title: [Chain of errors in laparoscopic appendectomy].
abstract: BACKGROUND
  The urachal cyst is a rare pathology in the adult patient and in general is asymptomatic. The goal of this presentation is to learn of the errors.
  
  
  METHODS
  A 22 year old female with clinical diagnosis of acute appendicitis was taken to surgical management. Laparoscopy confirmed the diagnosis. Laparoscopic appendectomy was performed uneventfully. Four weeks in the postoperative period the patient developed reddening and softening in the left surgical wound which was a trocar incision. The initial diagnosis was a granuloma which was removed surgically twice. A fistulogram and abdominal CT scan were negative. Finally, we decided to perform a laparatomy trought the same incision and we found an infected urachal cyst, which was excised. A retrospective analysis of the laparoscopic appendectomy shows the urachal cyst and the perforation by the trocars.
  
  
  CONCLUSIONS
  an inadequate process in the laparoscopic vision, in the diagnosis and technical errors were the cause of this chain of errors and a major temporal damage to this patient. An optimal laparoscopy would have detected the urachal cyst and treated of the two pathologies simultaneously. An adequate trocar placement would not have perforated the urachal cyst and therefore there would have been no postoperative symptoms. Finally open appendectomy could have avoided this chain of errors.
authors: Departamento de Cirugía, Patología, Guadalajara, Jalisco, México. arenas50@hotmail.com
authors: Humberto
authors: H
authors: Arenas-Márquez
authors: Jaime Francisco
authors: JF
authors: Hernández-Zúñiga
authors: Luis Manuel
authors: LM
authors: Barrera-Zepeda
authors: María Rosa
authors: MR
authors: Flores-Márquez
authors: Roberto
authors: R
authors: Chávez-Pérez
mesh_terms: D001062:Appendectomy / Q000009:adverse effects* / Q000379:methods; D001064:Appendicitis / Q000601:surgery; D017577:Cutaneous Fistula / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D057210:Delayed Diagnosis; D003951:Diagnostic Errors / Q000517:prevention & control; D005260:Female; D015745:Granuloma, Foreign-Body / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D007813:Laparotomy; D049291:Seroma / Q000175:diagnosis* / Q000601:surgery; D013525:Surgical Instruments; D013530:Surgical Wound Infection / Q000209:etiology* / Q000517:prevention & control; D013537:Sutures / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D014496:Urachal Cyst / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D014497:Urachus / Q000293:injuries*; D055815:Young Adult