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Dar DS. A Stumping Experience: An Autobiographical Case Report. Cureus 2023; 15:e45625. [PMID: 37868566 PMCID: PMC10588960 DOI: 10.7759/cureus.45625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Stump appendicitis, while being well recognized as a delayed complication following an appendectomy, is a relatively under-reported clinical entity, with an even lesser documentation frequency in the subcontinent, from where the author hails. This article recounts his brief yet consequential journey from ill-health to recovery, all the while giving an insight into a multitude of related experiences that served as learning points for the narrator. Additionally, this account of events, having been viewed through a hybrid doctor-patient lens, aspires to be a valuable addition to medical literature.
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Bašković M, Zaninović L, Čizmić A, Žganjer M. Stump appendicitis in children: a systematic review. Pediatr Surg Int 2023; 39:199. [PMID: 37188869 DOI: 10.1007/s00383-023-05475-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Stump appendicitis is a rare complication after primary appendectomy and is often not considered in the differential diagnosis of patients who have undergone an appendectomy. With this systematic review, the aim was to identify all cases of stump appendicitis in children in order to gain a better insight into the risk factors, clinical presentation, diagnostics, and treatment. METHODS Scopus and PubMed databases were searched. The search combinations used the following MeSH and free text terms: [(stump) OR (residual) OR (remaining) OR (retained) OR (recurrent)] AND (append*). Neither search filters nor text analysis tools were used. To be included, the report had to contain information about a patient between the age of 0 and 18 who was treated for stump appendicitis as a result of an inadequately performed appendectomy. RESULTS Out of the 19,976 articles, 29 of them, with a total of 34 cases, met the inclusion criteria. The mean age at the time of stump appendectomy was 13.32 ± 3.57 years, while the median time between primary and stump appendectomy was 7.5 (2.3 - 24.0) months. The ratio between boys and girls was 3.2: 1. Primary appendectomy was performed laparoscopically in a greater number of cases compared to the open approach (1.5: 1), and according to the available data, no higher proportion of complicated appendicitis was recorded during a primary appendectomy. The median duration of symptoms during stump appendicitis was 2 days, and in most cases, the pain was localized. Stump appendectomy in most cases was performed with an open approach, and in relation to the type of appendicitis, most of them were complicated. The mean value of the length of the stump was 2.79 ± 1.22 cm, and the smallest recorded length was 0.6 cm. CONCLUSIONS A non-specific clinical presentation with a history of appendectomy usually makes the diagnosis of stump appendicitis challenging for uninformed physicians, and due to untimely treatment, it usually results in complicated forms of stump appendicitis. Complete appendectomy remains the gold standard in the treatment of stump appendicitis.
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Affiliation(s)
- Marko Bašković
- Department of Pediatric Surgery, Children's Hospital Zagreb, Ulica Vjekoslava Klaića 16, Zagreb, 10000, Croatia.
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, 10000, Croatia.
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, Šalata 3, Zagreb, 10000, Croatia.
