VCOM Research Day Program Book 2023

Medical Student Research Case Reports

26 Use of Extravascular tPA for an Intra-abdominal Hematoma and Abscess

Haley Turany, DO, PGY 1; Arianna Vessal, VCOM, OMS IV; Saif Fiaz, NYIT, OMS IV; Albert Tuono, DO Corresponding author: avessal@vcom.vt.edu

LewisGale Hospital Montgomery, Blacksburg

Perforated appendicitis is a condition that can manifest with many different presentations. Patients may appear stable and afebrile, or they can present appearing acutely ill and with sepsis. Management of perforated appendicitis varies depending on the presentation of the patient and the complications that could potentially arise. Possible complications of perforated appendicitis include intra-abdominal abscess, phlegmon, sepsis or peritonitis. In a case such as this patient (perforated and stable, with an intra-abdominal abscess), typical algorithms

direct clinicians and surgeons towards either one of two routes: surgery to remove the appendix, or percutaneous drainage with antibiotics and interval appendectomy at a later time. This is the typical route available when providing care to patients with perforated appendicitis, but what happens when further complications arise and both of those options have already been pursued previously? This case report will discuss a potential third option, found upon literature review, and subsequently used after an interdisciplinary discussion regarding the risks and

benefits. It will examine the use of tissue plasminogen activator (tPA) to help further resolve intra-abdominal pathology related to complications from perforated appendicitis.

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