“Absceso retroperitoneal como complicación de apendicitis aguda”

Abstract

Acute appendicitis is the most frequent cause of acute abdomen and represents one of the most common emergencies that a surgeon faces. It occurs, generally, in patients between the second and third decades of life, being less frequent in the extremes of life. The estimated risk to present this pathology is between 7 and 8%. According to the INEC, in 2017, 38,533 cases5 of acute appendicitis were recorded in Ecuador, representing a rate of 22.97 cases5 per 10,000 inhabitants, thus being the first cause of morbidity in the country.

Currently the treatment of choice is surgical, there is a high risk of perforation and peritonitis especially in cases of delay in diagnosis and appropriate treatment; there is controversy about the correct treatment for an acute appendicitis that develops abscess or phlegmon.

The following, a male patient of 51 years of age, presented with abdominal pain, 8 days prior to admission of moderate intensity, 7/10 on the visual analog scale, that start in the epigastrium accompanied by nausea, fever, does not decrease with the intake of food, vomiting, deposition, urination and decubitus, self-medicated scopolamine butylbromide, without decreased the syntomatology on the third day goes to a private doctor,administring intravenous ceftriaxone 1g (IV), gentamicin 160 mg IV, single dose, ciprofloxacin 750 mg BID; until the day of admission without yielding pain. Until the day of admission present a pain that is located in the right iliac fossa, so he goes to this health house where he performs ecosonography (09/26/2017) which reports: biliary mud in a small amount, suggestive of appendicular plastron, TAC simple and contrasted abdomen and pelvis (09/26/2017) that reports: intraperitoneal abscess located in the right iliac fossa with extension to the flank and hypochondrium on the same side, volume approximately 300, with an increase in the density of mesentery fatty tissue suggestive picture of perforated appendix. Pathology that was resolved with three surgical interventions