Atypical presentation and unusual complications of appendicitis: a case report

Objective: To describe a case of acute appendicitis with an atypical presentation, complicated by hemoperitoneum, retroperitoneal hematoma, and pylephlebitis. Case report: A 55-year-old female patient without relevant history presented with 8 days of epigastric and right hypochondrial pain, fever, d...

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Autores principales: Diego, Carolina Lucía, Napoli, Juliana, Goransky, Jeremías
Formato: Artículo revista
Lenguaje:Español
Publicado: Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2025
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Acceso en línea:https://revistas.unc.edu.ar/index.php/med/article/view/45332
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institution Universidad Nacional de Córdoba
institution_str I-10
repository_str R-327
container_title_str Revista de la Facultad de Ciencias Médicas de Córdoba
language Español
format Artículo revista
topic appendicitis
hemoperitoneum
thrombophlebitis
pylephlebitis
spa
apendicitis
hemoperitoneo
tromboflebitis
pileflebitis
spa
apendicite
hemoperitônio
tromboflebite
pieflebite
spa
spellingShingle appendicitis
hemoperitoneum
thrombophlebitis
pylephlebitis
spa
apendicitis
hemoperitoneo
tromboflebitis
pileflebitis
spa
apendicite
hemoperitônio
tromboflebite
pieflebite
spa
Diego, Carolina Lucía
Napoli, Juliana
Goransky, Jeremías
Diego, Carolina Lucía
Napoli, Juliana
Goransky, Jeremías
Diego, Carolina Lucía
Napoli, Juliana
Goransky, Jeremías
Atypical presentation and unusual complications of appendicitis: a case report
topic_facet appendicitis
hemoperitoneum
thrombophlebitis
pylephlebitis
spa
apendicitis
hemoperitoneo
tromboflebitis
pileflebitis
spa
apendicite
hemoperitônio
tromboflebite
pieflebite
spa
author Diego, Carolina Lucía
Napoli, Juliana
Goransky, Jeremías
Diego, Carolina Lucía
Napoli, Juliana
Goransky, Jeremías
Diego, Carolina Lucía
Napoli, Juliana
Goransky, Jeremías
author_facet Diego, Carolina Lucía
Napoli, Juliana
Goransky, Jeremías
Diego, Carolina Lucía
Napoli, Juliana
Goransky, Jeremías
Diego, Carolina Lucía
Napoli, Juliana
Goransky, Jeremías
author_sort Diego, Carolina Lucía
title Atypical presentation and unusual complications of appendicitis: a case report
title_short Atypical presentation and unusual complications of appendicitis: a case report
title_full Atypical presentation and unusual complications of appendicitis: a case report
title_fullStr Atypical presentation and unusual complications of appendicitis: a case report
title_full_unstemmed Atypical presentation and unusual complications of appendicitis: a case report
title_sort atypical presentation and unusual complications of appendicitis: a case report
description Objective: To describe a case of acute appendicitis with an atypical presentation, complicated by hemoperitoneum, retroperitoneal hematoma, and pylephlebitis. Case report: A 55-year-old female patient without relevant history presented with 8 days of epigastric and right hypochondrial pain, fever, dark urine, and vasovagal syncope. Laboratory tests showed anemia, thrombocytopenia, liver dysfunction, and signs of sepsis. CT scan revealed an enlarged cecal appendix with wall disruption, portal and superior mesenteric vein thrombosis, and free fluid. Emergency laparoscopy was converted to laparotomy due to hemodynamic instability, revealing hemoperitoneum and retroperitoneal hematoma. Appendectomy, abdominal packing, and delayed closure were performed. The patient completed 19 days of antibiotic therapy, was transferred to the general ward on postoperative day 17, and discharged on day 20 with full recovery. Conclusion: Acute appendicitis complicated by hemoperitoneum, retroperitoneal hematoma, and pylephlebitis is rare but severe. Early diagnosis and appropriate surgical management are key to improving outcomes
publisher Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
publishDate 2025
url https://revistas.unc.edu.ar/index.php/med/article/view/45332
