Stump appendicitis after laparoscopic appendectomy: a rare clinical entity
Background: Stump appendicitis is an acute inflammation of the residual part of the appendix and a rare complication of incomplete appendectomy. This is a rare delayed complication after appendectomy with the reported incidence of 1 in 50,000 cases. Clinically it can be presented as acute abdomen and presents a diagnostic dilemma. Prompt recognition is important to lead to an early treatment, thus avoiding serious complications.
Case study: We present a 14-year-old girl with diagnosis of stump appendicitis, who underwent surgical treatment (open appendectomy) after having laparoscopic appendectomy a month before. Radiologically (UZV and CT scan) was diagnosed an inflammatory mass with abscess dimension 41 x 21 mm in the right iliac fossa. During operation a 1,5 cm-diameter appendiceal stump was noted in the anatomical region of the appendix. The appendiceal stump was resected and inverted into the cecal wall. Histopathology examination showed acute inflammation and patchy necrosis of the appendiceal stump. The post-operative course was uneventful. Patient was discharged on third post-operative day.
Conclusion: Stump appendicitis is a rare but serious complication of appendectomy. The prevalence and incidence of stump appendicitis has been increasing in the recent years. Clinical presentation of stump appendicitis mimics symptoms and signs of acute appendicitis or acute abdomen and with a previous appendectomy. So it must be considered in the differential diagnosis of acute abdomen despite the patient’s open or especially laparoscopic appendectomy history.
Gupta R, Gernshiemer J, Golden J, Narra N, Haydock T: Abdominal pain secondary to stump appendicitis in a child. J Emerg Med 2000;18:431-433.
Waseem M, Devas G: A child with appendicitis after appendectomy. J Emerg Med 2008; 34:59-61.
Erzurum VZ, Kasirajan K, Hashmi M: Stump appendicitis: a case report. J Laparoendosc Adv Surg Tech A 1997; 7:389-91.
Uludag M, Isgor A, Basak M: Stump appendicitis is a rare delayed complication of appendectomy: A case report. World J Gastroenterol 2006; 12:5401-5403.
Levine CD, Aizenstein O, Wachsberg RH: Pitfalls in the CT diagnosis of appendicitis. Br J Radiol 2004; 77:792-9.
Baldisserotto M, Cavazzola S, Cavazzola LT, Lopes MH, Mottin CC: Acute edematous stump appendicitis diagnosed preoperatively on sonography. AJR 2000:503-504.
Aschkenasy MT, Rybicki FJ. Acute appendicitis of the appendiceal stump. J Emerg Med. 2005; 28:41-3.
Simon SB, Jacqueline JC, Celia MD. Stump appendicitis af-ter open and laparoscopic appendectomies. Am Surg. 2012; 78:143-4.
Kanona H, Al Samaraee A, Nice C, Bhattacharya V. Stump appendicitis: a review. Int J Surg. 2012; 10:425-8.
Gasmi M, Fitouri F, Sahli S, Jemai R, Hamzaoui M. A stump appendicitis in a child: a case report. Ital J Pediatr. 2009; 35:35
Patel RP, Kan JH. Stump appendicitis. Pediatr Radiol. 2009; 39:306.
Liang MK, Lo HG, Marks JL. Stump appendicitis: A comprehensive review of literature. Am Surg. 2006;72:162–6.
Durgun AV, Baca B, Ersoy Y, Kapan M. Stump appendicitis and generalized peritonitis due to incomplete appendicectomy. Tech Coloproctol. 2003;7:102- 4.
Truty MJ, Stulak JM, Utter PA, Solberg JJ, Degnim AC. Appendicitis after appendectomy. Arch Surg. 2008;143:413–5.
Greenberg JJ, Esposito TJ. Appendicitis after laparoscopic appendectomy: A warning. J Laparoendosc Surg. 1996;6:185–7.
Wallbridge PH. Double appendix. Br J Surg. 1962;50:346–7.
Clark J, Theodorou N. Appendicitis after appendicectomy. J R Soc Med. 2004;97:543–4.
Mangi AA, Berger DL. Stump appendicitis. Am Surg. 2000;66:739–41.
Roberts KE, Starker LF, Duffy AJ, Bell RL, Bokhari J. Stump appendicitis: A surgeon's dilemma. JSLS. 2011;15:373–8.
Shin LK, Halpern D, Weston SR, Meiner EM, Katz DS. Prospective CT diagnosis of stump appendicitis. AJR Am J Roentgenol. 2005;184(Suppl 3):S62–4.
Watkins BP, Kothari SN, Landercasper J. Stump appendicitis: Case report and review. Surg Laparosc Endosc Percutan Tech. 2004;14:167–71.
O’Leary DP, Myers E, Coyle J, Wilson I. Case report of recurrent acute appendicitis in a residual tip. Cases J. 2010;3:14.
Copyright (c) 2019 Acta Chirurgica Croatica
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors hereby authorize the Acta Chirurgica Croatica (ACC) to publish their work.
The authors are aware that although ACC is Open Access journal, the copyright of all material published is vested in ACC. Open access articles are freely available to read, download, and share from the time of publication under the terms of the Creative Commons License Attribution ‐ NonCommerical No Derivative (CC BY‐NC‐ND) license. This license does not permit reuse for any commercial purposes nor does it cover the reuse or modification of individual elements of the work (such as figures, tables, etc.) in the creation of derivative works without specific permission of ACC and appropriate acknowledgment of its source. The authors permit ACC to allow third parties to copy any part of the work without asking for permission, provided that the reference to the source is given and that this is not done for commercial purposes. Except for copyright, other proprietary rights related to the work (e.g., patent or other rights to any process or procedure) shall be retained by the author. To reproduce any text, figures, tables, or illustrations from this work in future works of their own, the author must obtain written permission from ACC.
Each of the author(s) hereby also grants permission to ACC to use such author’s name and likeness in connection with any past, present or future promotional activity by ACC, including, but not limited to, promotions for upcoming issues or publications, circulation solicitations, advertising or other publications in connection with ACC. Also, each of the author(s) hereby grants permission to ACC to use the manuscript in editorial research related to the improvement of editorial conduct, decision making, and issues related to peer review.
Each of the author(s) hereby releases and shall indemnify and hold harmless ACC and its successors, assigns, licensees, officers, directors, employees, and their respective heirs and representatives from and against any and all liabilities, losses, damages and expenses arising out of any claims of any kind that may be asserted against any of them based in whole or in part on any breach of the author(s)’ representations or warranties herein or in the work or anything contained in the work, including but not limited to any claims for copyright infringement or violation of any rights of privacy or publicity.