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Cecectomy for complicated appendicitis

J E Thompson1, R S Bennion, P J Schmit

  • 1Department of Surgery, University of California Los Angeles School of Medicine.

Journal of the American College of Surgeons
|August 1, 1994
PubMed
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Aggressive surgical resection of the cecum during appendectomy for complicated appendicitis effectively treats the condition. This approach, involving removal of the cecum and adjacent infected tissue, demonstrated a low complication rate in selected patients.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Abdominal Surgery

Background:

  • Complicated appendicitis can lead to cecal leak or disruption due to disease severity, residual abscesses, inflammation, phlegmon, or nonviable intestine.
  • Traditional appendectomy may be insufficient when the appendiceal base or adjacent cecum viability is compromised.
  • Resectional therapy aims to improve outcomes by removing compromised tissue during appendectomy.

Purpose of the Study:

  • To evaluate the efficacy and safety of aggressive resectional therapy of the cecum in patients with complicated appendicitis.
  • To assess the outcomes of patients undergoing combined appendectomy and cecal resection for severe appendicitis.

Main Methods:

  • A prospective series of patients undergoing resectional therapy for complicated appendicitis over four years.

Related Experiment Videos

  • Exclusion of patients with other inflammatory conditions of the right colon.
  • Resection typically included the cecum, part of the right colon, and terminal ileum, with varying degrees of resection.

    • Main Results:

    • Seventeen patients underwent the procedure; 76.5% were male, with a mean age of 42.4 years.
    • Patients presented with a mean of 6.8 days of pain, often with a palpable mass and right lower quadrant tenderness; 10 had abscesses.
    • Fourteen patients had primary anastomosis, three had ileostomy; only two experienced complications (wound infection, pulmonary embolus), with no postoperative abscesses or fistulas.

    Conclusions:

    • Aggressive resectional therapy of the cecum during appendectomy is an effective treatment for selected patients with complicated appendicitis.
    • This approach can be performed safely, leading to favorable postoperative outcomes and low complication rates.
    • The study supports the use of cecal resection in cases where appendiceal base or cecal viability is questionable.