Abstract
Acute appendicitis remains the most common surgical emergency. Laparoscopy has gained increasing favor as a method of both investigating right iliac fossa pain and treating the finding of appendicitis. A question arises: what to do with an apparent healthy appendix discovered during laparoscopic surgery for other pathology. We present a case of unilateral hydroureteronephrosis complicated with rupture of the renal pelvis, due to gangrenous appendicitis with abscess of the right iliopsoas muscle and periappendicular inflammation in a 67-year-old woman, who underwent laparoscopic right annessiectomy for right ovarian cyst few years earlier, in which a healthy appendix was left inside. There is a lack of consensus in the literature about what to do with a normal appendix. The main argument for removing an apparently normal appendix is that endoluminal appendicitis may not be recognized during surgery, leading to concern that an abnormal appendix is left in place. Because of a lack of evidence from randomized trials, it remains unclear whether the benefits of routine elective coincidental appendectomy outweigh the costs and risks of morbidity associated with this prophylactic procedure. Nevertheless, it appears, from limited data, that women aged 35 years and under benefit most from elective coincidental appendectomy.
Highlights
Acute appendicitis remains the most common surgical emergency and diagnosis should be made on clinical grounds, sometimes this can be difficult
If we add the rupture of the renal pelvis and abscess of the iliopsoas muscle to the pool of symptoms, it is understandable that we are dealing with a rare and complex presentation of acute appendicitis
Some authors suggest that normal-looking appendices should be removed [3, 6] during laparoscopy for acute right iliac fossa pain, whereas other authors alert surgeons to the life-threatening consequences of performing a “healthy appendectomy” [7, 8], such as trauma induced by anaesthesia and surgery, higher rate of infectious complications
Summary
Acute appendicitis remains the most common surgical emergency and diagnosis should be made on clinical grounds, sometimes this can be difficult. Laparoscopy has gained increasing favor as method of both investigating right iliac fossa pain and treating the finding of appendicitis. Hydroureteronephrosis can be a sign of presentation of acute appendicitis, even though it is not as common as pain, nausea, vomiting, and fever [1, 2]. If we add the rupture of the renal pelvis and abscess of the iliopsoas muscle to the pool of symptoms, it is understandable that we are dealing with a rare and complex presentation of acute appendicitis
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