| | - Luca Zaninović
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, 10000, Croatia
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, Šalata 3, Zagreb, 10000, Croatia
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, Petrova 13, Zagreb, 10000, Croatia
| | - Ante Čizmić
- Department of Pediatric Surgery, Children's Hospital Zagreb, Ulica Vjekoslava Klaića 16, Zagreb, 10000, Croatia
| | - Mirko Žganjer
- Department of Pediatric Surgery, Children's Hospital Zagreb, Ulica Vjekoslava Klaića 16, Zagreb, 10000, Croatia
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Almas T, Nagarajan VR, Ahmed D, Ullah M, Ashary MA, Oruk M, Khan A, Amin K, Malik U, Ramjohn J, Huang H, Rifai A, Alzahrani A, Alqallaf N, Alsairefi S, Hur YS, Bhullar A, Abdulkarim K, Alwheibi E, Kadom M, Alshabibi A, Shafi A, Murad F, Mansoor E. Recurrent appendicitis of vermiform appendix after a prior appendectomy: A case report and review of the literature. Ann Med Surg (Lond) 2022; 77:103603. [PMID: 35638013 PMCID: PMC9142391 DOI: 10.1016/j.amsu.2022.103603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Acute appendicitis is one of the leading causes of acute abdominal pain and surgical emergency. Stump appendicitis is a known complication of appendectomy whereby a retained appendiceal tip serves as a nidus for recurrent bouts of inflammation. Nevertheless, full-blown appendicitis of the vermiform appendix after a prior appendectomy remains a diagnostic conundrum. Case presentation A 45-year-old woman presented with a six-month history of right iliac fossa pain. Pertinently, she had undergone a prior open appendectomy twelve years ago. Further investigative workup revealed full-blown appendicitis, which was not attributable to a retained appendiceal stump. A subsequent laparoscopic appendectomy was performed, and the resultant specimen was sent for further evaluation, confirming the diagnosis of recurrent appendicitis. Clinical discussion Acute appendicitis is one of the most common life-threatening abdominal surgical emergencies worldwide, with 300000 appendectomies performed annually in the United States alone. Stump and chronic appendicitis are two separate and exceedingly rare clinical entities that may present simultaneously and develop serious complications unless promptly recognized and appropriately managed. The present paper prompts the clinicians to distinguish amongst the two at the initial surgery in order to thwart further exacerbations. Conclusion While stump appendicitis is a rare but well-characterized complication of a prior appendectomy, full-blown appendicitis of vermiform appendix remains elusive. It is therefore imperative to distinguish between a duplicated and a recurrent appendix at the initial operative procedure to facilitate optimal patient management.
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Affiliation(s)
- Talal Almas
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Corresponding author. Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, Ireland.
| | | | - Danyal Ahmed
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Muneeb Ullah
- Department of Surgery, Maroof International Hospital, Islamabad, Pakistan
| | | | - Mert Oruk
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Arsalan Khan
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kiran Amin
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Uzair Malik
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Helen Huang
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ali Rifai
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ahlam Alzahrani
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Nagi Alqallaf
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sood Alsairefi
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Anhad Bhullar
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Eissa Alwheibi
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Mhmod Kadom
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Aaisha Alshabibi
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Adil Shafi
- Department of Surgery, Maroof International Hospital, Islamabad, Pakistan
| | - Faisal Murad
- Department of Surgery, Maroof International Hospital, Islamabad, Pakistan
| | - Emad Mansoor
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Abstract
<b>Aim:</b> The study was conducted to analyze stump appendicitis which is a long-term complication of appendectomy - the otherwise commonest general surgical procedure conducted in the world. </br></br> <b>Methods:</b> 48 cases included from 36 articles published in the peer reviewed journals of repute were evaluated for eight variables including: (I) age of the patient, (II) gender, (III]) duration of symptoms, (IV) imaging, (V) interval time since initial operation, (VI) details of initial operation, (VII) management, (VIII) stump length if managed by operation. </br></br> <b> Results:</b> 48 cases (27 males and 19 females) ranging in age from 2 to 72 years reported after a wide range of time (3 days - 46 years) after primary appendectomy. The duration of symptoms ranged from 1 day to 7 months. As many as 31 (64.5%) cases had inflamed stump appendix whereas 17 (33.5%) had perforation. Twenty-one (43.7%) had undergone laparoscopic primary appendectomy and 27 (56.3%) had undergone open appendectomy. Management of the retained stump included stump appendectomy in 42 (87.5%), right hemicolectomy in 2 (4.2%) and conservative in 4 (8.3%) cases. In the 44 cases managed by surgical intervention, the approach was open in 27 (61.4%) and laparoscopic in 17 (38.6%) cases. The length of the retained appendix stump ranged from 0.5 cm to 6.5 cm (mean 2.14 cm). </br></br> <b>Conclusion:</b> Stump appendicitis is an entity that a physician needs to suspect if a patient reports with features of appendicitis even after appendectomy had been conducted. Management is generally surgical and aimed at removal of the retained appendiceal stump.
