Acute Appendicitis Post Liver Transplant: A Case Report and Literature Review

Abstract

Although acute appendicitis is common, reported cases after orthotopic liver transplant are rare. A 29-year-old woman presented to the emergency department with right lower-quadrant pain and mild leukocytosis 2 years after having a liver transplant. A computed tomograph y scan revealed an inflamed appendix. On operation, an injected appendix was noted, and she underwent an uncomplicated laparoscopic appendectomy. Histology confirmed the diagnosis and her postoperative course was unremarkable. Owing to the rarity of these cases and paucity of knowledge on management, a high index of suspicion and immediate intervention are required to prevent major complications. This case is the first successful laparoscopic appendectomy after liver transplant ever reported.

Acute Appendicitis after Liver Transplant: A Case Report and Review of the Literature

“…Imaging tests are extremely useful in such cases. Abdominal ultrasound can confirm the diagnosis and has good accuracy if performed by an experience physician [3] [5]. Computed tomography has been describe as a method of choice, but despite not being an examiner-dependent method, if performed by a scanner of low sensibility, may result in delayed diagnosis and surgical treatment, as occurred in our case.…”

“…The different diagnosis is difficult and must include perforation of intestinal loops, biliary fistula, graft-related complications, such as infection, rejection and thrombosis [3]. There is also a high incidence of perforation of the appendix in the reported cases especially after three days of evolution [4] [5]. In our case, the patient was diagnosed with ulcerative colitis, winch made us think he might be having a recurrence of the disease, since the image in examination was nonspecific.…”

“…Conventional incision for appendectomy or laparotomy for cases of diagnostic uncertainty may be performed. There is also one reported case of laparoscopic appendectomy, but the patient in question was in the late postoperative period (two years), being described as a method that can be performed in selected cases [5].…”

Abdominal emergencies after liver transplantation: Presentation and surgical management

“…Emergency surgical management by open appendectomy is the treatment of choice in most studies. Laparoscopy is reported in only one case with unremarkable postoperative course but safety and benefit of a mini‐invasive approach should be assessed, especially in case of diffuse peritonitis …”

“…To support elective resection, the postoperative outcome after elective procedure was no different from that in immunocompetent patients. The often‐significant severity of sigmoid diverticulitis among transplant recipients has prompted consideration of pre‐transplant prophylactic surgery for patients with sigmoid diverticulosis proven by colonoscopy, but this is a feasible approach only for kidney transplant candidates, as patients awaiting heart, lung, or LT are generally too sick to tolerate any major surgical procedures …”