Incidental finding of double appendix during laparotomy for intussusception: A case report

Anatomical Variations of the Vermiform Appendix

OBJECTIVE

The aim of the present work is to systematically review and present the existing literature on anatomical variations of the appendix.

METHODS

Detailed research was conducted in the PubMed medical database, using the terms "Appendix" AND "Anatomical variations", and 74 articles were initially revealed. After the application of the inclusion and exclusion criteria, all the non-related articles were excluded, and thus 40 articles were finally selected.

DISCUSSION

The data analysis suggests that the location and form of the appendix may significantly vary among individuals. Common anatomical variations concerning its location include retrocecal, pelvic, retro-ileal, pre-ileal, prececal and paracecal appendices. The first two variants are the most common, although there is a discrepancy regarding their exact incidence. Rarely, the appendix may be intracecal, intramural, subhepatic or located in the left abdomen; mismatches of the McBurney guide point with the base of the appendix are also recorded. Concerning the appendix's form, several variations in the length, diameter, shape and number of appendages (doubling, tripling) may be present.

CONCLUSIONS

As evident from the presentation of the results, the vermiform appendix presents a wide variety and number of anatomical variations. The latter are of particular clinical importance and should be known to doctors - especially surgeons - to avoid complications in clinical practice.

Atypical Duplex appendix arising from the ascending colon: a case report

BACKGROUND

Duplex or vermiform appendix refers to the presence of an appendix beside the naturally occurring one. Although, duplex appendix emerges from the caecum most of the time, yet it is encountered in other parts of the colon. Inflammation of duplex appendix may represent not only a clinical, but also a surgical dilemma, and this would be confusing further among patients who already had prior appendectomy.

CASE PRESENTATION

We present a case of 29-years old Egyptian male patient with history of appendectomy one and half year before presenting to the emergency department with recurrent acute abdominal pain that was linked to duplex appendicitis abnormally emerged from the mid-ascending colon. The first episode was treated conservatively considering atypical right colon diverticulitis as a potential differential diagnosis. Seven months later the patient was treated by laparoscopic appendectomy and experienced an uneventful pot-operative course.

CONCLUSION

Duplex appendicitis, though rare, should be considered in the differential diagnosis of recurrent acute abdomen even after appendectomy.

Case report: Duplicated appendicitis with history of cloacal exstrophy causing bowel obstruction

INTRODUCTION

Cloacal and bladder exstrophy are rare embryological defects that can cause developmental disruption of surrounding organ structures, the pelvis, spinal cord, and small intestines being the most commonly affected. Duplicated appendix is another rare embryological defect that has historically caused confusing clinical presentations. Our case highlights a rare instance of a patient with cloacal exstrophy who presented with a bowel obstruction and an associated inflamed duplicated appendix.

CASE PRESENTATION

A newborn male is born with omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex. As primary surgical reconstruction was pursued, the patient was found to have a non-inflamed duplicated appendix, which was left unremoved. In the following months, the patient experienced episodes of small bowel obstruction, eventually requiring surgical intervention. During this operation, the duplicated appendix was noted to be inflamed, prompting removal of both appendices.

DISCUSSION

This case highlights the increased prevalence of duplicated appendix in a patient with cloacal exstrophy, as well as the utility of prophylactic appendectomy for patients incidentally found to have a duplicated appendix intraoperatively. The duplicated appendix may lead to increased rates of complications and atypical presentation of appendicitis, supporting the practice of prophylactic appendectomy in patients with an incidentally found duplicated appendix.

CONCLUSION

We suggest clinicians be aware of the association and potentially atypical presentation of appendicitis in patients with a duplicated appendix, particularly in the setting of cloacal exstrophy. The decision to prophylactically remove an incidentally found, non-inflamed duplicated appendix may be beneficial in preventing confusing clinical presentations and future complications.

Double appendixes: A rare case report

Anomalies of the appendix are rare, and one of the rarest is the double appendixes. Most anomalies of the appendix are observed in adults and are discovered incidentally during surgery that does not primarily involve the appendix. It is usually missed, often with life-threatening consequences.