TIFLECTOMY IN A YOUNG PATIENT FOR ACUTE APPENDICITIS COMPLICATED WITH APPENDICULAR PLASTROUS: CASE REPORT
DOI:
https://doi.org/10.56238/arev7n10-121Keywords:
Complicated Acute Appendicitis, Appendiceal Plastron, Typhlectomy in Young PatientsAbstract
Case Presentation: A 23-year-old Caucasian male patient from Presidente Prudente was admitted to Santa Casa de Misericórdia de Presidente Prudente with pain that had begun seven days earlier. The pain was in the mesogastric region, radiating throughout the abdomen, focusing on the right iliac fossa, and dysuria. The pain had worsened and the patient had become inactive one day earlier. Physical examination revealed a flat abdomen, decreased bowel sounds, tenderness in the right iliac fossa, negative abrupt decompression, and a palpable plastron in the right iliac fossa. BP: 110/60 mmHg. HR: 86 bpm. Temperature: 36.5°C. Laboratory tests and contrast-enhanced computed tomography (CT) of the abdomen and pelvis revealed an elongated appendix with internal calcification, measuring 5 mm, and surrounding thickening and blurring of fat, with the distal region measuring 21 mm. Urgent surgery was indicated, and the surgical procedure was initiated using videolaparoscopy, but due to the size of the appendix and several adhesions, a conversion to open surgery combined with typhlectomy was performed. The patient was placed on a diet on the second postoperative day (PO) and discharged on the fifth postoperative day. Discussion: Acute appendicitis is obstruction of the appendiceal lumen, causing luminal stasis, bacterial proliferation, and progressive inflammation. It can progress to perforation in 13.8% of cases and abscess in 2–6% of cases. Studies indicate that the gold standard surgical treatment for acute appendicitis is videolaparoscopy, which was the initial choice for the patient due to less postoperative pain, reduced risk of infection, and faster recovery. However, when extensive involvement of the appendiceal base and necrosis of the cecum were observed at the beginning of videolaparoscopic surgery, typhlectomy became necessary. According to the literature, this procedure has a higher complication rate; however, if performed correctly, it results in early discharge and a better prognosis. Conclusion: Immediate surgical treatment is of paramount importance for the patient's full recovery, along with the implementation of correct techniques. By performing laparotomy in conjunction with typhlectomy, the gold standard for complicated appendicitis with necrosis and cecal involvement, we have a broad perspective on appendectomy and partial removal of the cecum, thus making it the best choice, aiming to ensure the removal of nonviable tissue and control of the infectious source.
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References
1. Gutierrez, D., Hallam, B., Pinheiro, F., Rabello, R., & Damasceno de Oliveira,
L. L. (2022). A APENDICITE AGUDA: REVISÃO DE LITERATURA. Ensaios
USF, 6(1). https://doi.org/10.24933/eusf.v6i1.242 DOI: https://doi.org/10.24933/eusf.v6i1.242
2. Piscioneri, F. (2021). Apendicite Aguda. Em: Piscioneri, F., Kluger, Y., Ansaloni, L. (orgs.) Cirurgia de Emergência para Regiões de Baixos Recursos. Tópicos Atuais em Cirurgia de Cuidados Agudos e Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-68099-2_9 DOI: https://doi.org/10.1007/978-3-030-68099-2_9
3. Constantin M, Petrescu L, Mătanie C, Vrancianu CO, Niculescu AG, Andronic O, Bolocan A. The Vermiform Appendix and Its Pathologies. Cancers (Basel). 2023 Jul 29;15(15):3872. doi: 10.3390/cancers15153872. PMID: 37568688; PMCID: PMC10417615. DOI: https://doi.org/10.3390/cancers15153872
4. Wu, B., & Maa, J. (2021). Acute appendicitis. Schlossberg's Clinical Infectious Disease. https://doi.org/10.1383/surg.23.6.213.66556. DOI: https://doi.org/10.1093/med/9780190888367.003.0053
5. MATOS, Breno; SANTANA, Carolina; SOUZA, Déborah; RODRIGUES, Ednardo; GONÇALVES, Elisa; DIAS, Fabrício; MARQUES, Guilherme; PETRI, Gustavo; ABRANTES, Wilson Luiz. Apendicite aguda. Revista Médica de Minas Gerais, Belo Horizonte, 2011.
