PMC7305362_01
Image-A shows sonographic appearance of liver and gallbladder, image-B shows right kidney and pancreatic regions.
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Plain chest and abdominal radiograph with abdominal ultrasound (Fig. 1) appeared normal.
A & B shows huge peritoneal collection, white arrows in image-B.
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So, abdominal CT was done that showed a significant amount of collection in the right sub-phrenic, sub diaphragmatic, and pelvic area (Fig. 2).
Laparoscopic ports placement.
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Diagnostic laparoscopy proceeded with modified direct initial trocar access through umbilicus as our routine practice and other ports were placed as needed (Fig. 3).
A: Right iliac fossa, B: Pelvis, C: Right upper quadrant, D: Left upper quadrant, E: Appendix, F: Gall bladder, G: Appendicectomy.
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Huge amount of purulent and turbid collection was noted in all potential spaces (Fig. 4; A-D) with extensive fibrinous exudates over the liver, loops of intestine, and in the pelvic cavity. The appendix was found swollen but no perforation (Fig. 4; E). Gastro-duodenal area, gallbladder (Fig. 4; F), and ileum were carefully inspected. Appendicectomy was performed (Fig. 4; E, G) followed by thorough peritoneal irrigation with 2 L of warm normal saline and finally, a drain tube (DT) was placed in pelvis.
QR for video link.
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Operative time was 90 min (Fig. 5; QR for video link to the https://youtu.be/DvZvXl20-ns).