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Affiliation(s)
- Sajad Ahmad Salati
- Department of Surgery, College of Medicine, Qassim University, Saudi Arabia
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Casas MA, Dreifuss NH, Schlottmann F. High-volume center analysis and systematic review of stump appendicitis: solving the pending issue. Eur J Trauma Emerg Surg 2021; 48:1663-1672. [PMID: 34085112 DOI: 10.1007/s00068-021-01707-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/17/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Stump appendicitis (SA) is a rare long-term complication after laparoscopic appendectomy (LA) that can be associated with high morbidity due to delayed diagnosis. We aimed to determine the incidence, risk factors, diagnosis, and management of SA by reviewing our large cohort of LA and performing a systematic review of the literature. METHODS We retrospectively reviewed data of all patients who developed SA after LA between 2006 and 2020. Demographics, peri-operative variables, and postoperative outcomes were analyzed. A systematic review of the PubMed/MEDLINE, Embase and GoogleScholar bibliographic databases was also performed to identify publications regarding SA following LA. RESULTS A total of 2,019 patients underwent LA; 5 (0.25%) developed SA after a median of 292 days. The most common symptom at presentation was right lower quadrant pain. Four SA (80%) occurred in patients with a history of complicated appendicitis at index operation. All patients were diagnosed with computed tomography and underwent completion stump appendectomy by laparoscopy. No postoperative complications were recorded. A total of 55 studies with 76 cases of SA after LA were identified in the systematic review. Most SA (98.7%) underwent surgery: 52% by laparoscopic approach and 36% through an open approach. Stump appendectomy was performed in 94.4% cases and an extended resection in 5.6%. CONCLUSION Although SA is a rare complication after LA, a high index of clinical suspicious and imaging studies are key for early diagnosis and treatment. A laparoscopic resection of the inflamed appendiceal stump is feasible, safe, and highly effective. A minority of patients with severe cecum compromise may need extended resections or conversion to open surgery.
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Affiliation(s)
- María A Casas
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina
| | - Nicolás H Dreifuss
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina
| | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina.
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Al-Tarakji M, Muhammad Ali S, Khalaf M, Shahid F, Mohamed SSI. Adenocarcinoma of Stump Appendicitis: An Extremely Rare Pathology - A Literature Review. Cureus 2020; 12:e9482. [PMID: 32874810 PMCID: PMC7455462 DOI: 10.7759/cureus.9482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Emergency appendectomy for acute appendicitis is the most common emergency surgical procedure performed all over the world. While amputating the appendix from the cecum, a small (usually less than 5 mm) stump is left behind. Below this, the suture or stapler is applied to secure the base of the appendix, which is now known as a stump. Stump appendicitis, the inflammation of appendiceal remnant after an appendectomy, is a rare phenomenon. Additionally, the incidence of adenocarcinoma in the stump of the appendix is also extremely rare and can present with the symptoms of appendicitis. Adenocarcinoma in stump appendectomy patients can present from 5-43 years after the index appendectomy surgery. The majority of patients present with symptoms similar to that of appendicitis, with right lower quadrant abdominal pain, usually diagnosed via CT scans, after which they undergo stump appendectomy. The diagnosis of adenocarcinoma is only made on the histopathology report. We engaged in a review of the relevant literature published in the English language for the last 100 years. This was conducted by reviewing Google Scholar, PubMed, and MEDLINE® databases, as well as references to all related articles. There are only six cases reported in the literature, which shows the rarity of this condition. Regarding the appropriate treatment for this rare entity, multi-disciplinary team discussions should be carried out for optimum management of the individual patients. Right hemicolectomy is the recommended procedure for all patients, and prognosis depends on the staging of the disease.
