Complicated acute appendicitis with compromised appendiceal base: A review of surgical strategies

Abstract

Introduction: Acute appendicitis is one of the most frequent emergencies in hospitals around the world; it requires early surgical treatment in complicated cases. One of the challenges that the surgeon faces during appendectomy is when the base of the appendix is compromised by either a perforation or gangrene. To show the surgical strategies that have been reported, as well as the complications associated with a compromised appendicular base in a complicated acute appendicitis.Methods: A bibliographic search was carried out in the databases of Pubmed, Embase, Web of Science, and Google Scholar. The search expression (“appendiceal stump closure” OR “Closure of the appendiceal stump” OR “Management of appendiceal stump”) was used to search for articles. The inclusion criteria were observational studies (case reports, case series, or cross-sectional, case-control, or cohort studies).Discussion: Different techniques have been reported for the treatment of a compromised appendicular base. Among the most used are primary closure, partial resection of the cecum, cecostomy tube, ileocecectomy, and right hemicolectomy. The most frequent complications are surgical site infection, intra-abdominal abscess, postoperative ileus, intestinal obstruction, and others.Conclusions: The appendicular base, compromised by necrosis or perforation, requires adequate treatment in order to prevent dehiscence of the appendicular stump sutures and fecal peritonitis. A number of surgical options have been reported