Septic shock caused by acute appendicitis complicated with abscess formation within mesoappendix: A case report

INTRODUCTION: Acute appendicitis is the most common surgical emergency and may present with a wide variety of clinical manifestations. In rare circumstances, appendicitis can cause life-threatening complications e.g. septic shock. We present a case of septic shock caused by acute appendicitis complicated with abscess formation within the mesoappendix. PRESENTATION OF CASE: A 42-year-old male was presented with migratory right lower abdominal pain, accompanied by septic shock and acute kidney failure. We performed emergency appendectomy and unexpectedly observed an abscess within the mesoappendix during surgery. The patient received antibiotic therapy perioperatively. Escherichia coli and Klebsiella pneumoniae subspecies were isolated from the intraoperative pus specimen, and Bifidobacterium was isolated from his preoperative blood culture. Histopathology revealed acute suppurative appendicitis. The patient recovered uneventful and was discharged 5 days after surgery. DISCUSSION: We believe that the septic shock was associated with the small abscess formation in the mesoappendix. Bacteria within the mesoappendix could enter the bloodstream through the mesoappendiceal vessel and then septic shock and kidney failure occurred sequentially. We assume that the abscess within the mesoappendix was caused by a tiny perforation from the mesoappendiceal side. CONCLUSION: The case of acute appendicitis complicated with abscess formation within mesoappendix explains one of the causes which may lead to septic shock. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.