A 64-year-old patient underwent surgery for acute perforated appendicitis. Ileocaecal resection was performed and primary anastomosis was established. Vomiting appeared on day seven after surgery. Ileus was diagnosed and the patient underwent surgical revision. Laparotomy, multiple adhesions and fibrinous coatings of peritoneum were found. No signs of dehiscence of anastomosis were found, adhesiolysis was performed. The patient was admitted to the ICU.


Levels of inflammatory markers increased on day four after surgery. The abdomen has been permanently bloated since the last operation. Percussion revealed tympanic sounds. Auscultation revealed peristalsis. Spontaneous defecation once a day; however, significant reflux from the gastric tube was still present. The serous fluid was coming out of the drain.


Abdominal ultrasonography was performed; interesting findings were revealed:

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