Laparoscopic management of acute appendicitis in a kidney transplant recipient: a case report

Abdominal surgery in transplant recipients remains a major clinical challenge. Although appendicitis is common in the general population, it is rare among kidney transplant recipients. In such cases, classic clinical signs may be absent or misleading, leading to diagnostic delays and increasing the risk of severe complications, notably peritonitis.

We present a case of a 41-year-old man, a kidney transplant recipient in the right iliac fossa for 2 years, presenting with right-sided abdominal pain evolving over 5 days. Initial clinical impression suggested graft rejection due to fever, leukocytosis, and impaired renal function. Abdominal computed tomography (CT) showed a morphologically preserved graft and minimal intra-abdominal fluid, without clear signs of appendicitis. Exploratory laparoscopy revealed generalized purulent appendicular peritonitis, treated by laparoscopic appendectomy with peritoneal lavage, resulting in rapid recovery of renal function.

Although rare (0.01%-0.35%), acute appendicitis in kidney transplant recipients represents a significant diagnostic challenge. Atypical presentations complicate clinical interpretation, and diagnostic delays are a key prognostic factor directly impacting morbidity, justifying early CT imaging. Laparoscopy allows complete exploration, effective treatment, and graft preservation, while reducing complications and facilitating recovery.

This case highlights the rarity and potential severity of acute appendicitis in kidney transplant recipients. Early recognition through heightened clinical vigilance, prompt CT imaging, and a low threshold for surgical exploration are essential to prevent life-threatening complications. Laparoscopic management is safe and effective, allowing complete abdominal exploration while preserving graft function. Multidisciplinary coordination between surgeons, nephrologists, and radiologists is crucial to optimize patient outcomes.