous cholecystitis. Laparoscopy has proved to be a highly useful and ideal tool in the diagnosis and treatment of such surgical situations.

Highlights

Acute appendicitis and acute cholecystitis are among the most common causes of acute abdominal pain, which is commonly due to a single pathology; clinicians need to be aware that multiple pathologies can rarely coexist
Our aim of this study is to highlight the importance of utilizing laparoscopic exploration of the entire abdomen in all cases presenting with an acute surgical abdomen, even if the initial diagnosis shows a single pathology, as multiple pathologies can be coincidentally discovered
A recent review by Buhamed et al [2] found 11 case reports of co-existent acute appendicitis and acute cholecystitis, and four cases presented with right upper quadrant abdominal pain, which was similar to our patient’s main complaint

Summary

Introduction

Acute appendicitis and acute cholecystitis are among the most common causes of acute abdominal pain, which is commonly due to a single pathology; clinicians need to be aware that multiple pathologies can rarely coexist. The patient was in mild pain and hemodynamically stable (no fever or tachycardia) Her abdominal examination was significant for epigastric tenderness as well as a positive Murphy’s sign. US abdomen showed multiple gallbladder stones associated with a trace amount of pericholecystic fluid, gallbladder wall thickening (6.3 mm), and a normal common bile duct (CBD) caliber of 0.4 cm (Figures 1, 2). Aspiration of the gallbladder was carried out to enable adequate grasper function; adhesions were released, and cholecystectomy was performed Another suprapubic 5 mm port was inserted (Figure 3), and an appendectomy was performed. Histopathology confirmed the diagnosis of acute calculous cholecystitis and acute appendicitis (dilated lumen, filled with fecalith material and early acute inflammation)

Discussion

Conclusions

Disclosures