Stump appendicitis: a myth that can become reality

Abstract

Stump appendicitis is a rare etiology of acute lower right quadrant abdominal pain often forgotten in the emergency room (ER). The Mac Burney scar or a previous laparoscopic appendectomy always rule out the eventuality of appendicitis and mislead management. Advanced imaging tools are more than compulsory to help correct the diagnosis. Computed tomography (CT) scan is the option of choice that may be replaced if unavailable by simple ultrasound examination. The treatment is mainly surgical. We report the case of a stump appendicitis occurring 12 years after laparoscopic appendectomy in an 18-year-old girl. The diagnosis was based on consistent clinical signs and conclusive radiological data. A successful completion appendectomy was performed with good outcome.

Appendicitis after Appendectomy: A Rare Presentation of Acute Appendicitis as Stump Appendicitis

“…Many authors and literature suggest leaving behind a stump length of less than 5 mm as a longer length could allow for the fecalith impaction [ 8 ]. Therefore, it is recommended not to leave the appendiceal stump larger than 3 mm during an appendectomy [ 9 ]. Specific positional factors including a retrocecal appendix, subserosal appendix, and a duplicated appendix make it challenging to identify the cecal appendicular junction, contributing to this complication.…”

“…Specific positional factors including a retrocecal appendix, subserosal appendix, and a duplicated appendix make it challenging to identify the cecal appendicular junction, contributing to this complication. It can be overcome by correctly identifying the appendicular base by following the cecal tenia coli and a complete dissection of any subserosal appendix [9]. A few differentials also clinically mimic SA, including Crohn's disease, residual surgical drain tract, and epiploic appendicitis.…”

Stump appendicitis, a rare but serious complication of appendectomy : a case report

“…If the remnant stump is of sufficient length, it might be visualized as a tubular, thick-walled, fluid-filled, enhancing structure with or without an adjacent fluid collection, much like typical acute appendicitis (before initial appendectomy) [2,9]. In the era of laparoscopy a diagnostic laparoscopy may prove to be the next diagnostic and therapeutic option in case of ambiguity [10,11]. However some authors suggest that abdominal Ultra-sound may well have a high accuracy in establishing the diagnosis of stump appendicitis [4].…”

Stump appendicitis, a rare but serious complication of appendectomy: A case report

“…2,9 Diagnostic laparoscopy is the next diagnostic and therapeutic option in case of doubt. 10,11 However, abdominal ultrasound can be highly accurate in diagnosing stump appendicitis, some authors suggest. 4 Surgical resection (appendicectomy) is the most appropriate treatment in the cases reported in the literature.…”

“… 2 , 9 Diagnostic laparoscopy is the next diagnostic and therapeutic option in case of doubt. 10 , 11 However, abdominal ultrasound can be highly accurate in diagnosing stump appendicitis, some authors suggest. 4 …”