Ma J, Zha ZP, Zhou CP, Miao X, Duan SQ, Zhang YM. Acute appendicitis in the short term following radical total gastrectomy misdiagnosed as duodenal stump leakage: A case report. World J Gastrointest Surg 2022; 14(12): 1432-1437 [PMID: 36632116 DOI: 10.4240/wjgs.v14.i12.1432]
Corresponding Author of This Article
Ya-Ming Zhang, MD, Chief Doctor, Surgeon, Surgical Oncologist, Department of General Surgery, Anqing Municipal Hospital, No. 352 Ren-Ming Road, Anqing 246000, Anhui Province, China. zhangyaming2014@163.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jun Ma, Chao-Ping Zhou, Xiang Miao, Ya-Ming Zhang, Department of General Surgery, Anqing Municipal Hospital, Anqing 246000, Anhui Province, China
Zhen-Ping Zha, Department of Vascular Surgery, Anqing Municipal Hospital, Anqing 246000, Anhui Province, China
Shu-Qiang Duan, Department of Pathology, Anqing Municipal Hospital, Anqing 246000, Anhui Province, China
Author contributions: Ma J wrote and edited the original draft; Duan SQ and Miao X contributed to data collection and analysis; Zhou CP and Zha ZP reviewed the literature; Zhang YM reviewed and approved the final manuscript; All authors have read and approve the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ya-Ming Zhang, MD, Chief Doctor, Surgeon, Surgical Oncologist, Department of General Surgery, Anqing Municipal Hospital, No. 352 Ren-Ming Road, Anqing 246000, Anhui Province, China. zhangyaming2014@163.com
Received: September 15, 2022 Peer-review started: September 15, 2022 First decision: October 21, 2022 Revised: October 28, 2022 Accepted: November 22, 2022 Article in press: November 22, 2022 Published online: December 27, 2022 Processing time: 103 Days and 7.3 Hours
Abstract
BACKGROUND
Common diseases after radical gastrectomy include cholecystitis and pancreatitis, but the sudden onset of acute appendicitis in a short period following radical gastrectomy is very rare, and its clinical symptoms are easily misdiagnosed as duodenal stump leakage.
CASE SUMMARY
This is a case report of a 77-year-old woman with lower right abdominal pain 14 d after radical resection of gastric cancer. Her pain was not relieved by conservative treatment, and her inflammatory markers were elevated. Computed tomography showed effusion in the perihepatic and hepatorenal spaces, right paracolic sulcus and pelvis, as well as exudative changes in the right iliac fossa. Ultrasound-guided puncture revealed a slightly turbid yellow-green fluid. Laparoscopic exploration showed a swollen appendix with surrounding pus moss and no abnormalities of the digestive anastomosis or stump; thus, laparoscopic appendectomy was performed. The patient recovered well after the operation. Postoperative pathology showed acute purulent appendicitis. The patient continued adjuvant chemotherapy after surgery, completing three cycles of oxaliplatin plus S-1 (SOX regimen).
CONCLUSION
Acute appendicitis in the short term after radical gastrectomy needs to be differentiated from duodenal stump leakage, and early diagnosis and surgery are the most important means of treatment.
Core Tip: Common forms of abdominal inflammation occurring after radical gastrectomy are cholecystitis and pancreatitis, of which cholecystitis has the highest incidence. In contrast, the incidence of appendicitis in the short term after radical gastrectomy is rare and has not been reported before. Herein, we present a case of acute appendicitis in the short term following radical total gastrectomy. We suggest that acute appendicitis in the short term after gastric cancer surgery needs to be differentiated from duodenal stump leakage and that early diagnosis and surgery are the most important means of treatment.
