Management of Crepitus Near Postoperative Site After Appendectomy

Initial Assessment and Diagnostic Approach

The World Society of Emergency Surgery recommends immediate evaluation and management of crepitus near the postoperative site after appendectomy, as it likely indicates subcutaneous emphysema, which may be a sign of wound infection or anastomotic leak requiring prompt intervention 1, 2
Physical examination should focus on the extent of crepitus, signs of systemic infection, wound appearance, and abdominal examination for signs of peritonitis 2, 4, 5
Laboratory tests, including complete blood count with differential and C-reactive protein, should be performed to assess for leukocytosis and evaluate inflammatory response 1, 4, 5

Imaging with CT scan with contrast is recommended to identify potential intra-abdominal abscess, evaluate for anastomotic leak or stump dehiscence, and determine the extent of subcutaneous emphysema 2, 3, 5, 6
For localized crepitus without systemic signs, close monitoring, broad-spectrum antibiotics, and wound care with possible opening of superficial layers to allow drainage are recommended 1, 3, 7

The World Society of Emergency Surgery strongly recommends against the routine use of drains following appendectomy for complicated appendicitis in adults, as drains provide no benefit in preventing intra-abdominal abscess and may lead to longer hospitalization 1, 3
Anastomotic leak or stump dehiscence is a complication that requires prompt intervention, and progression to necrotizing soft tissue infection is a rare but serious complication 2, 3, 5

Wound ring protectors during the initial surgery have shown evidence of surgical site infection reduction in open appendectomy, and single preoperative dose of broad-spectrum antibiotics is effective in decreasing wound infection and postoperative intra-abdominal abscess 1, 8
Early mobilization and adequate nutritional support to promote wound healing are also recommended 2, 3