Experience in one-stage laparoscopic surgery for elderly periappendiceal abscess: A 75 year old case report and literature review

Rationale: Periappendiceal abscess is one of the common complications of acute appendicitis, especially in elderly patients. In the case of ineffective conservative treatment, the traditional surgical method is puncture tube or incision drainage, and secondary appendectomy. This paper explores the feasibility of laparoscopic surgery for periappendiceal abscess. Patient concerns: We report a 75-year-old male patient presented with a 12-day history of abdominal pain, fever, and a palpable mass with tenderness in the right lower abdomen. Abdominal computed tomography showed the periappendiceal abscess. Diagnosis: Periappendiceal abscess, acute gangrenous appendicitis, and perforation. Interventions: Emergency laparoscopic one-stage appendectomy was performed, with removing the appendix, clearing the surrounding infected areas, and suturing the appendiceal stump. Outcomes: The patient recovered well and was discharged from the hospital on the 7th postoperative day. He was followed up for 32 months without any abnormalities. Lessons: Elderly patients with periappendiceal abscess should be diagnosed and treated as early as possible, laparoscopic one-stage appendectomy is a safe and feasible option, with the advantages of minimal trauma and faster recovery. The key lies in the choice of laparoscopic surgery, operative techniques, postoperative management, and especially perioperative safety assurance.