Complicated Appendectomy with Perforation - Post-operative Recovery Concerns

Case at a Glance

A 43-year-old male presents with post-operative concerns following emergency appendectomy for perforated appendicitis, including persistent drainage from surgical drain site and ongoing abdominal discomfort three weeks post-surgery.

Patient's Story

The patient experienced progressive abdominal discomfort on July 4th, initially attributing symptoms to constipation. When over-the-counter laxatives provided no relief and pain became severe, he presented to the emergency department. He was diagnosed with acute appendicitis and admitted for surgical intervention. However, surgery was delayed for 14 hours, during which time the appendix perforated, causing severe lower abdominal pain. The patient underwent emergency appendectomy and remained hospitalized for 5 days post-operatively. A surgical drain was placed in the lower abdomen during the procedure.

Initial Assessment

Emergency department evaluation revealed classic signs of acute appendicitis. The patient had no significant medical history except for trazodone use for sleep. Physical examination and imaging confirmed the diagnosis, leading to hospital admission for surgical management.

The Diagnostic Journey

Initial presentation suggested constipation, but worsening pain pattern and lack of response to laxatives prompted emergency evaluation. Rapid diagnosis of acute appendicitis was made, though surgical intervention was unfortunately delayed, resulting in appendiceal perforation before operative management could be completed.

Final Diagnosis

Perforated appendicitis with secondary peritonitis, status post emergency appendectomy with surgical drain placement.

Treatment Plan

Emergency laparoscopic or open appendectomy was performed following appendiceal perforation. A surgical drain was placed to manage potential fluid collections. The patient received appropriate antibiotic therapy and remained hospitalized for monitoring. The drain was removed approximately two weeks post-operatively when output decreased appropriately.

Outcome and Follow-up

Three weeks post-operatively, the patient reports persistent drainage and mild odor from the previous drain site, along with ongoing lower abdominal discomfort. The drain site continues to produce purulent material despite removal over one week ago. Family member with nursing background assessed the site and noted no obvious signs of infection. The patient seeks guidance on optimal wound care management and pain control strategies, as communication with the surgical team has been limited. Current wound care consists of simple adhesive bandages, and the patient inquires about more effective dressing options and appropriate over-the-counter pain management.