Postoperative retained appendicoliths causing umbilical incision infection in children with acute appendicitis：a case report and literature review

doi:10.3877/cma.j.issn.1673-5250.2025.01.012

Objective

To investigate the clinical manifestations，treatment，and prognosis of umbilical incision infection caused by r esidual appendicoliths after surgery for acute appendicitis in children.

Methods

A retrospective analysis was conducted on a case of a child with acute purulent appendicitis admitted to Jinan Children's Hospital Affiliated to Shandong University on May 7，2024.Clinical medical records，main treatment processes，and prognosis were collected.Literature related to residual appendicoliths after surgery for acute appendicitis in children was searched in CNKI，Wanfang Database，VIP Chinese Science and Technology Journal Database，and Pub Med using"appendicitis surgery""fecalith residue""appendiceal fecalith residue""appendicitis surgery and fecalith residue"and"appendiceal fecalith remains"as keywords.The literature search was conducted from January 2000 to July 2024.This study was approved by the Medical Ethics Committee of Jinan Children's Hospital Affiliated to Shandong University （Approval No.SDFE-IRB/T-2024057），and informed consent was obtained from the guardian of the child.

Results

①The child was a 13-year-old girl admitted to the hospital with migratory right lower abdominal pain for 3 d.She was diagnosed with acute purulent appendicitis by laboratory and imaging examinations and underwent laparoscopic appendectomy.She was discharged smoothly after 8 d of hospitalization.On the second day after discharge （postoperative day 10），the umbilical incision became infected with purulent discharge，and dressing changes were immediately applied.On the 15th day of dressing changes，a fecalith（1.5 cm×1.0 cm）was spontaneously discharged from the umbilical incision，the child was continued with dressing changes，and the umbilical incision healed spontaneously after 7 d.Follow-up at 2 months showed that the child's incision had recovered well，with good diet and no abdominal or gastrointestinal discomfort.②Literature review results：according to the literature search strategies set by this study，12 relevant clinical researches about postoperative retained appendicoliths for appendicitis were retrieved，and with the child included in this study，a total of 13 children with residual appendicoliths after surgery for appendicitis were included in the literature review.Among these 13 cases，laparoscopic surgery was the main surgical approach（5 cases），followed by traditional open surgery（4 cases）；the time to occurrence of complications due to residual appendicoliths ranged from 2 days to 4 years postoperatively.In addition，the main complications caused by residual appendicoliths were abdominal abscess（5 cases），perihepatic abscess（3 cases），incisional infection（2 cases），gluteal abscess（1 case），cecal fistula（1 case），and migration of a right iliac fossa abscess to a subcutaneous abscess（1 case）.All children had a good prognosis.

Conclusions

Residual appendicoliths after surgery for acute appendicitis in children leading to complications are relatively rare，with surgery being the main treatment.It is necessary to be vigilant and avoid residual appendicoliths during surgery for acute appendicitis in children.

Key words: Appendicitis, Fecalith remains, Incision infection, Surgical procedures,operative, Laparoscopes, Complications, Literature review, Child

图1 本例患儿（女性，13岁）腹部彩色多普勒超声声像图（红色箭头所示为阑尾内粪石强回声）

图2 本例患儿（女性，13岁）换药时（术后第2天）辅料照片图（三角形所示为术后切口感染换药时所用辅料）图3 本例患儿（女性，13岁）术后切口感染（术后第25天）脐部切口排出粪石照片图（箭头所示为脐部切口排出粪石）注：本例患儿为急性阑尾炎术后阑尾粪石残留致脐部切品感染

