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Mathew M, Mathew T, Joseph E. First case of primary appendiceal tuberculosis presented as stump appendicitis. J Surg Case Rep 2023; 2023:rjad373. [PMID: 37388508 PMCID: PMC10299906 DOI: 10.1093/jscr/rjad373] [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] [Received: 05/19/2023] [Accepted: 06/11/2023] [Indexed: 07/01/2023] Open
Abstract
Tuberculosis (TB) remains as a significant global public health issue, especially in developing and underdeveloped nations. Extrapulmonary TB comprises 20% of the TB cases; of which 34.4% were in the lymphatics, 25.2% pleural, followed by 12.8% gastrointestinal and 9.4% in the central nervous system. Ileocecal involvement is the most common among gastrointestinal TB. Although it can cause secondary damage to the appendix, primary type of appendicular TB is rare and can occur with no other signs of the disease. A high index of suspicion is necessary for early diagnosis and treatment of TB. Similarly, stump appendicitis (SA) is a rare and delayed complication of appendectomy. Here we report a case of primary appendicular TB in a patient presented to a multi-specialty hospital in Kerala, India, with SA.
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Affiliation(s)
- Midhun Mathew
- Correspondence address. Royal College of Surgeons in Ireland, Dublin 2 D02 YN77, Ireland. Tel: +353892601166;
| | - Tony Mathew
- Department of General Surgery, Believers Church Medical College Hospital, Thiruvalla, Kerala 689103, India
| | - Elizabeth Joseph
- Department of Pathology, Believers Church Medical College Hospital, Thiruvalla, Kerala 689103, India
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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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An unusual case of perforated stump appendicitis: A case report. Ann Med Surg (Lond) 2022; 76:103447. [PMID: 35308435 PMCID: PMC8927796 DOI: 10.1016/j.amsu.2022.103447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance The stump appendicitis is a rare complication with incidence of 1 in 50,000 appendectomy cases. Case presentation Patient with a history of emergency open appendectomy one year back presented with symptoms as that of acute appendicitis like pain abdomen localized in right iliac fossa, nausea, vomiting and anorexia. Complete blood count showed leukocytosis. Clinical discussion Aside from classical clinical symptoms similar to acute appendicitis other causes of acute abdominal pain were ruled out with clinical laboratory and radiological investigations. This creates a dilemma and delay in diagnosis if investigations are not done promptly. Conclusion Due to prior surgical history of appendectomy and low index of suspicion, the diagnosis of stump appendicitis is often delayed which may result in serious complications like stump gangrene, perforation and peritonitis. Stump appendicitis is one of the rare complications of appendectomy. Stump appendicitis can occur mainly in patients who have undergone either laparoscopic or open appendectomy and may pose a serious diagnostic dilemma. Surgical resection (appendectomy) either open or laparoscopic is the most appropriate treatment in these cases. The interval between the initial appendectomy and the new presentation can range from 4 days to 50 years.
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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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Valdes Castañeda A, Arribas Martin JP, Mancera Steiner C, Cuevas Bustos RA, Zamora Duarte LM, Jafif Cojab M. Stump appendicitis after laparoscopic appendectomy; laparoscopic management and literature review. Int J Surg Case Rep 2021; 84:106156. [PMID: 34229211 PMCID: PMC8259332 DOI: 10.1016/j.ijscr.2021.106156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Appendectomy is one of the most common surgical procedures performed worldwide There are different etiologies for acute appendicitis such as obstruction of the appendiceal lumen by fecalith, lymphoid hyperplasia, or neoplasm. Laparoscopic appendectomy has become the treatment of choice for both complicated and uncomplicated appendicitis; common postoperative complications include wound infection, bleeding, intraabdominal abscess. Stump appendicitis is defined as the interval repeated inflammation of remaining residual appendiceal tissue after an appendectomy. Presentation of case 38-Year-old female patient with a history of laparoscopic appendectomy performed in 2016 for acute uncomplicated appendicitis. She arrived to the emergency room due to abdominal pain 7 out of 10, located in the periumbilical region, later with migration to the right lower quadrant, abdominal CT scan evidenced the presence of a cecal and pericecal inflammatory process as well as the base and residual proximal portion of the cecal appendix laparoscopic stump appendectomy was performed. Discussion Stump appendicitis (SA) is defined as the inflammation of the remnant of the cecal appendix after an appendectomy, whether due to impaction of a fecalith or secondary to an ischemic process, the probability of developing SA is estimated to be about 1/50,000 cases throughout life. The most frequently used treatment is exploratory laparotomy to complete the previous appendectomy; however, there are 5 reported cases of stump appendicitis, where surgical resolution was performed through laparoscopic surgery. Conclusions It is important to keep this entity in mind when evaluating a patient with acute abdomen with previous history of appendectomy, since the delay in diagnosis and treatment increases morbidity and mortality; laparoscopic stump appendectomy has been shown to be a safe treatment (Agha et al., 2020 [14]).1 Stump appendicitis (SA) is defined as the inflammation of the remnant of the cecal appendix after an appendectomy. Delay in diagnosis and treatment increases morbidity and mortality Laparoscopic stump appendectomy has been shown to be a safe alternative.
