Appendicitis is one of the most common surgical emergencies in general surgery. To our knowledge, this is the first reported case of diaphragmatic necrosis associated with appendicitis. A 38-year-old male north African patient with no past medical history presented with fever and right lower quadrant pain, for which he started oral self-medication with ibuprofen. Clinical and radiological examinations revealed perforated appendicitis with right-sided pleural empyema and pneumomediastinum. During the initial surgical procedure, we performed an appendicectomy, inserted a chest tube and administered a broad-spectrum antibiotic therapy. The following day, respiratory failure occurred, necessitating right sided thoracoscopy. This revealed diaphragmatic necrosis, which was treated by excision and tension-free suturing after conversion to open thoracotomy. Six days later, persistent sepsis necessitated a new exploratory laparotomy and a right-sided hemicolectomy with an ileocolostomy to treat colonic necrosis. The postoperative course was uneventful, and the patient was discharged one month after admission. Bowel continuity was restored six months later. After a one-and-a-half-year follow-up, the patient remained healthy with no long-term physical impairment. To the best of our knowledge, this is the first case of acute appendicitis complicated by diaphragmatic necrosis, empyema and pneumomediastinum to be reported in the medical literature. The pleural empyema and diaphragmatic defect were treated by conversion from thoracoscopy to thoracotomy and direct suture.
Karam et al. (Wed,) studied this question.