Emergency Laparoscopic Appendectomy for Pediatric Acute Gangrenous Perforated Appendicitis With Periappendiceal Abscess≤4 cm in Diameter
10.3969/j.issn.1009-6604.2025.04.005
- VernacularTitle:急诊腹腔镜阑尾切除治疗小儿急性坏疽穿孔性阑尾炎合并直径≤4cm阑尾周围脓肿
- Author:
Xuelai LIU
1
;
Mao YE
1
;
Le ZHENG
1
Author Information
1. 首都儿科研究所附属儿童医院普通外科,北京 100020
- Publication Type:Journal Article
- Keywords:
Acute appendicitis;
Pericecal abscess;
Laparoscopy;
Appendectomy;
Pediatric
- From:
Chinese Journal of Minimally Invasive Surgery
2025;25(4):216-221
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the experience of emergency laparoscopic appendectomy for pediatric acute gangrenous perforated appendicitis complicated with periappendiceal abscess≤4 cm in diameter.Methods From January 2021 to August 2024,49 children with acute gangrenous perforated appendicitis complicated by periappendiceal abscess ≤ 4 cm in diameter underwent three-port laparoscopic appendectomy.A 5 mm trocar and a 30° laparoscope were inserted through a supraumbilical midline incision.Two 5 mm trocars with operating forceps were placed at 2-3 cm proximal of the bladder and 2-3 cm below the umbilicus at the lateral edge of the left rectus abdominis.Blunt dissection was performed to release the omentum and intestinal adhesion,exposing the abscess in the intestinal interspace.The pus cavity was aspirated,and the diseased appendix was identified.After freeing and exposing the appendix,the mesoappendix was ligated at its base.The mesoappendix was then divided with an electric hook,and the diseased appendix was removed.Results All the 49 cases were operated successfully.The operative time was 50-150 min,with an average of(85.5±10.5)min.All the patients were able to get out of bed at 6-8 h postoperatively,and resumed flatus and started a liquid diet within 1.5-2 d.Postoperative blood tests on the 6th day showed normal white blood cell count,neutrophil count,and neutrophil ratio,with C-reactive protein levels ranging 26-55 mg/L.Ultrasound showed a low-density shadow in the cecum with a maximum diameter≤2.0 cm and a pelvic fluid depth≤2.0 cm.The average postoperative hospital stay was 8.5 d(range,6-11 d).Pathological reports confirmed acute gangrenous perforated appendicitis with periappendiceal abscess.Follow-ups for 6-18 months(mean,12.5 months)showed no complications such as wound infection,adhesive bowel obstruction,residual appendiceal stump inflammation,or pelvic abscess.Conclusions Emergency laparoscopic appendectomy for pediatric acute gangrenous perforated appendicitis complicated by periappendiceal abscess≤4 cm in diameter is safe and feasible.Key steps in the procedure include identifying and exposing the appendix and releasing intestinal adhesions.