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Affiliation(s)
| | - Syed Muhammad Ali
- Acute Care Surgery, Hamad General Hospital, Doha, QAT.,Surgery, Weill-Cornell Medical School, Doha, QAT
| | | | - Fakhar Shahid
- General Surgery, Hamad Medical Corporation, Doha, QAT
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Manatakis DK, Aheimastos V, Antonopoulou MI, Agalianos C, Tsiaoussis J, Xynos E. Unfinished Business: A Systematic Review of Stump Appendicitis. World J Surg 2020; 43:2756-2761. [PMID: 31375871 DOI: 10.1007/s00268-019-05101-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Stump appendicitis is defined as interval inflammation of any residual appendicular tissue, after an appendicectomy. We present a systematic review of case series and case reports on stump appendicitis, emphasising on risk factors, diagnosis and surgical management. METHODS The English literature (1945-2018) was reviewed, using PubMed, Embase and GoogleScholar, combining the terms "appendix", "appendicitis", "stump", "residual", "recurrent" and "retained". In total, 127 studies were included, describing 164 patients (males 59%, mean age 36 ± 17 years). RESULTS Index surgery was open in 59% and laparoscopic in 38%. It was described as "difficult" or "complicated" in 31%. 20% of patients reported episodes of recurrent abdominal pain during the time interval between index and stump appendicitis (range 2 weeks to 60 years, median 2 years). Right lower quadrant pain was the most frequent complain (88%), leukocytosis was found in 56%, whereas 92% of patients underwent imaging testing, which was diagnostic or highly suspicious in 67.5%. Mean delay between beginning of symptoms and surgery was 2.4 ± 2.3 days. The operative approach was open in 61% and laparoscopic in 35% of cases. The operation was characterised as "difficult" or "complicated" in 45%. In the majority (88%), a completion stump appendicectomy was performed, with 11% requiring more extensive procedures. Mean length of resected stump was 3.1 ± 1.6 cm (range 0.5-10 cm). CONCLUSIONS Stump appendicitis may occur following both open and laparoscopic approach, when the residual stump is > 0.5 cm. Its clinical significance lies in the delayed diagnosis, leading to higher incidence of complications and the need for more extensive surgery.
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Affiliation(s)
- Dimitrios K Manatakis
- Department of Surgery, Athens Naval and Veterans Hospital, 11521, Athens, Greece.
- Medical School, University of Crete, Heraklion, Crete, Greece.
| | - Vasileios Aheimastos
- Department of Surgery, Athens Naval and Veterans Hospital, 11521, Athens, Greece
| | | | - Christos Agalianos
- Department of Surgery, Athens Naval and Veterans Hospital, 11521, Athens, Greece
| | - John Tsiaoussis
- Medical School, University of Crete, Heraklion, Crete, Greece
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Ferreira de Lima S, Patena Forte J, de Castro M, Morão S, Alves R. Stump appendicitis in two adolescent boys: Rare presentations and alternative approaches in pediatrics. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2019.101334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Point-of-care ultrasound diagnosis of stump appendicitis in the emergency department. Ultrasound J 2019; 11:12. [PMID: 31359172 PMCID: PMC6638604 DOI: 10.1186/s13089-019-0128-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/03/2019] [Indexed: 11/20/2022] Open
Abstract
Background Stump appendicitis (SA) is a rare entity in patients with a history of appendectomy and may result in missed or delayed diagnosis. We report a case of SA diagnosed by emergency department (ED) point-of-care ultrasound (PoCUS) in an elderly woman, thus expediting her care. Case presentation An elderly female patient with a history of appendectomy 27 years ago was referred by her physician to the ED with right lower quadrant pain for 2 days. Using PoCUS the emergency physician identified SA. This was confirmed by computed tomography (CT) scan. The patient was then successfully managed non-operatively using antibiotics. Conclusions Despite its rarity, it is feasible to diagnose SA using PoCUS, as patients presenting with right lower quadrant pain and history of appendectomy are at risk for delayed diagnosis, perforation, and poor outcome. PoCUS may reduce time to diagnosis, time to definitive operative or non-operative management, and minimize morbidity.
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Dikicier E, Altintoprak F, Ozdemir K, Gundogdu K, Uzunoglu MY, Cakmak G, Onuray F, Capoglu R. Stump appendicitis: a retrospective review of 3130 consecutive appendectomy cases. World J Emerg Surg 2018; 13:22. [PMID: 29849750 PMCID: PMC5968495 DOI: 10.1186/s13017-018-0182-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Stump appendicitis is inflammation of remnant appendix tissue due to incomplete removal of the appendix. Due to appendectomy history, stump appendicitis diagnosis is usually delay and that can cause increase morbidity. Methods Medical records of patients who had surgery for acute appendicitis at a single center from 2008 to 2017 were retrospectively reviewed. During the evaluation of medical records, patients that had a previous operation for acute appendicitis or had "stump appendicitis" as an exploratory finding in operation notes were included. Results Appendectomy was performed in 3130 patients (2630 open surgeries and 380 laparoscopic surgeries). Stump appendicitis was diagnosed in five patients (0.15%). The appendectomies had been performed 4, 5, 7, 7, and 11 years previously. Mean time taken for surgery was 36 h after symptoms began. Open surgery was performed in three patients, laparoscopic procedures in others. Conclusion Awareness of stump appendicitis before radiological examinations may facilitate accurate diagnosis and decrease the duration of the decision-making process, leading to decreased morbidity.