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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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From Diagnosis to Management; Mucocele of Stump Appendicitis, Extremely Rare Finding in an Uncommon Surgical Disease: Literature Review. Int J Surg Oncol 2021; 2021:8816643. [PMID: 33628502 PMCID: PMC7892232 DOI: 10.1155/2021/8816643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/08/2021] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
Mucocele of the appendix is the accumulation of mucoid material in the appendiceal lumen. Although the terminology is imprecise, as it does not differentiate between the benign and malignant nature of the condition, preoperative recognition is imperative as spillage of the mucus during surgical handling can result in grave complications like pseudomyxoma peritonei. Mucocele developing in a stump of the appendix, i.e., a remnant of appendiceal tissue after surgical removal of an inflamed organ, is an extremely uncommon phenomenon, as not many cases are reported in the literature. In this review, all cases reported in English literature are discussed.
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Casas MA, Laxague F, Schlottmann F, Sadava EE. Re-laparoscopy for the treatment of complications after laparoscopic appendectomy: is it possible to maintain the minimally invasive approach? Updates Surg 2020; 73:2199-2204. [PMID: 33174113 DOI: 10.1007/s13304-020-00917-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022]
Abstract
Despite laparoscopy is considered an adequate tool for the diagnosis and management of postoperative surgical complications, its role after laparoscopic appendectomy (LA) remains uncertain. The aim of this study was to evaluate whether laparoscopy is useful for treating complications after laparoscopic appendectomy. A retrospective analysis of a prospectively collected database of patients undergoing LA, who needed a reoperation for postoperative complications during the period 2006-2020, was performed. Demographics, operative variables, and postoperative outcomes were analyzed. A total of 2019 LA were performed, and 41 patients (2%) underwent a RL for post appendectomy complications. Twenty-three patients (56%) were male. The mean age was 32 years old (16-92 years). The majority of patients (75%) had a complicated acute appendicitis in the first operation. The most common findings at RL were generalized peritonitis (36.4%) and intraabdominal abscesses (26.8%). Five patients (12.1%) developed stump appendicitis, all of them as a late complication. The procedures were completed laparoscopically in 85% and 6 patients (15%) required conversion to an open approach. Three patients (7.3%) required a percutaneous drainage and two patients (4.9%) needed an additional surgery (laparotomy) after RL, all of them presenting with generalized peritonitis at the RL. No mortality was registered. Re-laparoscopy is feasible, safe, and highly effective for the diagnosis and treatment of post appendectomy complications. RL should be encouraged to avoid more aggressive procedures.
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Affiliation(s)
- María A Casas
- Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Av. Pueyrredón 1640 (ATT 1118), Buenos Aires, Argentina
| | - Francisco Laxague
- Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Av. Pueyrredón 1640 (ATT 1118), Buenos Aires, Argentina
| | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Av. Pueyrredón 1640 (ATT 1118), Buenos Aires, Argentina
| | - Emmanuel Ezequiel Sadava
- Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Av. Pueyrredón 1640 (ATT 1118), Buenos Aires, Argentina.
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Abstract
OBJECTIVE. Recurrent inflammation of the appendiceal stump after appendectomy is rare; published case series have included no more than six patients. The purpose of this study was to report the clinical and CT findings in a larger original series. MATERIALS AND METHODS. A combined PACS and electronic medical record search identified the cases of 14 patients (nine men, five women; mean age, 42.8 years) with a confident diagnosis of stump appendicitis evaluated at CT. In seven cases, CT images obtained at the initial presentation of appendicitis were available for review. Relevant clinical and CT findings were reviewed by three abdominal radiologists in consensus. RESULTS. The mean time interval between initial appendectomy and stump appendicitis was 5.1 years (range, 5 weeks-17.5 years); seven cases occurred within 1 year of appendectomy. Ten (71%) of initial appendectomies were performed by a laparoscopic approach. CT showed the mean appendiceal stump length was 3.2 cm (range, 1.3-7.0 cm); residual stump length measured 2 cm or longer in all but one case. Appendicoliths were identified at the stump in seven (50%) cases; the mean diameter was 0.9 cm and mean maximal attenuation, 247 HU. Extensive inflammatory changes surrounded the appendiceal stump at CT in all cases, including peristump abscess in four (29%) cases. Seven of the 14 patients (50%) went on to open surgical management with either remnant appendectomy or partial ileocecectomy. CONCLUSION. Stump appendicitis has a characteristic CT appearance and may occur within the first year after appendectomy or many years later. A long (≥ 2 cm) appendiceal stump from laparoscopic appendectomy and retained appendicolith may predispose adult patients to recurrent obstruction and inflammation.
