Retroperitoneal abscess with concomitant hepatic portal venous gas and rectal perforation: a rare triad of complications of acute appendicitis. A case report

In addition to report our case, we carefully reviewed the literature in order to detect similar cases and the causes of such rare conditions.Only 26 cases (including our patient) of acute appendicitis complicated by retroperitoneal abscesses have been published in the English literature between 1955 and 2008. There was one case having hepatic portal venous gas, and one further case with a rectal perforation associated with acute appendicitis. All patients with retroperitoneal abscess presented with non specific clinic symptoms that not revealed any suspicion for such a complicated disease. Hence, delayed diagnosis and treatment are not uncommon.So far, no patient has been described with such a triad of rare complications related to acute appendicitis. We want to emphasize the insidious onset of retroperitoneal abscess formation, and the need of prompt recognition and adequate treatment to avoid deleterious outcome.Acute appendicitis is a very common disease with low morbidity and mortality rates in most countries. While uncomplicated appendicitis can easily be treated, complicated appendicitis with perforation and abscess formation remains a challenging treatment. In particular, large abscess and advanced peritonitis often require repeated surgical interventions combined with percutaneous drainage performed by interventional radiology, as well as intensive care and antibiotic treatment. Such treatment is associated with markedly increased complications, e.g. sepsis, prolonged ileus, and adhesion formation [1]. The development of incisional hernia, recurrent bowel obstruction, and impaired fertility rates in female patients are the main adverse events during long-term course [2]. In contrast, bowel necrosis with portal venous gas formation is very rare after complicated appendicitis [3]. Here we report a case of an extensive retroperitoneal abscess formation with rectal perforation and portal venous gas embolization after necrotizing acute appendicitis in a young mal