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Affiliation(s)
- Enis Dikicier
- Department of General Surgery, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Fatih Altintoprak
- Department of General Surgery, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Kayhan Ozdemir
- 2Department of General Surgery, Sakarya University Research and Educational Hospital, Sakarya, Turkey
| | - Kemal Gundogdu
- 2Department of General Surgery, Sakarya University Research and Educational Hospital, Sakarya, Turkey
| | - Mustafa Yener Uzunoglu
- 2Department of General Surgery, Sakarya University Research and Educational Hospital, Sakarya, Turkey
| | - Guner Cakmak
- 2Department of General Surgery, Sakarya University Research and Educational Hospital, Sakarya, Turkey
| | - Feyyaz Onuray
- 2Department of General Surgery, Sakarya University Research and Educational Hospital, Sakarya, Turkey
| | - Recai Capoglu
- 2Department of General Surgery, Sakarya University Research and Educational Hospital, Sakarya, Turkey
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Van Paesschen C, Haenen F, Bestman R, Van Cleemput M. Stump appendicitis 10 years after appendectomy, a rare, but serious complication of appendectomy, a case report. Acta Chir Belg 2017; 117:49-51. [PMID: 27471882 DOI: 10.1080/00015458.2016.1199353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We describe a case of stump appendicitis with the formation of abdominal abscesses in a 41-year-old patient 10 years prior appendectomy. The patient consulted with fever (38.1 °C) and abdominal pain, located at the right iliac fossa. Imaging studies showed signs of abscesses, located at the right iliac fossa, without clear origin of these abscesses. The abscesses were drained through diagnostic laparoscopy, no bowel perforation or clear origin of the abscedation was found during laparoscopy. During postoperative stay, the inflammatory parameters rose and the abscesses reoccurred. Re-laparoscopy was performed, the abscesses were drained and on careful inspection and adhesiolysis, a perforated stump appendicitis was revealed, covered underneath layers of fibrous tissue. Stump appendicitis is a rare complication seen after appendectomy and is generally not considered a possible etiology in patients presenting with fever and right iliac fossa abdominal pain with a history of appendectomy. This often delays the correct diagnosis and results in an associated increased incidence of complications. We describe a case of stump appendicitis occurring 10 years after initial appendectomy.
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Reddan T, Corness J, Powell J, Harden F, Mengersen K. Stumped? It could be stump appendicitis. SONOGRAPHY 2016. [DOI: 10.1002/sono.12098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Tristan Reddan
- Medical Imaging and Nuclear Medicine; Lady Cilento Children's Hospital; Australia
- Science and Engineering Faculty; Queensland University of Technology; Australia
| | - Jonathan Corness
- Medical Imaging and Nuclear Medicine; Lady Cilento Children's Hospital; Australia
| | - Jennifer Powell
- Medical Imaging and Nuclear Medicine; Lady Cilento Children's Hospital; Australia
| | - Fiona Harden
- Science and Engineering Faculty; Queensland University of Technology; Australia
- Hunter Industrial Medicine; Maitland NSW Australia
| | - Kerrie Mengersen
- Science and Engineering Faculty; Queensland University of Technology; Australia
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Stump appendicitis: surgical background, CT appearance, and imaging mimics. Emerg Radiol 2014; 22:13-8. [PMID: 24985784 DOI: 10.1007/s10140-014-1253-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/20/2014] [Indexed: 10/25/2022]
Abstract
Stump appendicitis, also known as remnant appendicitis, is an uncommon entity with little radiologic literature. It is the result of unintentional incomplete appendectomy with subsequent inflammatory changes in the appendiceal remnant. A retrospective review of the radiology and pathology archives at our institution over an 8-year period yielded six surgically/pathologically confirmed cases. Imaging findings at presentation were evaluated, including appendiceal stump length, appendiceal stump diameter, presence or absence of surrounding stranding in the periappendiceal fat, and presence or absence of complication (perforation or abscess). The CT findings of the six cases had an average surgical specimen appendiceal stump length of 3.5 cm (range 2.0-5 cm) and an average appendiceal diameter of 12.3 mm (range 10-16 mm). All six cases demonstrated the presence of periappendiceal inflammatory fat stranding on the CT scan. Range of imaging presentation is reviewed with pictorial examples as well as examples of potential false-positive cases (mimics) including Crohn's disease, residual surgical drain tract, and epiploic appendagitis. Familiarity with stump appendicitis as well as its imaging mimics may lead to earlier diagnosis and treatment and prevent unnecessary complications.