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Emile SH, Elfallal AH, Abdel-Razik MA, El-Said M, Elshobaky A. A randomized controlled trial on irrigation of open appendectomy wound with gentamicin- saline solution versus saline solution for prevention of surgical site infection. Int J Surg 2020; 81:140-146. [PMID: 32798761 DOI: 10.1016/j.ijsu.2020.07.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common complications after abdominal surgery. The present trial examined the efficacy of saline irrigation of open appendectomy wound with or without topical antibiotics in prevention of SSI. METHODS This was a double-blind randomized trial on patients with acute appendicitis who underwent open appendectomy. Patients were randomly allocated to one of three equal groups; group I had layer-by-layer wound irrigation with gentamicin-saline solution, group II had wound irrigation with saline solution, and group III received no irrigation (Control group). The main outcome measures were the incidence of incisional SSI, surgical site occurrence (SSO), other complications, operation time, postoperative pain, and patients' satisfaction. RESULTS 205 patients (113 female) of a mean age of 27.9 years were included. The average hospital stay and pain scores were similar in the three groups. Groups I and II had significantly lower rates of incisional SSI (4.3% Vs 2.9%; Vs 17.4%, p = 0.005) and SSO (24.6% Vs 13.4% Vs 43.5%; p = 0.0003) as compared to group III. Groups I and II had comparable rates of SSI and SSO. The three groups had similar rates of wound seroma, hematoma, and dehiscence. Groups I and II had significantly higher satisfaction with the procedure than group III. CONCLUSIONS Layer-by-layer irrigation of open appendectomy wound decreased the rates of incisional SSI and SSO significantly compared to the no-irrigation group. Adding gentamicin to saline solution was useless to improve the outcome and did not decrease rates of SSI or other complications.
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Affiliation(s)
- Sameh Hany Emile
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt.
| | - Ahmed Hossam Elfallal
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt.
| | - Mohamed Anwar Abdel-Razik
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt.
| | - Mohamed El-Said
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt.
| | - Ayman Elshobaky
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt.
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Stump appendicitis; a case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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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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Wong K, Ozgediz DE, Dodington J. History of appendectomy? An atypical case of recurrent abdominal pain. Am J Emerg Med 2020; 38:1295.e3-1295.e4. [PMID: 31948784 DOI: 10.1016/j.ajem.2020.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/04/2020] [Indexed: 11/16/2022] Open
Abstract
Acute appendicitis is a common condition emergency physician encounter during pediatric emergency visits. With a reported incidence of 1 in 50,000 appendectomies, stump appendicitis, an acute inflammation of the residual appendicular tissue, is a rare post-operative complication. The diagnosis of stump appendicitis is time-critical to prevent associated morbidities of abscess formation, perforation and sepsis. Another atypical presentation of appendicitis includes recurrent appendicitis, which is recognized as one or more previous episodes of similar clinical presentation as acute appendicitis, but symptoms subside within 24 to 48 hours. Intervals between attacks may vary from weeks to years during which the patient may be asymptomatic. Although recurrent appendicitis is rare, emergency physicians should be aware of this possibility and to not assume that previous appendectomy precludes recurrent appendicitis. This case highlights the importance of considering such unusual condition in a patient presenting with recurrent right-sided abdominal pain.
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Affiliation(s)
- Kei Wong
- Yale-New Haven Children's Hospital, Yale University School of Medicine, New Haven, CT, United States of America.
| | - Doruk E Ozgediz
- Yale-New Haven Children's Hospital, Yale University School of Medicine, New Haven, CT, United States of America
| | - James Dodington
- Yale-New Haven Children's Hospital, Yale University School of Medicine, New Haven, CT, United States of America
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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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The role of appendectomy at the time of laparoscopic surgery for benign gynecologic conditions. Curr Opin Obstet Gynecol 2019; 30:237-242. [PMID: 29889113 DOI: 10.1097/gco.0000000000000466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The risk-benefit ratio of concurrent appendectomy at the time of gynecologic surgery has long been debated and remains controversial. However, emerging data on the appendix's role in chronic pain syndromes point to a previously unrecognized link between gynecologic disorders and appendicular pathology. In this article, we review the indications for appendectomy at the time of laparoscopic gynecologic surgery for the treatment of endometriosis and chronic pelvic pain. RECENT FINDINGS The incidence of appendiceal endometriosis is highly variable depending on the patient population selected. Although rare in patients undergoing appendectomy for acute appendicitis, women with endometriosis may experience rates as high as 9.3-39.0%, especially when suffering from deep infiltrative endometriosis. Appendectomy may also significantly reduce pain in women with unexplained chronic pelvic pain. SUMMARY Despite lack of prospective data, retrospective studies suggest that appendectomy during gynecologic procedures for chronic pelvic pain and severe endometriosis may be beneficial and necessary to fully address the treatment of these complex gynecologic conditions. In these clinical scenarios, the benefits of laparoscopic appendectomy at the time of the primary gynecologic procedure may outweigh the risks and cost, and should be discussed with patients preoperatively.
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Balogun OS, Osinowo AO, Makanjuola AA, Nwokocha SO. Stump Appendicitis due to Retained Fecalith after Laparoscopic Surgery. Niger Med J 2019; 60:92-94. [PMID: 31462849 PMCID: PMC6688392 DOI: 10.4103/nmj.nmj_39_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Stump appendicitis is a rare cause of right iliac fossa pain in patients with a previous history of appendectomy for acute appendicitis. The presentation is often delayed and may pose a clinical diagnostic challenge to the surgeon. More often, a high index of suspicion backed with relevant radiologic investigations is required for diagnosis. Open and laparoscopic appendectomy may be complicated by stump appendicitis. We report our experience in a 49-year-old Nigerian who presented to us with recurrent right iliac fossa pain and abdominal distension of 2 weeks' duration. The patient had laparoscopic appendectomy 1 year prior to presentation to us. A diagnosis of stump appendicitis with small-bowel obstruction was made with an abdominal computed tomography scan. He had an open stump appendectomy and small-bowel adhesiolysis with a good postoperative outcome.
