Chronic Appendicitis-Induced Effusive-Constrictive Pericarditis and Hepatic Fibrosis: A Case Report.

Area of Science:

• Pediatric Cardiology
• Pediatric Surgery
• Gastroenterology

Background:

• Effusive-constrictive pericarditis (ECP) is a rare pediatric condition.
• Appendicitis typically presents as an abdominal emergency but can rarely cause systemic inflammation.
• This case details a unique presentation of chronic appendicitis with an appendicolith leading to ECP and hepatic fibrosis.

Purpose of the Study:

• To report a unique pediatric case of chronic appendicitis with an appendicolith causing systemic inflammation, effusive-constrictive pericarditis, and hepatic fibrosis.
• To highlight the diagnostic challenges and importance of identifying abdominal pathologies as a source of systemic inflammation in refractory cases.

Main Methods:

• A 14.5-year-old boy presented with symptoms of dyspnea, reduced exercise tolerance, fever, and abdominal pain.
• Diagnostic workup included echocardiography, CT scans, and laboratory tests.
• Management involved pericardiocentesis, subtotal pericardiectomy, and eventually appendectomy.

Main Results:

• Initial management focused on pericardial effusion, with partial relief from pericardiocentesis and subtotal pericardiectomy.
• A perforated appendix with an abscess was diagnosed 6 weeks later, necessitating appendectomy.
• Appendectomy led to complete symptom resolution, normalization of inflammatory markers, and improved hepatic and cardiac function.

Conclusions:

• Atypical appendicitis can present with systemic manifestations, including effusive-constrictive pericarditis and hepatic fibrosis.
• Recognizing abdominal pathologies as the primary source of systemic inflammation is crucial for effective management, especially in complex pediatric cases.
• Early intervention targeting the primary abdominal source can prevent severe complications and improve patient outcomes.