Síndrome adherencial post apendicectomía

Abstract

Peritoneal adhesions after abdominal surgeries are the most common cause of reoperations due to complications that include intestinal obstruction. Its development is linked to the physiology of the peritoneum. We analyze the case of a 10-year-old male patient, mestizo, with a history of appendectomy 5 years ago for complicated appendicitis, who presents diffuse colic-type abdominal pain that progresses from moderate to high intensity. It is accompanied by emesis for approximately 30 occasions, being at the beginning of alimentary content and later liquid. At physical examination, distended abdomen, diffuse pain, diminished hydro-acoustic sounds and signs of: McBurney; Blumberg; Psoas; Valsalva and Murphy positive. Laboratory: White Globules 11.9 103 / uL; Neutrophils 78.7%; Lymphocytes 13.2%; Normal hepatic profile; PCR negative. X-ray: dilation of intestinal loops is observed. Ultrasound: paretic loops, with inflammatory signs of mesenteric fat and free fluid at the pelvic level. Tomography there is presence of dilated loops. When not giving the picture, it was decided to perform an exploratory laparotomy, finding an intestinal loop with adhesions and little circulation, and a plastron of the greater omentum incarcerating the intestinal loop. The first and second post-surgical days the patient exhibits pain at the level of surgical wound is maintained with intravenous analgesia and indication of absolute diet. He remains hospitalized for 5 days after surgery, with favorable evolution; is discharged in stable condition.