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Affiliation(s)
- Olanrewaju Samuel Balogun
- Department of Surgery, General Surgery Unit, University of Lagos, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Adedapo O Osinowo
- Department of Surgery, General Surgery Unit, University of Lagos, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Ayomide A Makanjuola
- Department of Surgery, General Surgery Unit, University of Lagos, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Samuel O Nwokocha
- Department of Surgery, General Surgery Unit, University of Lagos, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
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Quadri R, Vasan V, Hester C, Porembka M, Fielding J. Comprehensive review of typical and atypical pathology of the appendix on CT: cases with clinical implications. Clin Imaging 2018; 53:65-77. [PMID: 30316106 DOI: 10.1016/j.clinimag.2018.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/13/2018] [Accepted: 08/22/2018] [Indexed: 12/14/2022]
Abstract
Acute appendicitis is the most common abdominal surgical emergency in the United States with approximately 250,000 cases annually. Computed Tomography (CT) has emerged as the most accurate diagnostic test to triage these patients for emergent surgery. Although the radiology search pattern is prioritized to detect an inflamed appendix, not all appearances equate to a typical surgical appendicitis. There are a select set of atypical pathologies involving the appendix that have subtle differences on CT, but can have catastrophic complications if treated with emergent appendectomy. This paper will review the spectrum of CT appearances and clinical management for typical and atypical appendiceal pathologies.
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Affiliation(s)
- Rehan Quadri
- University of Texas Southwestern Department of Radiology, United States of America.
| | - Vasantha Vasan
- University of Texas Southwestern Department of Radiology, United States of America
| | - Caitlin Hester
- University of Texas Southwestern Department of Surgery, United States of America
| | - Matthew Porembka
- University of Texas Southwestern Department of Surgery, United States of America
| | - Julia Fielding
- University of Texas Southwestern Department of Radiology, United States of America
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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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Essenmacher AC, Nash E, Walker SK, Pitcher GJ, Buresh CT, Sato TS. Stump Appendicitis. Clin Pract Cases Emerg Med 2018; 2:211-214. [PMID: 30083635 PMCID: PMC6075480 DOI: 10.5811/cpcem.2018.3.37730] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/26/2018] [Accepted: 03/28/2018] [Indexed: 11/11/2022] Open
Abstract
Abdominal pain is a frequent problem encountered in the emergency department, and acute appendicitis is a well-recognized diagnosis. Laparoscopic appendectomy has become one of the most common surgical procedures in the United States. Patients with a history of appendectomy may experience recurrent right lower quadrant abdominal pain from an infrequently encountered complication that may occur when the residual appendix becomes obstructed and inflamed. We describe two cases of stump appendicitis in pediatric patients with a review of clinical and imaging findings and surgical management.
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Affiliation(s)
- Alex C Essenmacher
- University of Iowa Hospitals and Clinics, Department of Radiology, Iowa City, Iowa
| | - Emma Nash
- University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa City, Iowa
| | - Sarah K Walker
- University of Iowa Hospitals and Clinics, Department of Surgery, Division of Pediatric Surgery, Iowa City, Iowa
| | - Graeme J Pitcher
- University of Iowa Hospitals and Clinics, Department of Surgery, Division of Pediatric Surgery, Iowa City, Iowa
| | - Christopher T Buresh
- University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa City, Iowa
| | - T Shawn Sato
- University of Iowa Hospitals and Clinics, Department of Radiology, Iowa City, Iowa
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Giudici F, Scaringi S, Zambonin D, Voglino C, Messerini L, Ficari F, Bechi P. Poor pathogenetic role of luminal obstruction in the development of appendicitis: A case report. Medicine (Baltimore) 2018; 97:e0381. [PMID: 29642194 PMCID: PMC5908613 DOI: 10.1097/md.0000000000010381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE In developed countries, the incidence of acute appendicitis is about 95 cases out of 100,000 per year, being one of the most common urgencies in general surgery worldwide. However, its pathogenesis is still poorly understood. Direct luminal obstruction (by a fecalith, lymphoid hyperplasia, or impacted stool) is reported to be the primary and principal cause of acute appendicitis. PATIENT CONCERNS During October 2016 a 58-year-old woman was operated because of a clinical recurrence of Crohn's disease. At surgery, performed through single incision laparoscopy, we observed an exceptional finding. DIAGNOSES Despite a previous ileo-cecal resection, the appendix was still present and vascularized by small vessels within the mesoappendix connected to the neo-terminal ileum mesentery; it was about 5 cm long and macroscopically not inflamed even if its base was clearly no longer connected with the cecum. OUTCOMES The patient underwent ileo-colic resection with en-bloc removal of the appendix. With a narrow metallic stylet probe we carefully tried to enter the appendix lumen through the opposite side from its fundus but we were not able to enter it before cutting the wall with scissors. Pathological examination confirmed the Crohn's disease recurrence affecting the small bowel and the appendix lumen obstructed in the presence of a fecalith but without any sign of inflammation. LESSONS This finding seems to highlight the poor pathogenetic role of luminal obstruction in the development of acute appendicitis.
