The Best Strategy for Nasogastric Tube Removal in Patients with Acute Appendicitis Complicated with Ileus: A Case Report and Review.

Abstract BackgroundAcute appendicitis is one of the most common causes of the acute abdomen. However, acute appendicitis complicated with ileus is uncommon. By presenting this case, we aim to give some suggestions on the postoperative care, especially an algorithm for the insertion and removal of nasogastric tube.Case presentation A 20-year-old man presenting with left lower abdominal pain and symptoms of ileus was diagnosed with acute appendicitis complicated with ileus by computed tomography scan. A nasogastric tube was inserted for the ileus preoperatively. He underwent laparoscopic appendectomy, during which periappendiceal abscess with local peritonitis was noted. The nasogastric tube was removed on the first postoperative day, but symptoms of ileus developed again. Urografin study revealed contrast media retaining in the small bowel, so nasogastric tube reinsertion was performed. The nasogastric tube was removed on the ninth postoperative day after the recovery from ileus. The patient was discharged on the thirteenth postoperative day.ConclusionPatients of acute appendicitis with ileus should be assessed carefully. Nasogastric tubes shouldn’t be removed until the following requirements are satisfied: Firstly, symptoms of abdominal distention and nausea relieve. Secondly, no more hypoactive bowel sounds are found. And finally, nasogastric tube drainage becomes less than 200mL per day, or the passage of flatus or stool presents.