Atypical presentation and unusual complications of appendicitis: a case report

Abstract

Objective: To describe a case of acute appendicitis with an atypical presentation, complicated by hemoperitoneum, retroperitoneal hematoma, and pylephlebitis.

Case report: A 55-year-old female patient without relevant history presented with 8 days of epigastric and right hypochondrial pain, fever, dark urine, and vasovagal syncope. Laboratory tests showed anemia, thrombocytopenia, liver dysfunction, and signs of sepsis. CT scan revealed an enlarged cecal appendix with wall disruption, portal and superior mesenteric vein thrombosis, and free fluid. Emergency laparoscopy was converted to laparotomy due to hemodynamic instability, revealing hemoperitoneum and retroperitoneal hematoma. Appendectomy, abdominal packing, and delayed closure were performed. The patient completed 19 days of antibiotic therapy, was transferred to the general ward on postoperative day 17, and discharged on day 20 with full recovery.

Conclusion: Acute appendicitis complicated by hemoperitoneum, retroperitoneal hematoma, and pylephlebitis is rare but severe. Early diagnosis and appropriate surgical management are key to improving outcomes.