Double acute appendicitis in appendical duplication

Abstract

Appendiks vemiformis duplikasyonu nadir bir doğumsal anomalidir ve genellikle laparotomi esnasında tesadüfen saptanır. Apendikslerin birinin diğerine ve çekuma göre lokalizasyonunu tanımlamada ve aynı zamanda duplikasyonun boyutunu göstermede modifiye Cave ve Wallbridge sınıflaması kullanılır. Bu yazıda akut karın ağrısı nedeniyle laparotomi uygulanan 45 yaşında bir hasta sunuldu. Operasyon bulguları, apendiks duplikasyonu ile birlikte çift akut apandisit şeklinde idi. Tip B duplikasyon olması nedeniyle apendiksler ayrı ayrı alındı. Apendektomi en sık uygulanan abdominal cerrahi olması nedeniyle tüm cerrahlar bu nadir klinik antiteyi akılda tutmalıdırlar.Anahtar Sözcükler: Apandisit; duplikasyon; appendiks vemiformis.Duplication of the vermiform appendix is a rare congenital abnormality and usually found incidentally during laparotomy. The Modified Cave-Wallbridge classification is used to describe the location of the appendixes in relation to each other and to the cecum as well as the extent of the duplication. We report a 45-year-old patient who underwent laparotomy for acute abdominal pain. The operative finding was double acute appendicitis in appendical duplication. The appendixes were removed separately, as it was type B duplication. Since appendectomy is the most common abdominal operation, all surgeons should keep this rare clinical entity in mind.Key Words: Appendicitis; duplication; vermiform appendix.Appendical duplication is a rare abnormality, with an estimated incidence of 0.004% among patients undergoing appendectomy. [1,2] We report a case of appendical duplication presented with double acute appendicitis. CASE REPORTA 45-year-old male presented with right lower quadrant pain, anorexia, nausea, and vomiting. The pain started in the epigastric region three days ago, and then intensified in severity with migration to the right lower quadrant. On physical examination, rigidity and rebound tenderness were noted in the right lower quadrant. The patient was febrile and tachycardic. White blood cell count was 21900/mm 3 . Other laboratory values were normal. Plain abdomen and chest X-rays appeared normal. Pelvic ultrasound in the emergency suite showed minimal periappendicular fluid and a non-peristaltic, non-compressible tubular structure with a diameter of 10 mm.McBurney incision was extended with the help of several retractors for optimal display of the surgical region, as shown in Figure 1. During exploration through the McBurney incision, a small amount of inflammatory fluid was noted. After cecal mobilization, two appendixes were seen: one on the corner where the taenia coli converge, and the other just next to it, with two separate bases. They shared the same mesoappendix, and both were erectile, hyperemic and inflamed; however, one was gangrenous and showed serosal necrosis (Figs. 1, 2). Routine appendectomy was performed for each. The postoperative period was uneventful, and the patient was discharged on the 3rd postoperative day.On pathological examination, the appendixes measured 5x0.7 cm and...

Caso inusual de duplicación apendicular complicado con apendicitis

“…Es importante tener en cuenta las enfermedades apendiculares dobles y hacer una búsqueda minuciosa, ya que en la mayoría de casos se presenta de forma silente o por inflamación de uno de los dos apéndices; además, se deben considerar otras condiciones que pueden generar dolor abdominal relacionado [12][13][14] .…”