6. CABALLERO-ALVARADO, J. et al. Complicated acute appendicitis with compromised appendiceal base: A review of surgical strategies. Polskie Przegląd Chirurgiczny, v. 96, n. 0, p. 65–70, 2023. DOI: 10.5604/01.3001.0053.6868. Disponível em: https://pubmed.ncbi.nlm.nih.gov/38348988/. Acesso em: 27 abr. 2025. DOI: https://doi.org/10.5604/01.3001.0053.6868
7. Capuchinho, Ana Luísa Brito Santanna, et al. “Epidemiologia e estimativa de custo das cirurgias de apendicectomia realizadas pelo sistema único de saúde no Brasil (2012-2021)”. Brazilian Journal of Health Review, vol. 6, no 5, outubro de 2023, p. 23912–30. DOI.org (Crossref), https://doi.org/10.34119/bjhrv6n5-442. DOI: https://doi.org/10.34119/bjhrv6n5-442
8. FRANCINO, Raíssa Paes; FIGUEIREDO, Luís Filipe S.; NUNES, Carlos P. Complicações de um diagnóstico tardio de apendicite. Revista da Faculdade de Medicina de Teresópolis, Teresópolis, v. 3, n. 1, p. [número de páginas], 2019. Disponível em: https://revista.unifeso.edu.br/index.php/faculdadedemedicinadeteresopolis/arti cle/view/1018. Acesso em: 17 abr. 2025.
9. GBD 2021 - Appendicitis Collaborator Group. Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021. Lancet Gastroenterol Hepatol, v. 9, n. 9, p. 825 858, 2024. DOI: 10.1016/S2468-1253(24)00157-2. Disponível em: DOI: https://doi.org/10.1016/S2468-1253(24)00157-2
https://pmc.ncbi.nlm.nih.gov/articles/PMC11306195/. Acesso em: 27 abr. 2025.
10. GOUVEIA, A. D. M. et al. Apendicite aguda: perfil epidemiológico no Brasil, de 2017 a 2021. Brazilian Journal of Development, Curitiba, v. 9, n. 3, p. 12182–12194, 2023. Disponível em: https://doi.org/10.34117/bjdv9n3-212. Acesso em: 17 abr. 2025. Periódicos USP DOI: https://doi.org/10.34117/bjdv9n3-212
11. KÖHLER, F. et al. Laparoscopic appendectomy versus antibiotic treatment for acute appendicitis—a systematic review. International Journal of Colorectal Disease, v. 36, n. 10, p. 22832286, 2021. DOI: 10.1007/s00384 021 03927 5. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33852068/. Acesso em: 27 abr. 2025. DOI: https://doi.org/10.1007/s00384-021-03927-5
12. KRZYZAK, M.; MULROONEY, S. M. Acute appendicitis review: background, epidemiology, diagnosis, and treatment. Cureus, v. 12, n. 6, p. e8562, 2020. DOI: 10.7759/cureus.8562. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32670699/. Acesso em: 27 abr. 2025. DOI: https://doi.org/10.7759/cureus.8562
13. Snyder MJ, Guthrie M, Cagle S. Acute Appendicitis: Efficient Diagnosis and Management. Am Fam Physician. 2018 Jul 1;98(1):25-33. PMID: 30215950.
14. Wong, Chee, e Syed Naqvi. “Appendicular Perforation at the Base of the Caecum, a Rare Operative Challenge in Acute Appendicitis, a Literature Review”. World Journal of Emergency Surgery, vol. 6, no 1, 2011, p. 36. DOI.org (Crossref), https://doi.org/10.1186/1749-7922-6-36. DOI: https://doi.org/10.1186/1749-7922-6-36
15. Gandhi, Jignesh A., et al. “Role of Limited Caecal Resection in Patients with Acute Gangrenous Appendicitis”. International Surgery Journal, vol. 3, no 4, dezembro de 2016, p. 1893–97. www.ijsurgery.com, https://doi.org/10.18203/2349-2902.isj20163034. DOI: https://doi.org/10.18203/2349-2902.isj20163034
16. Dalpiaz, Amanda et al. “Mimicry of Appendicitis Symptomatology in Congenital Anomalies and Diseases of the Genitourinary System and Pregnancy.” Current urology vol. 9,4 (2017): 169-178. doi:10.1159/000447136 DOI: https://doi.org/10.1159/000447136
17. Petroianu, A. (2012). Diagnosis of acute appendicitis.. International journal of surgery, 10 3, 115-9 . https://doi.org/10.1016/j.ijsu.2012.02.006. DOI: https://doi.org/10.1016/j.ijsu.2012.02.006
18. MONTANDON JÚNIOR, M. E. et al. Apendicite aguda: achados na tomografia computadorizada - ensaio iconográfico. Radiologia Brasileira, v. 40, p. 193–199, 1 jun. 2007. DOI: https://doi.org/10.1590/S0100-39842007000300012
19. LEGGIT, J. C. Acute Appendicitis: Computed Tomography for Diagnosis in Adults. American Family Physician, v. 102, n. 7, p. 403–404, 1 out. 2020.