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Bednar F, Skiba J, Mallat AF, Napolitano LM. Stump appendicitis. Surg Infect (Larchmt) 2014; 15:460-1. [PMID: 24821085 DOI: 10.1089/sur.2013.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Filip Bednar
- 1 Division of Acute Care Surgery (Trauma, Burn, Surgical Critical Care , Emergency Surgery), Department of Surgery, Ann Arbor, Michigan
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15
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Lupinacci RM, Bouchet-Doumenq C, Salepcioglu H, Egels S, Menegaux F, Trésallet C. Stump appendicitis. A diagnostic trap. Clin Res Hepatol Gastroenterol 2014; 38:e27-9. [PMID: 23414916 DOI: 10.1016/j.clinre.2012.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 11/30/2012] [Indexed: 02/04/2023]
Abstract
Stump appendicitis is an underestimated condition and a diagnostic trap that few surgeons think about when faced against localized pain in the lower-right abdomen. Misdiagnosis and therefore delay of the appropriate treatment results in increased morbidity. We report the case of a patient who presented a 7-day history of right iliac fossa abdominal pain. She had undergone open appendectomy in childhood. Stump appendicitis was not diagnosed immediately despite imaging (CT and MRI) and exploratory laparoscopy. In conclusion, surgeons and gastroenterologists need a heightened awareness of the possibility of stump appendicitis.
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Affiliation(s)
- Renato M Lupinacci
- Department of General, Visceral and Endocrine Surgery, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Cécile Bouchet-Doumenq
- Department of General, Visceral and Endocrine Surgery, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Harika Salepcioglu
- Department of General, Visceral and Endocrine Surgery, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Sophie Egels
- Department of Radiology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Fabrice Menegaux
- Department of General, Visceral and Endocrine Surgery, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Université Pierre et Marie Curie (Paris VI), Paris, France
| | - Christophe Trésallet
- Department of General, Visceral and Endocrine Surgery, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Université Pierre et Marie Curie (Paris VI), Paris, France.
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Stump appendicitis: an uncompleted surgery, a rare but important entity with potential problems. Case Rep Surg 2013; 2013:972596. [PMID: 23691424 PMCID: PMC3638532 DOI: 10.1155/2013/972596] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/19/2013] [Indexed: 11/17/2022] Open
Abstract
Appendicectomy for appendicitis is one of the commonest surgical procedures performed worldwide. The residual appendiceal stump left after an initial appendectomy risks the development of stump appendicitis. Stump appendicitis is a real recognized entity but not often considered when evaluating patients with right lower quadrant abdominal pain, especially those with past history of appendectomy. It remains a clinical challenge with the result that its diagnosis and effective treatment are often delayed with possible attendant morbidity or mortality. Stump appendicitis results from obstruction of the lumen of the remaining appendix stump, usually by a faecolith. This increases intraluminal pressure, impairing venous drainage and allowing subsequent bacterial infection. We present the case of a twenty-five (25)-year-old female who underwent laparoscopic appendicectomy and presented four and half (4(1/2)) months later with fever, right lower quadrant abdominal pain, and tenderness associated with repeated vomiting. Exploratory laparotomy was carried out after clinical and imaging studies which revealed big inflammatory mass with abscess at the right iliac fossa and recurrent appendicitis of the appendiceal stump. Surgical treatment is easy but recognition of this important entity but potentially dangerous condition should always be borne in mind in order to avoid delay in its diagnosis and treatment.
