PubMed · 15864372
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David R Berk, Karl G Sylvester. 2005. Subacute appendicitis.. https://doi.org/10.1177/000992280504400414
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A 5-year-old girl presented with abdominal pain suggestive of appendicitis. Intraoperatively, a solid cecal mass was identified along with mesenteric adenopathy. A right hemicolectomy was performed. Pathologic examination revealed a vascular malformation with evidence of recent hemorrhage.
The purpose of this study was to determine, by means of a systematic review, whether the method of wound closure in complicated appendicitis affects the incidence of wound infection. A comprehensive literature search of multiple databases including MEDLINE (1980-2003), was performed, using the Cochrane search strategy, for articles on wound closure and complicated appendicitis. Clinical trials examining the method of wound closure were selected for systematic review and all quasi-randomized and randomized trials underwent meta-analysis. Failure to close the wound as planned in delayed closure (DC) was considered indicative of a wound infection. Purulent drainage requiring wound opening indicated an infection in the wounds closed primarily. Six randomized trials were considered adequate for meta-analysis. None independently showed a statistically significant difference in the risk of developing a wound infection with primary closure (PC). When pooled data were subjected to meta-analysis, PC achieved a statistically significant reduction in the relative risk of treatment failure and did not lead to an increase in wound infections. Primary closure does not increase the risk of developing a wound infection after operation for perforated appendicitis. Given the lack of benefit of DC, and the less traumatic, less painful, and less costly nature of PC; primary closure is a safe and practical treatment option.
This report describes a rare complication of appendicitis, renal cellulitis, which led to a diagnostic dilemma in a 2-year-old girl who presented with fever of long duration.