Miroslav Zashev, Nevrie Niyazi, Ivan Genov, Eliz Sali, Milena Peruhova

Acute appendicitis in an immunocompromised patient following liver transplantation: A case report

Introduction

Acute appendicitis in an immunocompromised patient following liver transplantation: a case report. Case report on acute appendicitis in an immunocompromised liver transplant patient. Learn about unusual symptoms, diagnostic challenges, and the need for prompt imaging and laparoscopic surgery.

Abstract

Acute appendicitis (AA) is the most frequent emergency surgical condition globally, requiring early diagnosis and surgical intervention. In immunocompromised individuals, such as transplant recipients on immunosuppressive treatment, the disease can present with an unusual signs and symptoms, which can result in diagnostic delays and an increased risk of complications. We report the case of a 54-year-old male patient who has undergone orthotopic liver transplantation (OLT) and is currently on Tacrolimus therapy. The patient presented nonspecific abdominal symptoms, absence of fever, and increased inflammatory markers. Imaging studies verified acute appendicitis along with localized peritonitis. A laparoscopic appendectomy had been performed, followed by an uneventful postoperative course. Histopathology verified phlegmonous appendicitis along with fibrino-purulent periappendicitis. This case highlights the necessity of advanced clinical attention, prompt diagnostic imaging, and a laparoscopic approach in immunocompromised individuals.

Review

This case report addresses a critical clinical scenario: acute appendicitis (AA) in an immunocompromised patient, specifically a liver transplant recipient. The authors correctly point out that AA is a common surgical emergency, but its presentation in patients on immunosuppressive therapy can be significantly atypical, leading to diagnostic challenges and potentially severe outcomes. The report details the case of a 54-year-old male post-orthotopic liver transplantation (OLT) on Tacrolimus, who presented with non-specific abdominal symptoms, highlighting the complexities inherent in this patient population. The value of this report lies in its clear illustration of these diagnostic dilemmas. The patient's presentation with non-specific symptoms and absence of fever, despite elevated inflammatory markers, underscores the need for a high index of suspicion. The abstract effectively conveys that timely diagnostic imaging was crucial in verifying AA with localized peritonitis. The subsequent successful laparoscopic appendectomy and uneventful postoperative course, alongside the histopathological confirmation of phlegmonous appendicitis, demonstrate an optimal management pathway in a challenging clinical context. Ultimately, this case serves as a poignant reminder for clinicians regarding the necessity of heightened vigilance when evaluating abdominal pain in immunocompromised patients. The authors' conclusion regarding the importance of advanced clinical attention, prompt diagnostic imaging, and considering a laparoscopic approach is well-supported by the presented outcome. Such reports are invaluable in reinforcing best practices and contributing to the body of knowledge, guiding clinical decision-making to mitigate the risks associated with atypical presentations of common surgical emergencies in vulnerable patient populations.

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