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Mínguez G, Gonzalo R, Tamargo A, Turienzo E, Mesa A, Vazquez L. An unsuspected clinical condition: Appendicitis of appendicular residual, three cases report. Int J Surg Case Rep 2013; 4:371-4. [PMID: 23474976 DOI: 10.1016/j.ijscr.2013.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/26/2013] [Accepted: 01/30/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Stump appendicitis is a rare complication of appendectomy unusually included in the differential diagnosis. This is found in appendectomized patients with similar symptoms to those of a previous appendicitis. PRESENTATION OF CASE We present three cases, two women and a man of 67, 30 and 24 years old, respectively. They underwent surgery at our centre and their appendectomies presented technical difficulties: problems when identifying the appendicular base or the complete appendicular structure. In the first case, diagnosis and therapy were performed with laparoscopy. The second case was diagnosed by an abdominal ultrasound (US) which revealed a tubular structure with thickened walls. An abscess was observed in the computed tomography (CT) scan for the third case and a laparotomy revealed the retained appendix. DISCUSSION Although there are several factors that can contribute to this rare pathology, the main cause of stump appendicitis is the persistence of a large appendicular remnant. CT and US are very useful diagnosis tools. Treatment consists to a completion appendectomy of the stump which can be carried out by an open or a laparoscopic approach. CONCLUSION In this rare pathology a prior history of appendicectomy can delay the diagnosis and increase its associated morbidity and even mortality. In patients with abdominal pain in the right lower quadrant and previous appendectomy, it is important to include this pathology in the differential diagnosis, in order to not delay the treatment and thus avoid complications.
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Affiliation(s)
- Germán Mínguez
- General and Digestive Surgery Service, Hospital Universitario Central de Asturias, Calle de Celestino Villamil s/n, 33006 Oviedo, Asturias, Spain.
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Yang Y, Clark TR, Phan HH. Stump appendicitis after childhood incidental appendectomy. J Pediatr Surg 2012; 47:e15-7. [PMID: 23164023 DOI: 10.1016/j.jpedsurg.2012.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 06/20/2012] [Accepted: 06/20/2012] [Indexed: 01/07/2023]
Abstract
Stump appendicitis is a rare late complication of appendectomy. Most cases present months to years following surgery for acute appendicitis. Cases of stump appendicitis after incidental appendectomy are very rare. We present a case of stump appendicitis after incidental appendectomy during a procedure for duodenal obstruction as an infant.
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Affiliation(s)
- Yifan Yang
- Department of Surgery, University of California, Davis Medical Center, Sacramento, CA 95817, USA.
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Abstract
BACKGROUND Stump appendicitis is defined by the recurrent inflammation of the residual appendix after the appendix has been only partially removed during an appendectomy for appendicitis. Forty-eight cases of stump appendicitis were identified in the English literature. DATABASE The institutional CPT codes were evaluated for multiple hits of the appendectomy code, yielding a total of 3 patients. After appropriate approval from an internal review board, a retrospective chart review was completed and all available data extracted. All 3 patients were diagnosed with stump appendicitis, ranging from 2 months to 20 years after the initial procedure. Two patients underwent a laparoscopic and the one an open completion appendectomy. All patients did well and were discharged home in good condition. CONCLUSION Surgeons need a heightened awareness of the possibility of stump appendicitis. Correct identification and removal of the appendiceal base without leaving an appendiceal stump minimizes the risk of stump appendicitis. If a CT scan has been obtained, it enables exquisite delineation of the surrounding anatomy, including the length of the appendiceal remnant. Thus, we propose that unless there are other mitigating circumstances, the completion appendectomy in cases of stump appendicitis should also be performed laparoscopically guided by the CT findings.
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Affiliation(s)
- Kurt E Roberts
- Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut 06510, USA.
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