Laparoscopic Appendectomy Turned Hepatotomy Revealing Rare Streptococcus Species: A Case Report

Review Data

1. Summary of the Article

The manuscript presents a case report of a 55-year-old male with an atypical complication of appendicitis: the development of hepatic abscesses due to rare Streptococcus species. The patient initially misdiagnosed with viral gastroenteritis was later found to have appendiceal and hepatic abscesses. Surgical intervention (laparoscopic appendectomy and hepatotomy) was combined with broad-spectrum antibiotics and drainage. The case underlines the significance of early diagnosis, microbiological evaluation, and appropriate management in similar clinical scenarios.

2. Novelty and Significance

Strength:

• The case adds value by highlighting an uncommon complication (hepatic abscesses) arising from perforated appendicitis with rare pathogens like Streptococcus gordonii and Citrobacter koseri.
• Raises awareness about diagnostic delays and the criticality of imaging in evaluating atypical abdominal pain.

3. Scientific Rigor and Methodology

Positive:

• The clinical course, surgical findings, and microbiological results are described clearly and logically.
• Appropriate antibiotics and surgical decision-making align with standard clinical practice.

Concerns:

• The case could benefit from a brief discussion of differential diagnosis and exclusion of other hepatic abscess sources.
• Lacks detail on follow-up imaging or long-term outcomes.

4. Data Analysis and Interpretation

As a case report, no statistical analysis is expected. However, interpretation of microbiology results is accurate and clinically relevant.

Adding a short discussion on pathogenicity of the rare Streptococcus species would improve the scientific depth.

5. Ethical Considerations and Disclosures

Patient consent is not explicitly mentioned. A statement confirming that informed consent was obtained should be added.

No conflicts of interest or funding disclosures are stated; these should be included as per journal policy.

6. Specific Comments and Suggestions

Major Revisions:

·       Add an explicit statement confirming informed patient consent for publication.

·       Include a short discussion comparing this case with similar reports in the literature to contextualize the rarity.

·       Add references for Streptococcus gordonii and Citrobacter koseri as emerging pathogens in hepatic infections.

Minor Revisions:

·       Correct minor typographical errors (e.g., extra spaces in keywords section).

·       Consider adding a postoperative follow-up paragraph (even if uneventful) to complete the clinical narrative.

·       Use consistent formatting for bacterial names (italicize genus and species).

8. Final Recommendation

Accept with Minor Revisions.
The case is relevant, clinically educational, and well-presented. With the suggested additions and corrections, it will meet publication standards.

If you have any questions and clarifications you can write to the journal.

Thanks,
Science Repository Team