Facharzt FMH Chirurgie Practice Questions - Facharzt FMH Für Chirurgie Spécialiste FMH En Chirurgie Exam

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A 48-year-old female presents with a 6-day history of right lower quadrant abdominal pain, fever (38.8°C), and palpable right iliac fossa fullness. She is hemodynamically stable without diffuse peritonitis. Contrast-enhanced CT reveals a perforated retrocecal appendicitis with a well-defined 5.2 cm fluid collection (abscess) containing gas bubbles, walled off by the cecum and terminal ileum. What is the most appropriate initial management strategy according to WSES guidelines?

Immediate emergency open right hemicolectomy with end ileostomy Percutaneous image-guided catheter drainage combined with intravenous broad-spectrum antibiotics, followed by optional interval appendectomy Emergency diagnostic laparoscopy with extensive blunt dissection of the inflammatory mass to perform appendectomy Immediate colonoscopic transcecal stent placement into the abscess cavity

Correct Answer:

Percutaneous image-guided catheter drainage combined with intravenous broad-spectrum antibiotics, followed by optional interval appendectomy

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