Appendicitis in an Appendicostomy

Abstract

A 25-year-old man presented with right lower quadrant abdominal wall erythema, a punctum of purulence, and localized pain at the site of a previous appendicostomy. Cross-sectional imaging revealed appendicitis at his previous appendicostomy with a fecalith near the skin. He was managed with appendectomy. The surgical approach mimicked a loop ileostomy reversal by circumferentially dissecting the tissue around the appendicostomy to the level of the fascia and then dividing the appendix at the base of the cecum through a small two-centimeter incision. Appendicitis in a previous appendicostomy is uncommon and has only been described in three previous case reports (two adults and one child) and was surgically approached through a low-midline laparotomy. Our case is unique as it is an uncommon presentation of a common disease managed with a minimally invasive approach not previously described.

Inside out? An appendix demonstrating adult sequelae of paediatric problems

“…The most common complications for Malone's appendicostomy include stoma stenosis, faecal leakage around the insertion site and stoma site infections 5,6 . On review of the literature appendicitis in an appendicostomy is a very rare complication with very few reports of it happening 7–9 …”

“…5,6 On review of the literature appendicitis in an appendicostomy is a very rare complication with very few reports of it happening. [7][8][9] This case highlights an important topic-as paediatric care advances, more patients with a complex paediatric surgical background are surviving to adulthood. As professionals who practice in adult medicine or surgery, we will continue to see complications or outcomes of these patients more commonly.…”