Stump appendicitis after laparoscopic appendectomy: a rare clinical entity

  • Asmir Jonuzi
  • Nusret Popovic
  • Zlatan Zvizdic
  • Emir Milisic
Keywords: open appendectomy, stump appendicitis, acute abdomen

Abstract

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.

Downloads

Download data is not yet available.

References

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.

Published
2019-11-03
How to Cite
1.
Jonuzi A, Popovic N, Zvizdic Z, Milisic E. Stump appendicitis after laparoscopic appendectomy: a rare clinical entity. ACC [Internet]. 2019Nov.3 [cited 2019Nov.19];16(1):21-4. Available from: https://acc.hkd.com.hr/index.php/ACC/article/view/73
Section
Case Reports