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Affiliation(s)
| | | | | | | | - Luca Messerini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Paolo Bechi
- Department of Surgery and Translational Medicine, Surgical Unit
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Giwa A, Reyes M. Three times a charm… a case of repeat appendicitis status post two prior appendectomies. Am J Emerg Med 2017; 36:528.e1-528.e2. [PMID: 29269161 DOI: 10.1016/j.ajem.2017.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/08/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Appendicitis is defined as the bacterial proliferation and inflammation of the vermiform appendix, typically caused by a fecalith . There have been a few cases reported in the literature of recurrent appendicitis status post an appendectomy, however there has been no reported case of a recurrence status post two prior appendectomies. We would like to present the first case of recurrent appendicitis status post two prior appendectomies. CASE REPORT A 32year old otherwise healthy male presented to the ER on 8/27 with right lower quadrant pain and no other symptoms. His initial triage vital signs were within normal limits. Of note patient had an appendectomy on 8/15/17 and a repeat appendectomy on 8/22/17 for recurrent appendicitis. Other than the RLQ abdominal pain, the patient's review of systems and physical examination were unremarkable. Patient's WBC was 7.5 and lactate was 1.4. A CT of the abdomen/pelvis showed a 1.3cm inflamed appendix. Patient was admitted to the Surgery service on IVF and IV antibiotics. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Appendicitis should continue to be on an emergency physician's differential for a patient with RLQ pain even when the patient has had a prior appendectomy. Appropriate management in the ER can lead to improved treatment, timely surgical consultations and decreased complications.
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Affiliation(s)
- Al Giwa
- Hackensack University Medical Center, Emergency Trauma Center, Hackensack, NJ, USA.
| | - Miguel Reyes
- Hackensack University Medical Center, Emergency Trauma Center, Hackensack, NJ, USA
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22
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Nadeem K, Jacob MO, Jacob O. Out of sight, out of mind: perforated distal stump appendicitis. ANZ J Surg 2017; 89:E210-E211. [PMID: 29130557 DOI: 10.1111/ans.14244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/12/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Khadijah Nadeem
- Department of Surgery, Alice Springs Hospital; Flinders University, Darwin, Northern Territory, Australia
| | - Mathew O Jacob
- Department of Surgery, Alice Springs Hospital; Flinders University, Darwin, Northern Territory, Australia
| | - Ollapallil Jacob
- Department of Surgery, Alice Springs Hospital; Flinders University, Darwin, Northern Territory, Australia
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23
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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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24
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Shah T, Gupta RK, Karkee RJ, Agarwal CS. Recurrent pain abdomen following appendectomy: Stump Appendicitis, a surgeon's dilemma. Clin Case Rep 2017; 5:215-217. [PMID: 28265375 PMCID: PMC5331228 DOI: 10.1002/ccr3.781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 12/20/2016] [Accepted: 11/25/2016] [Indexed: 11/10/2022] Open
Abstract
Although there are many causes of pain right lower abdomen, stump appendicitis should always strike a clinician in postappendectomy patients even if it is a rare diagnosis. Here, we are discussing a 35‐year female with stump appendicitis who underwent completion appendectomy.
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Affiliation(s)
- Tuhin Shah
- Department of Surgery BPKIHS Dharan Nepal
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25
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Ramírez AG, Fierro F, Holguín DA, Méndez M. Stump appendicitis in a 2 year-old patient. Case report and literature review. CASE REPORTS 2017. [DOI: 10.15446/cr.v3n1.59469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
La apendicitis del muñón es una causa poco común de abdomen agudo quirúrgico en niños, razón por la cual su diagnóstico no se sospecha con frecuencia. Este artículo reporta el caso de un paciente de dos años admitido en el servicio de urgencias por vómito, dolor abdominal y fiebre.Al ingreso, el paciente presentaba taquicardia, taquipnea, distensión abdominal y dolor difuso a la palpación del abdomen; los laboratorios evidenciaban leucocitosis, trombocitosis y elevación de la PCR. Inicialmente, se consideró obstrucción intestinal con base en antecedentes de peritonitis secundaria a una apendicitis perforada; sin embargo, debido al deterioro hemodinámico y al aumento del dolor abdominal, fue llevado a laparotomía exploratoria de urgencia.Durante el procedimiento se encontró peritonitis generalizada con apendicitis de la base, perforación intestinal, múltiples adherencias y, de forma incidental, un divertículo de Meckel. Se realizaron las intervenciones quirúrgicas correspondientes, y por su grave estado, fue hospitalizado en la unidad de cuidados intensivos (UCI), en donde recibió tratamiento con antibiótico de amplio espectro por 14 días y varios lavados peritoneales; por último, el paciente fue dado de alta satisfactoriamente.Aunque la apendicitis del muñón no es una causa frecuente de abdomen agudo, es necesario considerarla en aquellos pacientes con antecedentes de apendicitis y que ingresan por dolor abdominal, ya que la demora en el tratamiento se asocia con mayor morbilidad y aumento en los costos de atención.
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26
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Maffi M, Lima M. Acute Appendicitis. PEDIATRIC DIGESTIVE SURGERY 2017:279-290. [DOI: 10.1007/978-3-319-40525-4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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27
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Hendahewa R, Shekhar A, Ratnayake S. The dilemma of stump appendicitis - A case report and literature review. Int J Surg Case Rep 2015; 14:101-3. [PMID: 26255005 PMCID: PMC4573603 DOI: 10.1016/j.ijscr.2015.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/19/2015] [Accepted: 07/19/2015] [Indexed: 01/07/2023] Open
Abstract
Stump appendicitis is a rare presentation and therefore presents as a diagnostic dilemma. A PubMed search was conducted to identify cases of stump appendicitis following appendectomy. We report a case of a 72 year old female who presents 7 years post appendectomy with stump appendicitis. Systematic review of 61 cases were analyzed and outcomes highlighted.
