Life-saving emergency Laparoscopic surgery for Perforation Peritonitis with Septicaemia

in Max Super Speciality Hospital, Saket

Feb 02 , 2023

A 46-year-old male diabetic, hypertensive, hypothyroid patient, came to the emergency with severe pain in the right lower abdomen for 2 days. On examination, he had hypotension and tachycardia. On abdominal examination, distension and guarding rigidity were observed. The doctors had a suspicion of perforation peritonitis.

The patient was immediately shifted for CT abdomen, which showed thickened and retrocecal appendix, with hyperdense intraluminal foci suggestive of appendicoliths, and there was marked adjacent fat stranding and thickening of peritoneal reflections, there was significant free fluid in the abdomen, free air was noted in the abdomen, adjacent small bowel were adherent to each other.

Lab parameters showed an increase in TLC count. A diagnosis of appendicular perforation with pyoperitoneum was confirmed. The patient was planned for emergency life-saving surgery. In view of sepsis, high-risk consent was taken. Diagnostic laparoscopy showed a retrocecal appendix with thickened and wide base perforated in the middle, and the tip was sloughed out with appendicolith lying in the peritoneal cavity.

Around 600ml pus was seen in and around the pelvis. Caecal mobilisation was done, and the appendix was freed from the mesoappendix. In view of thickened and wide base appendix ENDO GIA 45mm purple stapler was fired at the base of appendix. A thorough wash was given in the abdominal cavity, and two drains were placed in the right iliac fossa and the pelvis, respectively. Post-operatively, the patient showed good recovery.

Laparoscopy in the emergency setting decreases the morbidity of the procedure with faster recovery.