Traumatic appendicitis: a case report and literature review
© Bouassria et al.; licensee BioMed Central Ltd. 2013
Received: 22 May 2013
Accepted: 5 August 2013
Published: 9 August 2013
Appendicitis and trauma may exist together, which causes an interesting debate whether trauma has led to appendicitis. We report a case of appendicitis after an abdominal trauma. Our patient developed acute appendicitis following a stab wound in the right iliac fossa. Surgical exploration confirmed the traumatic origin of appendicitis, appendectomy was performed and our patient made an excellent recovery. In non operative management of abdominal trauma, physical examinations and radiological explorations should be repeated in order to diagnose traumatic appendicitis.
Trauma and appendicitis are the commonest emergency conditions requiring surgery, especially in young adults. The pathological process in appendicitis generally starts with obstruction of the appendiceal lumen and may progress to peritonitis and development of intraabdominal abscess via appendiceal inflammation and perforation. An abdominal trauma may be responsible for damage of digestive tract or solid organs (liver or spleen). Occasionally, appendicitis and trauma exist together, which causes an interesting debate whether trauma has led to appendicitis. Actually, the role of abdominal trauma is still uncertain in the etiology of appendicitis. Blunt abdominal trauma or penetrating trauma like a stab wound may lead to an acute inflammatory response which is suggested to be the probable mechanism of traumatic appendicitis.
We report a case of appendicitis after an abdominal trauma (stab wound). To our knowledge, it is the first case of acute appendicitis after a stab wound reported in the literature.
This study was performed according to the declaration of Helsinki and approved by the Local Ethical Committee.
Review of the cases of traumatic appendicitis reported in the literature
Cause of traumatic appendicitis
Mechanism of traumatism
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Bicycle Fall, Industrial accident
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Abdominal trauma during scuffle, sports injury, industrial accident, car crash
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Industrial accident, Bicycle fall
1993 – 2002
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4 car crashes, 1 fall from a height of 10 meters
A.O. C iftçi, and al.Eur J Pediatr Surg1996;6:350–3.
Hager and al., Emerg Med J 2002 19:366–367
Fall from a ladder
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Blunt abdominal trauma
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Fall, Kicked in the abdomen, Bicycle fall
Serour and al have claimed that direct appendiceal injury is generally coexistent with other intra-abdominal organ injuries, and that the appendix is very rarely affected by direct trauma as it is very mobile and its dimensions very small . As for our patient, hypothesis of appendicitis and abdominal trauma both existing together was easily dismissed because he was attacked by a sharp instrument. The stab wound in the right iliac fossa produced a penetrating abdominal wound. Then, the sharp instrument traumatized the meso colon and the meso appendix, causing the para colic retroperitoneal hematoma and hematomas of the caecal wall and the appendiceal wall. The result of these anatomic lesions was acute appendicitis due to the consequent luminal obstruction of the appendix.
Appendicitis may follow abdominal trauma. Blunt abdominal trauma leading to appendicitis is rare, and occasionally, appendicitis and trauma exist together, which causes an interesting debate whether trauma has led to appendicitis. We report a case of abdominal trauma due to a sharp instrument which directly led to acute appendicitis. As the abdominal trauma was not a BAT, it was easy to relate the stab wound in the right iliac fossa to acute appendicitis. In non operative management of abdominal trauma, physical examinations, abdominal ultra sonography and/or abdominal computed tomography should be repeated for diagnosis of traumatic appendicitis in order to prevent potential complications of appendicitis.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
School of medicine and pharmacy of fez, Sidi Mohammed Ben Abdellah University department of surgery, university hospital Hassan II, BP: 1893; km2.200, route de sidi Hrazem; fez 30000, morocco.
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