Case Report
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World J Gastroenterol. Jul 7, 2014; 20(25): 8317-8319
Published online Jul 7, 2014. doi: 10.3748/wjg.v20.i25.8317
Appendicitis with psoas abscess successfully treated by laparoscopic surgery
Yasunori Otowa, Yasuo Sumi, Shingo Kanaji, Kiyonori Kanemitsu, Kimihiro Yamashita, Tatsuya Imanishi, Tetsu Nakamura, Satoshi Suzuki, Kenichi Tanaka, Yoshihiro Kakeji
Yasunori Otowa, Yasuo Sumi, Shingo Kanaji, Kiyonori Kanemitsu, Kimihiro Yamashita, Tatsuya Imanishi, Tetsu Nakamura, Satoshi Suzuki, Kenichi Tanaka, Yoshihiro Kakeji, Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, Hyogo Prefecture 650-0017, Japan
Author contributions: Otowa Y, Sumi Y, Kanemitsu K and Yamashita K operated the patient; Nakamura T diagnosed the patient at the outpatient department; Kanaji S, Imanishi T and Suzuki S drafted the paper; Otowa Y wrote and Tanaka K and Kakeji Y critically revised the paper with an important conceptual and editorial input.
Correspondence to: Dr. Yasunori Otowa, Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, Hyogo Prefecture 650-0017, Japan. otoway@med.kobe-u.ac.jp
Telephone: +81-78-382-5925 Fax: +81-78-382-5939
Received: November 26, 2013
Revised: February 25, 2014
Accepted: April 5, 2014
Published online: July 7, 2014
Processing time: 219 Days and 5.4 Hours
Abstract

Although acute appendicitis is a common disease, retroperitoneal abscesses are rarely observed. Here, we report a case consisting of a psoas abscess and cutaneous fistula caused by appendicitis. The patient was a 56-year-old male who was introduced to our institution due to an intractable right psoas abscess. Imaging tests had been performed over the previous 3 years; however, clinicians could not find the origin of the abscess and failed to resolve the problem. A successful operation was performed via a laparoscopic approach, and 17 mo have passed without recurrence. The advantage of laparoscopic surgery is well understood in cases of appendicitis with abscesses. However, the indication for laparoscopic approach is not clear for retroperitoneal abscesses. From our experience, we can conclude that appendicitis with retroperitoneal abscesses can be managed and treated using a laparoscopic approach.

Keywords: Appendicitis; Laparoscopic surgery; Psoas abscess; Retroperitoneal abscess; Right leg pain

Core tip: A psoas abscess caused from appendicitis is sometimes observed, and it has a high mortality rate because of the difficulty in diagnosing the origin of the abscess preoperatively. In our case, the patient had been previously treated for 3 years; however, the clinicians could not find the origin of the abscess and failed to resolve the problem. We successfully treated the patient using a laparoscopic approach. Only a small number of similar cases have treated patients using a laparoscopic method. We believe that this method helps diagnose the origin of the abscess and successfully treat complicated cases.