“Apendicitis de presentación atípica

Abstract

Acute appendicitis is a surgical entity that worldwide represents 47.8% of surgical emergencies; the risk of appendicitis in the course of life is 8.6% in men and 6.7% in women. (1) Being the appendix the organ with more variations in terms of anatomical presentation, they make their clinical picture vary in such a way that in spite of diverse descriptions of signs and symptoms of the disease, many times their diagnosis is difficult. The subhepatic position of the appendix is the result of an abnormality of development, the clinical picture of retrocecal ascending subhepatic appendicitis may present with abdominal pain in the right upper quadrant and be confused with a picture of acute cholecystitis, urolithiasis, terminal ileitis, neoplasms and irritable colon.(2) The treatment of this type of surgical entities is focused on the promptness of their diagnosis, with the aim of preventing complications such as formation of an appendicular plastron, perforation and abdominal sepsis. In the presence of an appendicular plastron there is no consensus on the definitive treatment, being able to opt for immediate surgical management versus initial medical management and later deferred appendectomy.

Next, we present a case of a 32-year-old patient, previously healthy, who comes to our home for presenting abdominal pain of 17 days of evolution located in the upper abdomen, was assessed by several physicians prior to entering this health home, after clinical assessment and complementary imaging tests, it is presumed that acute appendicitis is atypical presentation, diagnostic laparoscopy was performed, resulting in a subhepatic appendicular plastron, conversion to conventional laparotomy was decided with the aim of raffia, however due to the coldness of the tissues, it is not possible to achieve the objective, 2 months later an interval appendectomy is performed as definitive appendiceal plastron treatment. During the development of the present clinical case we will specify in detail the clinical picture, diagnostic methods, treatment and subsequent evolution that the patient had during his hospital stay.