CECECTOMY FOR COMPLICATED APPENDICITIS

BACKGROUND: Cecal leak or disruption after appendectomy for complicate d appendicitis is a consequence of severity of disease and is related to residual abscess cavity, inflammation, phlegmon, and nonviable inte stine. in an attempt to improve results, we have begun to resect the c ecum and other localized infected tissue in instances of complicated a ppendicitis in which the viability of the appendiceal base and adjacen t cecum is questionable. STUDY DESIGN: This is a prospective series of all patients who have undergone resectional therapy for complicated a ppendicitis in the last four years. Patients with other inflammatory c onditions of the right colon have been specifically excluded. RESULTS: Seventeen patients have undergone resectional therapy for complicated appendicitis. Thirteen (76.5 percent) were men; the mean age was; 42. 4 years. The mean temperature and leukocyte count were 37.8 degrees C and 16.1 X 10(9) per L, respectively. These patients presented with a mean of 6.8 days of abdominal pain. Nine had a palpable abdominal mass , and all had tenderness in the right lower quadrant. In ten patients an abscess was encountered at operation. While the extent of the resec tion varied, it generally included the cecum, part of the right colon, and 5 to 7 cm of terminal ileum. Fourteen patients had a primary anas tomosis, while the other three had the creation of an ileostomy. Compl ications were encountered in only two patients: one wound infection an d one pulmonary embolus. There were no instances of postoperative intr a-abdominal abscess, intestinal obstruction, or fecal fistula. All pat ients had a benign postoperative course and were discharged on the ave rage of 9.9 days postoperatively. The ileostomies in three patients ha ve been closed and no complications have occurred on follow-up examina tion. CONCLUSIONS: We conclude that aggressive resectional therapy of the cecum during appendectomy in selected patients with complicated ap pendicitis is effective therapy and can be performed safely.