First case report of horseshoe appendix in Morocco according according to SCARE guidelines

Horseshoe appendix: A case report and literature review

RATIONALE

Horseshoe appendix is 1 of the rarest types of duplex appendix characterized by 1 appendix having 2 openings at the cecum. Clinically, it is extremely rare and is detected incidentally at surgery. Therefore, accurate and timely diagnosis is important for enhanced prognosis, treatment planning, and optimizing patient outcomes. This case report presents the first case of horseshoe appendix in France.

PATIENT CONCERNS

A French 15-year-old boy, presented to the emergency department with pain in the right iliac fossa that had been worsening for 4 days. Considering his symptoms, abdominal ultrasound, radiological examination, and computed tomography (CT) scan results, an acute appendix was suspected.

DIAGNOSES

Acute appendicitis (AA) with "horseshoe" type appendix.

INTERVENTIONS

Surgical intervention with exploratory laparoscopy was performed immediately.

OUTCOMES

We found a heterogeneous image, partially fluid in the right iliac fossa, measuring approximately 16 × 9 mm, with inflammatory remodeling of the fat upon contact. The radiological examination concluded that complicated AA was suspected. Finally, the pathological report revealed acute suppurative appendicitis with peritoneal reaction.

LESSONS

Horseshoe appendix is rare. Considering his symptoms, radiological examination, ultrasound, and CT scan results, an acute appendix was suspected. The patient was successfully treated using emergency surgery and antibiotics treatment thanks to further diagnosis via exploratory laparoscopy and pus microbial analysis.

Rare appendicular anomaly of horseshoe appendix diagnosed intra-operatively during laparoscopic appendectomy: case report

Acute appendicitis is the most common cause of lower abdominal pain among patients presented to the Emergency Department. Appendicular anomalies in general are rare, and the horseshoe appendix is considered the rarest, with few reported cases in the literature. We are presenting a young female patient, medically and surgically free, who presented to the Emergency Department with persistent right lower quadrant, associated with vomiting for 2 days. Vitally was stable, and labs were remarkable for leukocytosis and neutrophil shift. Abdomen CT scan showed a dilated appendix up to 1 cm with mural edema and hyperenhancement surrounded by mild fat stranding, minimal free fluid, and thickened adjacent peritoneal reflection. In conclusion, routinely performed surgeries can surprise the surgeon with unusual findings. Knowing the anatomy and possible associated anomalies is a cornerstone for any surgery. Even with the rarity of these anomalies, a high index of suspicion and careful recognition are required.

Appendiceal duplication: a case report of horseshoe-shaped appendix and implications for patient safety

Appendiceal anomalies, particularly double appendices, are rare and mainly detected during non-appendiceal surgery in adults. Misrecognizing them can have serious consequences, both clinically and legally. It is critical that surgeons pay attention to the anatomical variations of the vermiform appendix, and always consider the possibility of duplicated appendix when diagnosing a right iliac fossa pain. Misdiagnosis can lead to life-threatening medical complications for the patient, with medico-legal implications.