Comprehensive Surgical Approach To Acute Abdomen With Combined Pathologies: A Case Report From Paraguay
DOI:
https://doi.org/10.62486/sic2026294Keywords:
acute abdomen, intestinal ischemia, appendicitis, inguinal hernia, intussusceptionAbstract
Acute abdomen requires urgent intervention for potentially life-threatening conditions. We report the case of a 59-year-old male with acute abdominal pain and bloody stools treated at the Regional Hospital of Pilar, Paraguay. Exploratory laparotomy revealed intestinal ischemia with necrosis, congestive appendicitis, inguinal hernia, colocolic intussusception, and diverticulosis. A comprehensive surgical approach resulted in favorable postoperative recovery. This case highlights the critical role of timely diagnosis and multidisciplinary management in optimizing outcomes for complex acute abdomen presentations.
References
1. Kumar MS, Bharath B, Balasubramanya KS, Thinagaran K. The non traumatic acute abdomen and its clinical spectrum. Int Surg J. 2019;6(5):1710–5. Disponible en: https://www.ijsurgery.com/index.php/isj/article/view/4069. [Consultado el 10 de abril de 2025].
2. Bastakoti A, Khatiwada A, Neupane N, et al. A rare concurrence of acute appendicitis with Meckel’s diverticulitis: a case report. Ann Med Surg (Lond). 2025;87(3):1729–32. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981367/. [Consultado el 10 de abril de 2025].
3. Bala M, Catena F, Kashuk J, et al. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2022;17:54. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9276543/. [Consultado el 11 de abril de 2025].
4. Lotfollahzadeh S, Lopez RA, Deppen JG. Appendicitis. En: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK493193/. [Consultado el 11 de abril de 2025].
5. Greenseid S, Moody A, Quan G. Concurrent presentation of unrelated perforated appendicitis and high-grade small bowel obstruction: A case report. J Case Rep Images Surg. 2024;10(2):10–13. Disponible en: https://www.ijcrisurgery.com/archive/article-full-text/100141Z12SG2024. [Consultado el 12 de abril de 2025].
6. Balani P, Bhuiyan AS, Dalal VN, Maheshwari GS. Early Detection and Successful Management of Acute Mesenteric Ischaemia in Symptomatic COVID-19 Patient. Indian J Surg. 2022;84(1):209–11. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039803/. [Consultado el 12 de abril de 2025].
7. Dileep K, Kumar NU, Kothareddy L. Evaluation of Acute Abdomen by Multidetector Computed Tomography: A Prospective Study in a Tertiary Care Hospital in Andhra Pradesh, India. Curr Med Issues. 2024;22(1):21–5. Disponible en: https://www.cmijournal.org/article.asp?issn=0973-4651;year=2024;volume=22;issue=1;spage=21;epage=25;aulast=Dileep. [Consultado el 13 de abril de 2025].
8. Siewert B, Raptopoulos V, Mueller MF, Rosen MP, Steer M. Impact of CT on diagnosis and management of acute abdomen in patients initially treated without surgery. AJR Am J Roentgenol. 1997;168(1):173–8. Disponible en: https://www.ajronline.org/doi/10.2214/ajr.168.1.8976942. [Consultado el 13 de abril de 2025].
9. Leoni ML, Cerati G, Corso RM, et al. Emergency awake laparotomy under neuraxial anesthesia in acute abdomen: feasibility and outcomes in a case series. J Pers Med. 2024;14(8):845. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10434567/. [Consultado el 13 de abril de 2025].
10. Zaboli A, Ausserhofer D, Pfeifer N, Magnarelli G, Ciccariello L, Siller M, Turcato G. Acute abdominal pain in triage: A retrospective observational study of the Manchester triage system’s validity. J Clin Nurs. 2021;30(13–14):2036–44. Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/jocn.15635. [Consultado el 13 de abril de 2025].
11. Gupta R, Parashar S, Gupta R. Dual Pathology: A Rare Association in Surgical Acute Abdomen. Cureus. 2021;13(6):e15926. Disponible en: https://www.cureus.com/articles/57989-dual-pathology-a-rare-association-in-surgical-acute-abdomen. [Consultado el 13 de abril de 2025].
12. Stabilini C, van Veenendaal N, Aasvang E, et al. Update of the international Hernia Surge guidelines for groin hernia management. BJS Open. 2023;7(5):zrad080. Disponible en: https://academic.oup.com/bjsopen/article/7/5/zrad080/7312617. [Consultado el 13 de abril de 2025].
13. Dayı S, Anayurt M, Çınar F, Kırmacı İ, Sancar S. Approach to concurrent inguinal hernias during laparoscopic appendectomy for early appendicitis. Langenbecks Arch Surg. 2024;409(1):83–9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/38438562/. [Consultado el 13 de abril de 2025].
14. Frazier A, Mbah R, Williams JT. Rare Idiopathic Adult Intussusception: A Case Report. Cureus. 2024;16(1):e52022. Disponible en: https://www.cureus.com/articles/146888-rare-idiopathic-adult-intussusception-a-case-report. [Consultado el 13 de abril de 2025].
15. Shenoy S. Adult intussusception: A case series and review. World J Gastrointest Endosc. 2017;9(5):220–7. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437388/. [Consultado el 13 de abril de 2025].
16. Martínez-Pérez C, García-Coret MJ, Villalba-Ferrer FL. La enfermedad diverticular hoy. Revisión de la evidencia. Rev Cir. 2021;73(3):322–8. Disponible en: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S2452-45492021000300322. [Consultado el 13 de abril de 2025].
17. Pereira AP, Teixeira F, Melo G, et al. Continuous spinal anesthesia for emergent laparotomy in a patient with severe pulmonary comorbidities: A case report. Cureus. 2024;16(11):e74683. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604209/. [Consultado el 13 de abril de 2025].
18. Teo A, Wang C, Wilson RB. Time is of the essence: evaluation of emergency department triage and time performance in the preoperative management of acute abdomen. ANZ J Surg. 2019;89(9):1102–7. Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/ans.15255. [Consultado el 13 de abril de 2025].
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Copyright (c) 2026 Márcia Nayane Da Silva, Jessica Benitez Duarte, José Domingo Alvarez Gomez, Luciana Daniela Garlisi-Torales, Rossana Elizabeth Poletti Duarte (Author)

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