20. 1- Ozdemir K, Harmantepe AT, Dulger UC, Gonullu E, Dikicier E, Bayhan Z, Altintoprak F. Comparison of treatment methods in plastron appendicitis: a tertiary center experience. Malawi Med J. 2023 Dec;35(4):224-227. doi: 10.4314/mmj.v35i4.5. PMID: 38362573; PMCID: PMC10865056. DOI: https://doi.org/10.4314/mmj.v35i4.5
21. Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, Boermeester M, Sartelli M, Coccolini F, Tarasconi A, De' Angelis N, Weber DG, Tolonen M, Birindelli A, Biffl W, Moore EE, Kelly M, Soreide K, Kashuk J, Ten Broek R, Gomes CA, Sugrue M, Davies RJ, Damaskos D, Leppäniemi A, Kirkpatrick A, Peitzman AB, Fraga GP, Maier RV, Coimbra R, Chiarugi M, Sganga G, Pisanu A, De' Angelis GL, Tan E, Van Goor H, Pata F, Di Carlo I, Chiara O, Litvin A, Campanile FC, Sakakushev B, Tomadze G, Demetrashvili Z, Latifi R, Abu-Zidan F, Romeo O, Segovia-Lohse H, Baiocchi G, Costa D, Rizoli S, Balogh ZJ, Bendinelli C, Scalea T, Ivatury R, Velmahos G, Andersson R, Kluger Y, Ansaloni L, Catena F. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27. doi: 10.1186/s13017-020-00306-3. PMID: 32295644; PMCID: PMC7386163. DOI: https://doi.org/10.1186/s13017-020-00306-3
22. Sadaf, Fnu, et al. “Conversion Rates and Outcomes of Laparoscopic Appendectomy in Complicated Appendicitis: A Retrospective Study”. Cureus, agosto de 2025. DOI.org (Crossref), https://doi.org/10.7759/cureus.90411. DOI: https://doi.org/10.7759/cureus.90411
23. Monrabal Lezama M, Casas MA, Angeramo CA, Bras Harriott C, Schlottmann
F. Conversion from Laparoscopic to Open Appendectomy: Trends, Risk Factors and Outcomes. A 15-Year Single-Center Analysis of 2193 Adult Patients. World J Surg. 2022 Nov;46(11):2642-2647. doi: 10.1007/s00268-022-06670-2. Epub 2022 Jul 24. PMID: 35871658; PMCID: PMC9309015. DOI: https://doi.org/10.1007/s00268-022-06670-2
24. Turgut HT, Subasi O. Comparison of ileocecal resection and right hemicolectomy in the surgical treatment of complicated appendicitis. Ulus Travma Acil Cerrahi Derg. 2023 Jun;29(6):705-709. doi: 10.14744/tjtes.2023.83357. PMID: 37278071; PMCID: PMC10315939. DOI: https://doi.org/10.14744/tjtes.2023.83357
25. Teixeira FJR Jr, Couto Netto SDD, Akaishi EH, Utiyama EM, Menegozzo CAM, Rocha MC. Acute appendicitis, inflammatory appendiceal mass and the risk of a hidden malignant tumor: a systematic review of the literature. World J Emerg Surg. 2017 Mar 9;12:12. doi: 10.1186/s13017-017-0122-9. PMID: 28286544; PMCID: PMC5343298. DOI: https://doi.org/10.1186/s13017-017-0122-9
26. DRUSZCZ, C. C. et al.. Aplicação multicêntrica informatizada da coleta de dados clínicos na apendicite aguda. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), v. 20, n. 3, p. 165–171, jul. 2007. DOI: https://doi.org/10.1590/S0102-67202007000300009
27. Nogueira, P. L. B., Mariano, J. T., Martos, M. S., Heinen, V. B. da S., Trevisan,
E. M., Costa, L. B. C. da, … Teodoro, L. V. C. (2023). Epidemiologia das doenças do apêndice em adultos nos anos de 2019 e 2020 no Brasil. COORTE - Revista Científica Do Hospital Santa Rosa, (15). https://doi.org/10.52908/coorte.v0i15.288 DOI: https://doi.org/10.52908/coorte.v0i15.288