表1 文献检索涉及的12例阑尾炎术后阑尾粪石残留并发症患儿及本例患儿临床特征比较

文献（第1作者，发表年）	国家	年龄（岁）/性别	阑尾切除术术式	并发症出现时间	粪石残留相关并发症	残留粪石发现方式	治疗术式	预后
本研究	中国	13/女	腹腔镜	9 d	切口感染	换药	①	治愈
贾晓军^［3］，2000	中国	12/—	—	—	腹部脓肿、腹壁窦道	手术探查	②	治愈
Hörmann^［4］，2001	瑞士	6/—	—	—	腹痛、发热，腹部脓肿	超声、X射线摄片	②	治愈
Abularrage^［5］，2008	美国	10/男	开腹	1个月	腹痛、发热，腹部脓肿	腹部CT检查	③	治愈
Abularrage^［6］，2008	美国	3/女	腹腔镜	10 d	腹痛、发热，腹部脓肿	腹部CT检查	③	治愈
Temeltas^［7］，2009	土耳其	14/男	开腹	4年	发热、臀部疼痛，臀部脓肿	腹部CT检查	④	治愈
Maatouk^［8］，2011	英国	17/女	腹腔镜	1年	发热、腹痛、肝周脓肿	腹部CT检查	③	治愈
宋魁^［9］，2013	中国	8/—	—	15～20 d	切口感染	伤口换药	①	治愈
Black^［10］，2013	美国	6/女	腹腔镜	2周	发热、腹痛、肝周脓肿	腹部CT检查	⑤	好转
杨吉^［11］，2014	中国	17/男	开腹	4个月	切口感染、切口出现瘘口盲肠瘘	腹部CT检查、瘘管造影	⑥	治愈
Singh^［12］，2019	美国	10/男	腹腔镜	18 d	发热、腹痛、肝周脓肿	腹部CT检查	③	治愈
Sagkriotis^［13］，2020	英国	18/女	开腹	2 d	发热、呕吐、腹胀、肠梗阻	腹部CT检查	⑦	治愈
Albdah^［14］，2021	沙特阿拉伯	15/男	腹腔镜	5 d	腹痛、腹泻、盆腔脓肿	腹部CT检查	⑧	好转
Drew^［15］，2022	澳大利亚	13/女	腹腔镜	2个月	发热、腹痛、右髂窝见皮下粪石伴脓肿	腹部CT检查、超声检查	⑨	治愈

表1 文献检索涉及的12例阑尾炎术后阑尾粪石残留并发症患儿及本例患儿临床特征比较

文献（第1作者，发表年）	国家	年龄（岁）/性别	阑尾切除术术式	并发症出现时间	粪石残留相关并发症	残留粪石发现方式	治疗术式	预后
本研究	中国	13/女	腹腔镜	9 d	切口感染	换药	①	治愈
贾晓军^［3］，2000	中国	12/—	—	—	腹部脓肿、腹壁窦道	手术探查	②	治愈
Hörmann^［4］，2001	瑞士	6/—	—	—	腹痛、发热，腹部脓肿	超声、X射线摄片	②	治愈
Abularrage^［5］，2008	美国	10/男	开腹	1个月	腹痛、发热，腹部脓肿	腹部CT检查	③	治愈
Abularrage^［6］，2008	美国	3/女	腹腔镜	10 d	腹痛、发热，腹部脓肿	腹部CT检查	③	治愈
Temeltas^［7］，2009	土耳其	14/男	开腹	4年	发热、臀部疼痛，臀部脓肿	腹部CT检查	④	治愈
Maatouk^［8］，2011	英国	17/女	腹腔镜	1年	发热、腹痛、肝周脓肿	腹部CT检查	③	治愈
宋魁^［9］，2013	中国	8/—	—	15～20 d	切口感染	伤口换药	①	治愈
Black^［10］，2013	美国	6/女	腹腔镜	2周	发热、腹痛、肝周脓肿	腹部CT检查	⑤	好转
杨吉^［11］，2014	中国	17/男	开腹	4个月	切口感染、切口出现瘘口盲肠瘘	腹部CT检查、瘘管造影	⑥	治愈
Singh^［12］，2019	美国	10/男	腹腔镜	18 d	发热、腹痛、肝周脓肿	腹部CT检查	③	治愈
Sagkriotis^［13］，2020	英国	18/女	开腹	2 d	发热、呕吐、腹胀、肠梗阻	腹部CT检查	⑦	治愈
Albdah^［14］，2021	沙特阿拉伯	15/男	腹腔镜	5 d	腹痛、腹泻、盆腔脓肿	腹部CT检查	⑧	好转
Drew^［15］，2022	澳大利亚	13/女	腹腔镜	2个月	发热、腹痛、右髂窝见皮下粪石伴脓肿	腹部CT检查、超声检查	⑨	治愈

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