An 85-year-old man presented to the emergency department (ED) with right lower quadrant pain. On physical examination, the patient showed rebound tenderness with guarding. He received a CT scan of his abdomen, which revealed an inflamed, dilated appendix with surrounding inflammatory changes. The patient was taken to the operating room (OR) for laparoscopic appendectomy. The surgeon had recently joined the medical staff after completing a general surgery residency and then a breast surgery fellowship, and so was still subject to proctoring. The operative report notes that two other surgeons came into the OR to confirm that the appendix was removed with no retained tissue.
Postoperatively, the patient continued to have right lower quadrant pain, which led to a repeat CT scan showing inflammatory changes in the right pericecal region. Because the pathological specimen from the appendectomy had not yet been read, the pathologist was called to determine whether there were some findings that might explain the patient's persistent symptoms. When she examined the specimen, she found no appendiceal tissue.
The patient was emergently taken back to the OR, and the appendix was located and excised. The patient had a stormy postoperative course, complicated by aspiration pneumonia requiring intubation, but ultimately made a full recovery.
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