Horseshoe Appendix: An Extremely Rare Appendiceal Anomaly

Abstract

A four and half-year-old male child was admitted with 4 days history of pain in the lower abdomen associated with vomiting and fever for 2 days. On examination the child was febrile and tenderness felt at the right iliac fossa. The Total Leukocyte Count was raised-15,600cumm. Diagnosis of acute appendicitis was made provisionally and supported by ultrasound finding of the abdomen which showed the appendix measuring 14mm in diameter with adhesions. The child was managed with non operative measures and underwent interval appendectomy 4 months later. A Grid iron incision was made on the right iliac fossa and the cecum was identified. The taenia coli were traced down to its confluence and the base was identified. Attempt was made to release the tip but found out that it was communicating with the cecum by another stump. The two "bases" or "stumps" were positioned frontally on the cecum with a central mesoappendix [Table/ Fig-1,2]. Appendectomy was completed [Table/ Fig-3]. The postoperative recovery was uneventful and the patient was discharged on the 3 rd postoperative day.

Fistulae involving the appendix: a systematic review of the literature

“…[103][104][105][106][107] Appendiceal fistulae to the GI tract included 10 cases to the sigmoid colon alone, [108][109][110][111][112][113][114][115][116][117] with an additional two concurrently fistulating to the bladder. 118,119 There were 21 cases of fistula to the ileum, 84,[120][121][122][123][124][125][126][127][128] two to the jejunum, 84,129 six to the duodenum, 84,[130][131][132][133] eight to the caecum, 84,[133][134][135][136][137][138] three to the ascending colon, 48,139,140 one to the transverse colon, 141 one to the rectum, 142 and one to a gastrojejunal anastomosis from prior gastroenterostomy. 143 In three cases, fistulae invol...…”

“…Fistulae involving the duodenum have varied causes including appendicitis, adenocarcinoma, endometriosis and tuberculosis. 84,130,131 Large bowel Fistulae between the appendix and the caecum 84,[133][134][135][136][137][138] can be congenital or acquired. A congenital communication between the appendix and the caecum is termed a 'horseshoe appendix', in contradistinction to an acquired fistula.…”

A case report of complete appendiceal duplication on the normal site of a single caecum: A new variant?

“…Regardless of classification, failure to identify and document duplicated appendix, including its associated anomalies, may come back later to haunt the patient and clinicians as there is a risk of physical and medicolegal consequences respectively [ 3 ]. It is therefore important to search for other anomalies in the same sitting or afterwards where possible [ 18 ]. In patients with imperforate anus, surgeons at times perform a diversion colostomy through a limited incision precluding thorough examination of the viscera and thus may only discover the duplication during further reconstructive surgeries [ 2 , 18 ].…”

One type of duplex appendix: horseshoe appendix

“…Whether these malformations have a relationship with tumorigenesis needs to be explored. In only one other case, there was a search for other malformations during the operation, 8 which should be emphasized in future studies.…”