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Case Reports
. 2021 Jan 5:62:13-15.
doi: 10.1016/j.amsu.2020.12.034. eCollection 2021 Feb.

Catastrophic appendicitis operation, successful repair in tertiary limited resources hospital: A case report

Dian Adi Syahputra  1 , Munthadar M Isa  1 , Muhammad Jailani  2
Affiliations
Case Reports

Catastrophic appendicitis operation, successful repair in tertiary limited resources hospital: A case report

Dian Adi Syahputra et al. Ann Med Surg (Lond). .

Abstract

Introduction: Acute appendicitis is one of the most common surgical diseases. Perforated appendicitis resulting in catastrophic complication because of a burst abdomen with necrotizing fasciitis of the abdominal wall is exceedingly a rare case.

Presentation of case: A 13-year-old girl with perforated appendicitis who had undergone laparotomy had to experience a burst abdomen with necrotizing fasciitis of the abdominal wall. The patient has temporarily closed the abdominal cavity with a urine bag (modified Bogota bag). After 23 times replacement of the Bogota bag and the condition of the sepsis and nutrition had improved, the abdominal wall reconstruction was performed by carrying out two random rotational flaps to close the abdominal defect. One year later, the patient came for ileocolostomy closure; then the patient was sent home with uneventful condition.

Discussion: Perforated appendicitis is a type of acute appendicitis with a low morbidity rate. Compared to other complications, burst abdomen and necrotizing fasciitis (NF) in perforated appendicitis are exceptionally rare events. Surgery with sepsis and recurrent intra-abdominal abscesses as a result of previous surgery are the causes of burst abdomen. The use of abdominal drainage has also been shown to cause NF. Both of these conditions will increase the cost and length of stay, and reduce the quality of life. The rotational flap procedure is the procedure of choice for a large burst abdomen.

Conclusion: Surgeons should and have to perform a meticulous operation to prevent catastrophic complication and to increase the quality of life.

Keywords: Appendicitis operation; Burst abdomen; Case report; Modified bogota bag; Necrotizing fasciitis; Rotational flap.

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Conflict of interest statement

The authors declare that there is no conflict of interest regarding publication of this paper.

Figures

Fig. 1
Fig. 1
A. The clinical picture in the referral hospital in Banda Aceh, ileostomy in the left abdominal and abdominal drain in the right flank, B. After the first operation, wide fasciitis necroticans in the right flank and pelvis, divided ileocolostomy and defect in the abdominal wall, C. Temporary closure of the abdomen with the urine bag.
Fig. 2
Fig. 2
A. Six days after the first reconstruction. Random rotational flap (blue arrow), defect from rotational flap and fasciitis necroticans in the left inguinal were closed with skin graft from both thighs (yellow star), infection of skin graft (red star), and ischemia edge from rotational flap proximal. B. The condition one year later, before stoma closure. C. The condition 2 weeks after stoma closure, there is a minor superficial wound infection from laparotomy site. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
See this image and copyright information in PMC

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