Procedures
Laparoscopic appendectomy
Complications
Complication risk rises significantly with perforation and delayed presentation. Always review the final pathology report.
Sources:
| Complication | Timeframe | Mechanism | Presentation | Management |
|---|---|---|---|---|
| Surgical site infection (SSI) | Days-weeks | Wound contamination, especially in perforated cases | Erythema, purulent drainage, tenderness at port sites | Drain an infected wound when indicated; add antibiotics for systemic illness or significant surrounding infection |
| Intra-abdominal abscess | Days-2 weeks postop | Inadequate source control in perforated appendicitis; fecalith spillage | Fever, leukocytosis, RLQ or pelvic pain, failure to improve | CT-guided percutaneous drainage; antibiotics; rarely reoperation |
| Appendiceal stump leak | Early postop (days) | Clip failure, friable base, inadequate staple line | Peritonitis, fever, leukocytosis, free air or fluid on CT | Urgent surgical assessment and source control; drainage or repair/resection depends on the leak and patient stability |
| Bleeding | Intraop or early postop | Inadequate hemostasis; clip slippage from appendiceal artery | Poor visualization intraop; dropping Hgb or peritonitis postop | Intraop control; may require conversion to open; transfusion if needed |
| Right ureter injury (rare) | Intraop or delayed recognition | Injury near a retrocecal appendix or inflamed tissues | Urinary leakage, flank pain, or urinary fistula; presentation varies | Prompt urologic assessment; repair or urinary diversion depends on the injury |
| Port-site hernia | Weeks-months | Risk increases at larger trocar sites, particularly the umbilicus | Bulge or pain at port site; may present with bowel obstruction | Surgical assessment; urgent evaluation for obstruction or suspected strangulation |
| Ileus | Early postop | Bowel manipulation; inflammation; opioid use | Nausea, distension, delayed return of bowel function | Supportive care; early ambulation; minimize opioids |
| Incidental appendiceal NET | Pathology result | Incidental neuroendocrine tumor on specimen pathology | Often an incidental finding; review tumor size, grade, invasion, and margins | Specialist assessment; right hemicolectomy for tumors >2 cm. Smaller tumors require risk-based assessment. |