A Case of Retroperitoneal Abscess Arising from a Perforated Appendiceal Diverticulum Treated by Laparoscopic Appendectomy

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  • 腹腔鏡下虫垂切除術を施行した後腹膜膿瘍を伴う虫垂憩室穿孔の1例
  • 症例 腹腔鏡下虫垂切除術を施行した後腹膜膿瘍を伴う虫垂憩室穿孔の1例
  • ショウレイ フククウキョウ カ チュウスイ セツジョジュツ オ シコウ シタ アトバラマク ノウヨウ オ トモナウ チュウスイ ケイシツセンコウ ノ 1レイ

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A 59-year-old man presented with fever and low back pain that developed during chemotherapy for right lung lower lobe adenocarcinoma, and abdominal CT revealed a retroperitoneal abscess. The infection persisted even after antimicrobial therapy, therefore, percutaneous abscess drainage was performed. The inflammation improved after the drainage, however, intestinal juice began discharging from the drainage tube. A repeat CT revealed a fistula between the abscess cavity and the appendix. Therefore, perforation of the appendix was diagnosed, and laparoscopic appendectomy was performed. The postoperative course was good, and the patient was discharged on postoperative day 11. Histopathology of the resected specimen revealed the diagnosis of perforated appendiceal diverticulum. Retroperitoneal abscess complicating a perforated appendiceal diverticulum is rare. We analyzed the data of 6 cases, including our case, in regard to the success of preoperative diagnosis and effective treatment strategies. We consider that appendiceal diverticulitis is diagnosable in the early stages of the disease before abscess formation becomes significant, and that interval laparoscopic appendectomy after percutaneous drainage is a useful treatment strategy.

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