Introduction Stump appendicitis is one of the rare delayed complications post appendectomy with a reported incidence of 1 in 50,000 cases. Stump appendicitis can present as a diagnostic dilemma if the treating clinician is unfamiliar with this rare clinical entity. A PubMed search was conducted to identify cases of stump appendicitis following appendectomy. Sixty one cases of SA that were reported in English medical literature were analyzed. Presentation of case We report a case of stump appendicitis (SA) with a systematic review and challenges encountered during the management. Discussion The interval from original appendectomy to stump appendicitis ranged from 4 days to 50 years. SA followed appendectomy in 58% of open and 31.6% of laparoscopic procedures. SA was frequently misdiagnosed as constipation, gastroenteritis or right sided diverticulitis, therefore leading to a significant delay to surgery. Computerized Tomography diagnosed SA in 56.3% of cases. Perforation with gangrene of the stump occurred in 60%. Conclusion Stump appendicitis can represent a diagnostic dilemma if the treating physician is unfamiliar with this uncommon clinical entity. Radiological imaging is required to aid diagnosis and a completion appendectomy is the modality of treatment.
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Affiliation(s)
- Rasika Hendahewa
- Caboolture Hospital, McKean Street, 4510 Caboolture, QLD, Australia
| | - Ashvini Shekhar
- Caboolture Hospital, McKean Street, 4510 Caboolture, QLD, Australia.
| | - Sujith Ratnayake
- Caboolture Hospital, McKean Street, 4510 Caboolture, QLD, Australia
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29
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Drahush NM, Dowden JE, Maxwell RA. Stump Appendicitis after Remote Appendectomy. Am Surg 2015. [DOI: 10.1177/000313481508100405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nicholas M. Drahush
- Department of Surgery University of Tennessee College of Medicine, Chattanooga Chattanooga, Tennessee
| | - Jacob E. Dowden
- Department of Surgery University of Tennessee College of Medicine, Chattanooga Chattanooga, Tennessee
| | - Robert A. Maxwell
- Department of Surgery University of Tennessee College of Medicine, Chattanooga Chattanooga, Tennessee
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30
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Recurrent (stump) appendicitis: a case series. Am J Emerg Med 2015; 33:480.e1-2. [PMID: 25227975 DOI: 10.1016/j.ajem.2014.08.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/21/2014] [Indexed: 12/29/2022] Open
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31
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Martínez Chamorro E, Merina Castilla A, Muñoz Fraile B, Koren Fernández L, Borruel Nacenta S. Stump appendicitis: preoperative imaging findings in four cases. ACTA ACUST UNITED AC 2014; 38:1214-9. [PMID: 23784550 DOI: 10.1007/s00261-013-0008-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Appendiceal stump appendicitis is a rare entity caused by inflammation of the appendiceal remnant after incomplete appendectomy. We describe four patients with inflammations of the appendiceal stump, which were preoperatively diagnosed using ultrasonography and/or multidetector computed tomography. Stump appendicitis is a complication that should be taken into consideration when patients with a history of appendectomy present with right lower quadrant pain. Imaging techniques play a key role in the diagnosis.
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Affiliation(s)
- Elena Martínez Chamorro
- Emergency Radiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n, Madrid, 28041, Spain,
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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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33
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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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34
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Kim DJ, Park SW, Choi SH, Lee JH, You KW, Lee GS, Moon HC, Hong GY. A case of endoscopic removal of a giant appendicolith combined with stump appendicitis. Clin Endosc 2014; 47:112-4. [PMID: 24570893 PMCID: PMC3928483 DOI: 10.5946/ce.2014.47.1.112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 06/09/2013] [Accepted: 07/18/2013] [Indexed: 11/24/2022] Open
Abstract
Stump appendicitis is an acute inflammation of the residual appendix and is a rare complication after appendectomy. The physician should be aware of the possibility of stump appendicitis in patients with right lower abdominal pain after appendectomy so that delayed diagnosis and treatment can be prevented. Stump appendicitis is usually treated by surgical resection, and endoscopic treatment has not been reported previously. A 48-year-old man who had undergone appendectomy 35 years earlier presented to the hospital because of right lower quadrant discomfort. A computed tomography scan showed a large stone in the residual appendix. Colonoscopic findings revealed a large, smooth, protruding lesion at the cecum with a stone inside the appendiceal orifice. Endoscopic removal after incision of the appendiceal orifice was performed successfully.
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Affiliation(s)
- Du Jin Kim
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Sang Wook Park
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Seung Ho Choi
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Jong Hoon Lee
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Kyoung Wan You
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Geum Soo Lee
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Hyeung Cheol Moon
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Gun Young Hong
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
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35
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Minilaparoscopic appendectomy using a new spiral needle. Surg Endosc 2014; 28:2086-9. [PMID: 24515261 DOI: 10.1007/s00464-014-3436-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/09/2014] [Indexed: 12/14/2022]
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36
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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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Abstract
When an emergency medicine physician evaluates a child with abdominal pain and a history of appendectomy, appendicitis is often excluded from the differential. We present a case of a 16-year-old boy who developed stump appendicitis 3 years after laparoscopic appendectomy. Knowledge of this rare phenomenon in children can lead to timely diagnosis and avoid the significant additional morbidity associated with perforation of the stump.
