ORIGINAL ARTICLE EXPERIMENTAL/SPECIAL TOPICS Acute Abdomen After Abdominoplasty: Differential Diagnosis Renato Silva da Freitas • Adriana Sayuri Kurogi Ascenc ¸o • Ivan Maluf Junior • Isis Nasser • Priscila Balbinot • Marlon Augusto Camara Lopes • Antonio Jorge Forte • Jose Alfredo Sadowski Received: 16 July 2012 / Accepted: 15 January 2013 Ó Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2013 Abstract Abdominoplasty is a very common elective procedure in plastic surgery. Surgical accidents can lead to serious complications that result in an acute surgical abdomen, but in rare cases, an acute surgical abdomen not related to the procedure develops. This report discusses the diagnostic approach for patients with an acute abdomen after abdominoplasty and presents a case of appendicitis in the immediate postoperative period. The importance of postoperative follow-up evaluation by the same surgeon who performed the procedure is discussed as well as the need for adequate general surgery training to obtain the correct diagnosis and perform the urgent operation required to avoid a detrimental outcome. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords Abdominoplasty Á Complications Á Differential diagnosis Á Acute abdomen Abdominoplasty is a very common elective procedure in plastic surgery. Although surgeons strive for a smooth postoperative course, occasional complications of this procedure include seromas, hematomas, skin infections, and abdominal skin flap necrosis [1]. Surgical accidents can lead to serious complications such as perforation of the intestinal wall secondary to liposuction performed during abdominoplasty. Plication of the abdominal wall causes an increase in intraabdominal pressure, which could potentially result in compartment syndrome. Moreover, inadequate plication may transfix the intestines, especially when the muscle is very thin. Finally, the use of nonsteroidal antiinflammatory drugs (NSAIDs) for analgesia may promote gastric ulcer formation and perforation [2, 3]. The data in the literature are scarce regarding acute surgical abdomen after abdominoplasty. Because this sur- gery is purely aesthetic and speedy recovery is expected so that patients can return to work, surgeon bias may impair the diagnosis of this rare complication. Therefore, our report discusses the diagnostic approach for patients with acute abdomen after abdominoplasty and presents a case of appendicitis in the immediate postoperative period. Case Report A 34-year-old Caucasian woman presented with a medical history of hypertension controlled with oral medication as well as a surgical history of laparoscopic cholecystectomy and gastric fundoplication performed 1 year previously. She had excessive abdominal tissue and fat, with an inci- sional hernia in the supraumbilical region. The patient was placed in the supine position and underwent general anesthesia with tracheal intubation. R. S. da Freitas Á A. S. K. Ascenc ¸o Á I. Maluf Junior (&) Á I. Nasser Á P. Balbinot Á M. A. C. Lopes Á J. A. Sadowski Section of Plastic and Reconstructive Surgery, Hospital de Clinicas da UFPR, Curitiba, Brasil e-mail: ivanmalufjr@yahoo.com.br R. S. da Freitas e-mail: dr.renato.freitas@gmail.com A. J. Forte Section of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, UK 123 Aesth Plast Surg DOI 10.1007/s00266-013-0078-4