Case report

Pseudoaneurysm of the inferior epigastric artery as a rare complication of abdominal tension sutureRamin Bozorgmehr 1; Mohammad Hadi Bahri1; Negin Pouroushaninia 2; Maryam Rashidian 2; Nazanin Alibeik 3; Neda Rahimian3; Mojtaba Ahmadinezhad 1; Javad Zebarjadi Bagherpour 1*Department of General Surgery, Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran.Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, IranDepartment of Internal Medicine, Firoozgar Hospital, School of Medicine, , Iran University of Medical Sciences, Tehran, Iran.

1 INTRODUCTIONAcute appendicitis continues to be the most frequent cause of acute abdomen requiring surgical intervention and the most common general surgical emergency seen in the majority of hospitals. It usually presents in the first 24 to 48 hours of onset. The diagnosis of acute appendicitis is usually based on a carefully taken history and physical examination. Radiologic studies can also be helpful in patients with atypical presentations(1, 2). The most used imaging studies are ultrasonography and computed tomography. While ultrasonography is more accessible, the latter is the modality of choice due to finer accuracy(3).Since only two-thirds of patients with acute appendicitis present with the classic symptoms, patients with less acute symptoms may be missed (4). One of the complications of a missed acute appendicitis is perforation of the appendix, which should be suspected in cases with temporary improvement in visceral pain, soon followed by symptoms of peritonitis (1). In this report, we present a 44-year-old Afghan male, a rare case of undiagnosed appendicitis, manifested first time with fasciitis and several abdominal abscesses with no physical examination, radiologic, or laboratory findings in favor of appendicitis. The diagnosis of Perforated appendicitis finally became clear after three months via laparotomy when the patient referred again to surgery clinic with intestinal obstruction. We believe this is the first report of fasciitis and obstruction as together being very delayed consequences of appendicitis, leading to a late diagnosis thereof. This case has been reported in line with the SCARE criteria (5).