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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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Affiliation(s)
- Y-L Chen
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Kanona H, Al Samaraee A, Nice C, Bhattacharya V. Stump appendicitis: a review. Int J Surg 2012; 10:425-8. [PMID: 22846617 DOI: 10.1016/j.ijsu.2012.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 07/14/2012] [Accepted: 07/15/2012] [Indexed: 12/11/2022]
Abstract
Acute appendicitis is perhaps the commonest cause of acute abdomen and surgical intervention in the form of open or laparoscopic appendicectomy. Stump appendicitis is an uncommon late complication of appendicectomy; where inflammation occurs in the remaining appendicular stump. Delayed diagnosis of this condition may result in serious complications. This literature review has looked into the clinical presentation, diagnosis and treatment of Stump appendicitis.
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Affiliation(s)
- Hala Kanona
- City General Hospital, Stoke-on-Trent, Staffordshire ST4 6QG, UK
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Leff DR, Sait MR, Hanief M, Salakianathan S, Darzi AW, Vashisht R. Inflammation of the residual appendix stump: a systematic review. Colorectal Dis 2012; 14:282-93. [PMID: 21054746 DOI: 10.1111/j.1463-1318.2010.02487.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM A systematic review of the literature was undertaken to examine reported cases of stump appendicitis (SA) to determine the relationship between SA and the original operative strategy (open vs laparoscopic), and to evaluate the clinical features and diagnosis. METHOD A Pub-med search was conducted to identify cases of appendicitis of a residual stump following appendicectomy. Two original cases of SA following laparoscopic appendicectomy treated in our own hospitals are also included in the analysis. Sixty cases of SA reported in the English medical literature were analysed. RESULTS The interval from the original appendicectomy ranged from 4 days to 50 years. SA followed appendicectomy in 58% of open and 31.6% of laparoscopic procedures. SA was frequently misdiagnosed as constipation or gastroenteritis, with a significant delay to surgery. Computerized tomography diagnosed SA in 46.6% of cases. Perforation with gangrene of the stump occurred in 40%. CONCLUSION Stump appendicitis is rare. It may complicate open or laparoscopic appendicectomy. A high level of suspicion should be maintained in any patient with right sided abdominal pain and a history of prior appendicectomy.
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Affiliation(s)
- D R Leff
- Department of BioSurgery and Surgical Technology, Imperial College London, London, UK
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Subramanian A, Liang MK. A 60-year literature review of stump appendicitis: the need for a critical view. Am J Surg 2011; 203:503-7. [PMID: 22153086 DOI: 10.1016/j.amjsurg.2011.04.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 04/04/2011] [Accepted: 04/11/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stump appendicitis is an underreported and poorly defined condition. It is the development of obstruction and inflammation of the residual appendix after appendectomy. This is a review of the basic clinical, pathological, and surgical significance of stump appendicitis, and the "critical view" required for prevention. DATA SOURCES PubMed MEDLINE search was performed using terms "stump appendicitis" and "retained appendix" to obtain reported cases of stump appendicitis. Sixty-one cases were identified. Each case was charted based on 14 variables. Data were analyzed. CONCLUSIONS Stump appendicitis warrants early detection. Patients can present with abdominal pain, nausea, and vomiting. A prior history of appendectomy can delay the diagnosis. A diagnosis can be made with an abdominal ultrasound or computed tomography scan. If treated early, laparoscopic or open completion appendectomy can be performed. If diagnosis is delayed and perforation is found, extensive resection is often required. A "critical view," as described in this article, is key for prevention.
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Affiliation(s)
- Anuradha Subramanian
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Michael E. DeBakey Veterans' Affairs Medical Center, Houston, TX 77030, USA
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Liu K, Fogg L. Use of antibiotics alone for treatment of uncomplicated acute appendicitis: a systematic review and meta-analysis. Surgery 2011; 150:673-83. [PMID: 22000179 DOI: 10.1016/j.surg.2011.08.018] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 08/18/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND The use of antibiotics alone in the treatment of uncomplicated acute appendicitis has been controversial. The present report is based on a systematic review and meta-analysis of existing studies that compared antibiotics treatment to appendectomy in patients with uncomplicated acute appendicitis. METHODS A Medline search was performed for studies published between 1970 and 2009. Studies were selected based on specific inclusion and exclusion criteria. Six reports comprised of 1,201 patients were analyzed. RESULTS In patients treated with antibiotics alone, 6.9 ± 4.4% failed to respond and required appendectomy, and acute appendicitis recurred in 14.2 ± 10.6%. One appendectomy patient had a recurrence. A normal appendix was found in 7.3 ± 5.1% of patients at appendectomy. Complications were considerably less likely to occur with antibiotic treatment than with appendectomy. Major surgical complications included enterocutaneous fistula and reoperation. CONCLUSION In some cases, antibiotic treatment may fail, and there is a risk of recurrence. However, surgically treated patients, including those with the potential for spontaneous resolution and those with a normal appendix, are subjected to the risks of operative morbidity and mortality. Antibiotic therapy incurs significantly fewer complications. Prospective randomized studies are urgently needed to conclusively define the roles of appendectomy and antibiotic treatment in the management of uncomplicated acute appendicitis.
