Complicated acute appendicitis: anatomical variations and the diagnostic challenge - a clinical-surgical approach

Abstract

This paper describes the clinical case of J.O.S., a 30-year-old male patient diagnosed with complicated acute appendicitis, highlighting the anatomical variations and the challenges faced during management. The patient presented classic symptoms of appendicitis, such as abdominal pain located in the right lower quadrant, fever and leukocytosis. However, he also presented symptoms such as vomiting, diarrhea, general malaise, dysuria and right lower back pain that made the diagnosis of complicated acute appendicitis difficult. The diagnosis was confirmed by imaging tests, such as ultrasound and computed tomography, which also revealed anatomical variations in the positioning of the appendix, increasing the complexity of the case. The discussion addressed the importance of early diagnosis and the need for rapid surgical intervention to avoid serious complications. The chosen surgical technique was open appendectomy, which, despite the anatomical variations, was performed successfully. The study also details the anesthetic management, possible peri- and postoperative complications, such as surgical wound infection and intra-abdominal abscesses, and strategies to minimize them. The outcome of the case was favorable, with the patient having a good postoperative recovery and discharge from hospital without complications. The study reinforces the importance of detailed anatomical knowledge, technical skill and rapid decision-making in the management of complex cases of acute appendicitis, contributing to the medical literature with a report that illustrates the challenges and strategies to overcome them.