Description

Acute appendicitis complicated by abscess and phlegmon represents one of the most challenging scenarios in emergency abdominal surgery. At World Laparoscopy Hospital (WLH), Gurgaon, surgeons have successfully demonstrated how advanced laparoscopic techniques can manage such complex cases with precision, safety, and minimal postoperative morbidity. Case Overview A 28-year-old patient presented at WLH with severe right lower quadrant pain, fever, and elevated white blood cell count. Ultrasonography and CT imaging revealed acute appendicitis with periappendicular abscess and inflammatory phlegmon, suggesting a contained perforation. Traditionally, such cases have been managed with open surgery or conservative antibiotic therapy followed by interval appendectomy. However, with the evolution of minimally invasive surgery, WLH surgeons opted for a single-stage laparoscopic approach to treat both infection and inflammation simultaneously. Surgical Technique Under general anesthesia, three-port laparoscopic access was established. The inflamed appendix was found densely adherent to surrounding loops of ileum and omentum, with a localized abscess cavity containing purulent material. Careful and gentle hydrodissection and blunt dissection were employed to separate adhesions without injury to the bowel. The abscess cavity was thoroughly aspirated and irrigated with warm saline until the field was clear. The appendiceal base was identified after careful skeletonization, and the appendix was ligated using endoloops. The specimen was retrieved in an endoscopic bag to prevent contamination. A closed-suction drain was placed near the abscess cavity to ensure postoperative drainage. Postoperative Recovery The patient’s postoperative course was uneventful. Intravenous antibiotics were continued for 48 hours, followed by oral therapy. The drain was removed on the third day, and the patient was discharged on the fourth day with minimal pain and no wound infection. Follow-up ultrasound showed complete resolution of the abscess cavity. Discussion At World Laparoscopy Hospital, this case highlights the superiority of laparoscopy even in complicated appendicitis with abscess and phlegmon. The magnified view allows for meticulous dissection, better visualization of inflamed tissues, and precise abscess drainage. Moreover, the approach significantly reduces hospital stay, postoperative pain, and adhesion formation compared to conventional open surgery. The case also demonstrates WLH’s expertise in using energy-based instruments and atraumatic dissection techniques, ensuring safety even in highly inflamed and friable tissue planes. With continuous laparoscopic education and training under the guidance of Dr. R. K. Mishra, WLH remains a global center of excellence for advanced minimal access surgery. Conclusion This successful laparoscopic management of acute appendicitis with abscess and phlegmon at World Laparoscopy Hospital exemplifies how modern surgical technology and expert skills can transform high-risk emergency cases into safe, efficient, and minimally invasive procedures. WLH continues to set global standards in laparoscopic surgery—where innovation meets compassion and excellence saves lives.