Describe the Inflammatory appendiceal mass (appendiceal phlegmon).
Description: an ill-defined mass of inflammatory periappendiceal tissue
Clinical features: manifests as a tender mass in the RLQ
Treatment
Nonoperative management of acute appendicitis
Consider interval appendectomy.
Describe apenndiceal abscess.
Description: a localized collection of pus and necrotic tissue that forms around an inflamed appendix, which typically follows an untreated perforated appendix
Clinical features: manifests as a tender mass in the RLQ in an acutely ill patient (i.e., high-grade fever, possible paralytic ileus, leukocytosis, signs of sepsis)
Abscess < 4 cm: antibiotic therapy alone is usually sufficient.
Abscess > 4 cm: image-guided percutaneous drainage or surgical drainage; send aspirate for cultures
Describe the gangrenous appendicitis.
Description: irreversible necrosis of the appendiceal wall
Clinical features
Manifests with high-grade fever, tachycardia, severe RLQ pain and tenderness
Typically diagnosed intraoperatively: The appendix has a mottled purple appearance.
Treatment: emergency appendectomy and IV antibiotics
Describe the perforated appendix.
Description: rupture of the appendix
Early presentation: localized/generalized peritonitis and decreased bowel sounds
Generalized peritonitis indicates a free rupture of the appendix into the peritoneal cavity.
Localized peritonitis suggests a concealed perforation.
Delayed presentation: appendiceal mass or appendiceal abscess
Early presentation
Emergency appendectomy and IV antibiotics
Obtain pus or exudate for cultures intraoperatively. [19]
Tailor antibiotics accordingly.
Describe pylephlebitis.
Description: septic thrombosis of the portal vein or its branches
Etiology: a complication of intraabdominal sepsis (e.g., due to perforated appendicitis, diverticulitis, or necrotizing pancreatitis)
Clinical features: fever, abdominal pain
Diagnostics
CT: filling defect in the portal vein or its branches
Bacteremia
Treatment: broad-spectrum antibiotics
Prognosis: Thrombosis of the portal circulation can result in bowel infarction and death.
Last changed2 years ago