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spelling I10-R327-article-453322025-06-26T19:09:18Z Atypical presentation and unusual complications of appendicitis: a case report Presentación atípica y complicaciones inusuales de apendicitis: reporte de un caso Apresentação atípica e complicações inusuais da apendicite: relato de um caso Diego, Carolina Lucía Napoli, Juliana Goransky, Jeremías Diego, Carolina Lucía Napoli, Juliana Goransky, Jeremías Diego, Carolina Lucía Napoli, Juliana Goransky, Jeremías appendicitis hemoperitoneum thrombophlebitis pylephlebitis spa apendicitis hemoperitoneo tromboflebitis pileflebitis spa apendicite hemoperitônio tromboflebite pieflebite spa Objective: To describe a case of acute appendicitis with an atypical presentation, complicated by hemoperitoneum, retroperitoneal hematoma, and pylephlebitis. Case report: A 55-year-old female patient without relevant history presented with 8 days of epigastric and right hypochondrial pain, fever, dark urine, and vasovagal syncope. Laboratory tests showed anemia, thrombocytopenia, liver dysfunction, and signs of sepsis. CT scan revealed an enlarged cecal appendix with wall disruption, portal and superior mesenteric vein thrombosis, and free fluid. Emergency laparoscopy was converted to laparotomy due to hemodynamic instability, revealing hemoperitoneum and retroperitoneal hematoma. Appendectomy, abdominal packing, and delayed closure were performed. The patient completed 19 days of antibiotic therapy, was transferred to the general ward on postoperative day 17, and discharged on day 20 with full recovery. Conclusion: Acute appendicitis complicated by hemoperitoneum, retroperitoneal hematoma, and pylephlebitis is rare but severe. Early diagnosis and appropriate surgical management are key to improving outcomes Objetivos: Describir un caso de apendicitis aguda de presentación atípica, complicada con hemoperitoneo, hematoma retroperitoneal y pileflebitis. Caso clínico:  Paciente femenina de 55 años, sin antecedentes relevantes, con 8 días de dolor en epigastrio e hipocondrio derecho, fiebre, coluria y síncope vasovagal. Presentaba anemia, trombocitopenia, alteración hepática y signos de sepsis. La tomografía mostró apéndice cecal aumentado, disrupción parietal, trombosis de la vena porta y mesentérica superior, y líquido libre. Se realizó laparoscopia convertida a laparotomía por inestabilidad hemodinámica, hallándose hemoperitoneo y hematoma retroperitoneal. Se efectuó apendicectomía, packing abdominal y cierre diferido. Completó 19 días de antibioticoterapia, pasó a sala general al día 17 postoperatorio y fue dada de alta al día 20, con recuperación completa. Conclusión: La apendicitis aguda con complicaciones como hemoperitoneo, hematoma retroperitoneal y pileflebitis es infrecuente, pero grave. El diagnóstico oportuno y el manejo quirúrgico adecuado son fundamentales para mejorar el pronóstico   Objetivo: Descrever um caso de apendicite aguda com apresentação atípica, complicada por hemoperitônio, hematoma retroperitoneal e pieflebite. Relato de caso: Paciente feminina de 55 anos, sem antecedentes relevantes, apresentou dor em epigástrio e hipocôndrio direito há 8 dias, febre, colúria e síncope vasovagal. Exames laboratoriais mostraram anemia, trombocitopenia, disfunção hepática e sinais de sepse. A tomografia revelou apêndice cecal aumentado, ruptura parietal, trombose da veia porta e mesentérica superior e líquido livre. Foi realizada laparoscopia de urgência, convertida para laparotomia por instabilidade hemodinâmica, com achado de hemoperitônio e hematoma retroperitoneal. Realizou-se apendicectomia, packing abdominal e fechamento tardio. A paciente completou 19 dias de antibioticoterapia, foi transferida para enfermaria no 17º dia pós-operatório e teve alta no 20º dia, com recuperação completa. Conclusão: Apendicite aguda complicada por hemoperitônio, hematoma retroperitoneal e pieflebite é rara e grave. O diagnóstico precoce e o manejo cirúrgico adequado são fundamentais para melhorar o prognóstico Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2025-06-26 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion text/html application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/45332 10.31053/1853.0605.v82.n2.45332 Revista de la Facultad de Ciencias Médicas de Córdoba.; ##issue.vol## 82 ##issue.no## 2 (2025); 431-441 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 82 Núm. 2 (2025); 431-441 Revista da Faculdade de Ciências Médicas de Córdoba; v. 82 n. 2 (2025); 431-441 1853-0605 0014-6722 10.31053/1853.0605.v82.n2 spa https://revistas.unc.edu.ar/index.php/med/article/view/45332/49090 https://revistas.unc.edu.ar/index.php/med/article/view/45332/49379 Derechos de autor 2025 Universidad Nacional de Córdoba https://creativecommons.org/licenses/by-nc/4.0