Which finding is a relative contraindication to laparoscopic appendectomy?

• A. Phlegmon
• B. Large abscess
• C. Simple appendicitis
• D. Cholecystitis

Answer: (A)

A phlegmon signals a localized but intense inflammatory reaction with swollen, indistinct tissue planes around the appendix. This makes it hard to safely identify and dissect the structures laparoscopically because the anatomy is obscured and the tissue is friable, increasing the risk of inadvertent injury to surrounding bowel or vessels and making complete removal of the appendix more difficult. Because of these safety concerns, a phlegmon is considered a relative contraindication to proceeding with laparoscopic appendectomy; many surgeons would opt for conversion to an open approach or staged management depending on the situation.

In contrast, a simple appendicitis situation is straightforward for laparoscopy, and a large abscess, while more challenging, can often be addressed with drainage or managed with conversion if needed. Cholecystitis involves the gallbladder and is not a direct issue with the appendix, so it doesn’t factor as a contraindication to laparoscopic appendectomy.