Incidental Visceral Peritoneal and Hepatic Sarcoidosis During Routine Laparoscopic Appendectomy: A Case Report and Implications for Laparoscopic Entry

A 50-year-old male with a history of pulmonary sarcoidosis presented to the DC Veterans Affairs Medical Center with acute appendicitis. Laparoscopic view of the liver and peritoneum revealed studding lesions with biopsy confirmation of non-necrotizing granulomas consistent with intra-abdominal sarcoidosis. Operative and postoperative hospital courses were uncomplicated. In our case, avoidance of peritoneal sarcoid disease segments during laparoscopic entry into the abdomen may have helped reduce the chances of postoperative complications such as surgical site infection, wound dehiscence, or development of ventral hernias. However, further research into laparoscopic entry in peritoneal sarcoid patients is required to further elucidate the subject and to help guide management. Literature reviews on intra-abdominal and peritoneal sarcoids, as well as surgical implications for laparoscopic entry, were discussed.