A Case of Postoperative Sepsis Triggered by Fecal Retention at the Suture Site After Appendectomy

Postoperative sepsis after appendectomy can sometimes be led by surgical site infection, intra-abdominal abscess, or intestinal obstruction. However, there have been no reports that postoperative sepsis is certainly caused by only fecal retention in the intestine, including the appendectomy stump. A 60-year-old healthy woman visited a doctor with a chief complaint of right lower abdominal pain. Abdominal computed tomography (CT) showed a swollen appendix with fecal calculus, and then the patient was diagnosed with acute appendicitis. The patient underwent a laparoscopic appendectomy the next day. The appendix was resected at the level of the appendicular root with an endostapler. The patient was discharged from the hospital on postoperative day (POD) 4 in a good general condition. However, the patient visited the hospital on POD 15 with a chief complaint of fever. A medical interview revealed a decrease in the number of bowel movements compared to before the appendectomy. The quick Sequential Organ Failure Assessment (SOFA) score with the vital signs showed two points, and the SOFA score with the blood examination showed a total increase of four points compared to the previous blood examination. The patient was therefore suspected of sepsis after appendectomy. Abdominal CT showed obvious fecal retention in the ileocecal region, including the appendectomy site. Furthermore, abdominal contrast CT did not reveal any obvious thrombosis in the portal venous system. With conservative treatment by antibiotics and laxatives, the fever gradually resolved, and the patient was discharged on POD 27. Abdominal radiography showed no findings of fecal retention. The patient has had regular bowel movements and has not experienced a recurrence of the symptoms. Postoperative sepsis might be caused even in healthy patients. It was conceivable that postoperative assessment of bowel movements was necessary to detect the risk of postoperative sepsis.