Role of limited caecal resection in patients with acute gangrenous appendicitis

Abstract

Background: Acute appendicitis is the most common acute surgical condition of the abdomen. Diagnosis is made based on full clinical history and examination, blood investigations and imaging. Delay in diagnosis and treatment leads to its perforation. Perforated appendicitis is associated with higher mortality rate (5%). For perforated appendicitis, especially in long duration of the disease, the standard technique of the appendectomy may not be sufficient for prevention of subsequent complications (i.e. intestinal fistulae, peritonitis, intra-abdominal abscesses, and acute intestinal obstruction).Methods: This retrospective non-randomised study was carried out in KEM hospital, Mumbai, India from 2010 to 2016. It involved 23 patients (diagnosed as acute appendicitis) who underwent limited caecal resection for the appendicular pathology where the appendicular tissue was not suitable for the placement of appendiceal ligature or caecal purse-string suture.Results: Out of 23 patients undergoing limited caecal resection in our setup, only 1 patient (4.35%) developed a faecal fistula which was managed conservatively with application of sterile dressing daily, which healed over time.Conclusions: This retrospective study demonstrates that the technique of limited caecal resection for appendicular base pathology (perforation and gangrene) seems a viable option in advanced cases of perforated appendix and is also helpful in reducing the chances of development of post-operative faecal fistula.