Abdominal sepsis with multiple organ dysfunction in a teenager after laparoscopic appendectomy on the background of primary immunodeficiency

Despite the widespread use of laparoscopic appendectomy as a routine intervention in pediatric surgery, postoperative infectious complications in some cases become extremely severe. An example is the clinical case of a 15-year-old teenager with a severe postoperative condition after laparoscopic appendectomy performed for gangrenous-perforated appendicitis. Goal. To draw attention to the need for an individualized approach in the treatment of patients with severe complications after abdominal surgery, as well as to the importance of assessing the immune status in children who demonstrate an inadequate response to standard therapy. Materials and methods. Anamnesis data, the results of a comprehensive study of specialized specialists, and data from laboratory and instrumental examination of the patient were used for the analysis. The research methods included physical examination, laboratory tests (hematological, biochemical blood and urine tests), as well as instrumental diagnostic methods such as ultrasound and other necessary techniques to detect postoperative complications. Results. The patient had liver abscesses, diffuse peritonitis, severe polysegmental pneumonia, acute tubulointerstitial nephritis, anemia, and signs of multiple organ failure. Based on a combination of clinical and laboratory data, primary immunodeficiency is suspected. Conclusion. The described clinical case highlights the importance of applying an integrated approach to the treatment of patients with severe postoperative complications. Assessment of the immune status in children with an inadequate response to standard therapy can contribute to the timely diagnosis of primary immunodeficiency and optimization of therapeutic measures. This case demonstrates the need to call for a deeper study and individualization of approaches in the treatment of such patients.  

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