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Affiliation(s)
- Katherine Liu
- Department of General Surgery, Rush University Medical Center, Chicago, IL 60612, USA.
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Affiliation(s)
- Mazen Al-Mansour
- Department of Surgery University of New Mexico School of Medicine Albuquerque, New Mexico
| | - Libby Watch
- Department of Surgery University of New Mexico School of Medicine Albuquerque, New Mexico
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Vettoretto N, Gobbi S, Corradi A, Belli F, Piccolo D, Pernazza G, Mannino L. Consensus conference on laparoscopic appendectomy: development of guidelines. Colorectal Dis 2011; 13:748-54. [PMID: 21651696 DOI: 10.1111/j.1463-1318.2011.02557.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Laparoscopic appendectomy (LA) is not yet unanimously considered the gold standard treatment for appendicitis, despite the increasing use of advanced laparoscopic operations and the high incidence of the disease. METHOD Due to the results of an audit which classified LA as widespread in Italy, a Consensus Conference was organized, in order to give evidence-based answers to the most debated problems regarding the operation. After researching the literature, a panel of 20 experts were selected and interviewed on hot topics; a subsequent discussion using the Delphi methodology was utilized in the course of the consensus conference and submitted to the evaluation of an audience of surgeons. RESULTS Checkpoint statements were formulated whenever an agreement was reached. A level of evidence was then assigned to single statements and the process revised by two external reviewers. CONCLUSION Consensus development guidelines are herein reported and regard diagnostic pathway, diagnostic laparoscopy, indications, behaviour in case of innocent appendix, technical aspects, learning curve; however, some questions remain unsolved due to the lack of evidence.
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Affiliation(s)
- N Vettoretto
- Laparoscopic Surgery Unit, M Mellini Hospital, Chiari, Italy.
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47
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Current analysis of endoloops in appendiceal stump closure. Surg Endosc 2010; 25:124-9. [PMID: 20552371 DOI: 10.1007/s00464-010-1144-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 05/11/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND An inadequate closure of the appendix stump leads to intra-abdominal surgical site infection. The effectiveness of various appendiceal stump closure methods, for instance, staplers or endoloops, was evaluated. Many analyses show that the use of a stapler for transection and closure of the appendiceal stump lowers the risk of this infection but a statistically significant risk of postoperative intra-abdominal abscess or wound infection was not considered in any randomized study. The aim of this study was to evaluate the complications after using endoloops in a high-volume center. METHODS The data of 1,790 patients who underwent laparoscopic appendectomy between January 1998 and December 2006 and a single center was prospectively acquired. The standard procedure used was an appendiceal stump closure using endoloops and a selective use of staplers. The outcome criteria for inclusion in the study were intra-abdominal abscess formations, other specific intraoperative and postoperative complications, and the different costs of the operation. RESULTS Laparoscopic appendectomy was performed in 1,790 (80.8%) patients and open appendectomy in 425 (19.2%) patients. Conversion to open surgery occurred in 74 (4.13%) patients. Laparoscopic appendectomy with stump closure using endoloops was performed in 1,670 (97.3%) patients and stump closure using a stapler in 46 (2.7%) patients. Among 851 patients with acute appendicitis, 284 patients with perforated appendicitis, and 535 patients with other or no pathology, the rate of intra-abdominal abscess after using an endoloop or a stapler was not significantly different (1.5 vs. 0%, p = 0.587; 3.5 vs. 4.2%, p = 0.870; 0.7% vs. 0, p = 0.881, respectively). There were no significant differences between the endoloop group and the stapler group with respect to the other specific intraoperative and postoperative complications. CONCLUSION This study shows the safety of the endoloop for clinical daily routine. A selective procedure for stump closure has been established. Appendiceal stump closure using an endoloop is an easy, safe, and cost-effective procedure.
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Jayamanne H, Evans MD, Stephenson BM. Open or laparoscopic appendicectomy? A response. Colorectal Dis 2010; 12:154-5. [PMID: 19832876 DOI: 10.1111/j.1463-1318.2009.02065.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Case report of recurrent acute appendicitis in a residual tip. CASES JOURNAL 2010; 3:14. [PMID: 20157645 PMCID: PMC2821303 DOI: 10.1186/1757-1626-3-14] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 01/09/2010] [Indexed: 12/20/2022]
Abstract
Introduction Residual appendicitis involving the stump of the appendix has been well described in the literature in the past. Case report We report the case of a 43 year old male with acute onset of abdominal pain who had undergone an appendicectomy ten years previously. Ultrasound revealed the presence of an inflamed tubular structure. Subsequent laparotomy and histology confirmed that this structure was an inflamed residual appendiceal tip. Conclusion Residual tip appendicitis has not been reported in the literature previously and should be considered in the differential diagnosis of localised peritonitis in a patient with a history of a previous open appendicectomy.
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Patel RP, Kan JH. Stump appendicitis. Pediatr Radiol 2009; 39:306. [PMID: 19002452 DOI: 10.1007/s00247-008-1045-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 10/01/2008] [Accepted: 10/10/2008] [Indexed: 11/30/2022]
Affiliation(s)
- Rina P Patel
- Vanderbilt University School of Medicine, 1211 Medical Center Drive, Nashville, TN, 37232, USA.
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