A corrugated drain was inserted. The abdominal incision was closed by a mass closure technique using loop PDS 2/0 and absorbable sutures to subcutaneous tissue and staples to skin. Figure 3 A large perforation

of the appendix at the base of the caecum. Figure 4 The perforation was oversewn and omentum was used to cover the defect on the caecum. Post operative progress. Inflammatory markers were MLN0128 manufacturer responding with intravenous antibiotic. No further spiking temperature. The drain was removed postoperative day 5 and patient was discharged the next day. The histolopathology of the appendix showed acutely inflamed appendix with periappendiceal abscess formation. The epithelium shows reactive/reparative changes. No malignancy is seen. Discussion Appendicitis perforations,

commonly occur at the tip of the appendix, are associated with the presence of a faecolith on CT scan and not the anatomical location of the appendix (retrocaecal appendix) as previously thought [1]. Perforation of caecum is an uncommon differential diagnosis for an acute appendicitis. Other possible causes selleck screening library of caecum perforation include perforated right diverticulitis [2, 3], caecal tumor, and rarely associated with foreign body [4, 5], in burn patient [6], tuberculosis infection [7] and following caesarean section [8, 9] or iatrogenic endoscopic procedure had been reported. Surgery for colonic perforation is associated with high morbidity and mortality rates. While omental patch Ribose-5-phosphate isomerase repair is a common surgical approach to management of stomach and duodenum perforation, there are only few reports in the literature that compare two very different surgical approaches – omental patch with primary repair vs right hemicolectomy. In the presence of an uncomplicated perforation, absence of severe infection, and well controlled localized haemostasis – a less invasive surgical approach with post operative intravenous antibiotics would be the management of choice. Right hemicolectomy carries a higher morbidity and mortality but it is generally

recommended only in selected cases – severe inflammation, torsion, haemorrhage, and inflammatory mass or caecal neoplasm found intraoperatively [10]. The presence of severe appendicitis; or caecum appears necrotic in some cases warrants right hemicolectomy to be performed. A caecum perforation is a very rare identity and so far only nine case reports have been published (Table 1). The most frequent operation for perforated caecum is right hemicolectomy although some surgeons might advocate oversewn the perforation is equally adequate in repairing the defect. The advantages of the latter are associated with shorter length of hospital stay, less blood loss, easier haemostasis control, and lower risk of anastomosis breakdown. However, there is no clinical data yet to support this hypothesis.