Drainage of periappendiceal abscess and removal of free fecalith--extraperitoneal approach

Acute Appendicitis with Appendicolith and its Complication and Management: A Case Report

Acute appendicitis is a common cause of acute abdominal pain requiring urgent surgery. Despite characteristic clinical signs, diagnosis can be challenging, leading to unnecessary appendectomies. This case report focuses on a 34-year-old male with escalating right lower quadrant abdominal pain. Imaging revealed acute appendicitis with a substantial appendicolith. Surgical intervention involved a open appendectomy with possible ileocecal resection due to cecal inflamation. Surgical findings indicated successful resection, and the patient recovered without complications. While urgent appendectomy is the norm, conservative approaches are gaining traction for peri-appendiceal abscesses. Interval appendectomy post-conservative treatment is a debated strategy. Management decisions are influenced by patient factors and disease severity. Future research is needed to establish standardized treatment protocols for complicated appendicitis. The case illustrates the evolving landscape of acute appendicitis management.

The Application of Dual-Pathway Contrast-Enhanced Ultrasound (CEUS) in the Treatment of Periappendiceal Abscesses

OBJECTIVES

To explore the value of an ultrasound contrast agent (Sonovue) as an interventional treatment for periappendiceal abscesses.

METHODS

From January 2019 to December 2020, 30 patients were recruited who were admitted to Jinan Central Hospital due to periappendiceal abscesses. Before the operation, 2.5 ml of SonoVue® contrast agent was injected intravenously to determine the non-enhanced area of liquefaction and necrosis in the abscess cavity. The puncture sites were selected. Percutaneous catheterization and drainage (PCD) were performed under contrast-enhanced ultrasound guidance. After the operation, 1 ml of diluted SonoVue® suspension was injected through the drainage tube to observe the position of the drainage tube, the degree of drainage and the development of the abscess.

RESULTS

An ultrasound contrast agent was used preoperatively to assess the extent of the abscess. Liquefaction and necrosis were observed in the abscess cavity. CEUS showed hyperenhancement in the wall of the abscess in the arterial phase and the liquefied necrotic area in the abscess cavity was not enhanced before PCD. CEUS allowed operators to confidently identify the puncture site. Amongst the 30 cases of PCD, 27 cases showed the clear positioning of the drainage tube. The head of the drainage tube was placed in the ideal position and development could be seen in the abscess cavity. The diffusion effect of the contrast agent was good with no spillover and the drainage was unobstructed. Abscess development was observed in 3 patients after puncture injection of the contrast agent but the head of the drainage tube was not in the predetermined position. After adjusting the position of the drainage tube, CEUS was repeated and showed a strong diffusion effect of the contrast agent.

CONCLUSIONS

Intravenous injection of Sonovue before PCD of periappendiceal abscesses can evaluate the extent of the abscess, liquefaction and necrosis in the abscess cavity. The approach can also provide guidance for the placement of the drainage tube. After the operation, a diluted contrast agent was injected through the drainage tube. The position of the drainage tube and the flow direction of the contrast agent could be seen. This approach has good value for clinical applications to accurately judge the position of the drainage tube.