‘Residual’ appendicitis following incomplete laparoscopic appendicectomy

Stump appendicitis: a review

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.

Inflammation of the residual appendix stump: a systematic review

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.

Stump Resections Resulting from Incomplete Operations

Stump viscera caused by an incomplete operation can present the same symptoms as before the first operation. Furthermore, as an acute clinical event, these incomplete resections may sometimes cause acute abdomen and may need emergency surgical intervention. A 34-year-old woman with a history of laparoscopic cholecystectomy 5 days before was admitted with acute abdominal symptoms. Abdominal exploration revealed that she had undergone incomplete resection of the gallbladder. Another patient, a 21-year-old man, was admitted with complaints of fluid drainage from his appendectomy incision scar. He was diagnosed as having enterocutaneous fistula. Abdominal exploration revealed a stump appendix fistulizing to the abdominal wall. The third patient was a 32-year-old man with an appendectomy scar who was admitted with complaints of acute appendicitis. The patient was diagnosed as having acute appendicitis and underwent an appendectomy. A stump appendix was removed during the operation. Surgeons should be aware of stump pathologies and keep in mind a possible incomplete operation to prevent delayed diagnosis and treatment.

Stump Appendicitis: A Comprehensive Review of Literature

Appendectomy for appendicitis is one of the most common procedures performed in the United States. Residual tissue left after an initial appendectomy risks the development of stump appendicitis. A comprehensive review of the English-language literature revealed 36 reported cases of stump appendicitis. Typically, patients present with signs and symptoms similar to acute appendicitis; however, due to prior surgery, the diagnosis is difficult and the rate of appendiceal stump perforation is extremely high. Herein, we present a case of a 32-year-old female presenting with right lower quadrant pain, nausea, and fever 5 months after laparoscopic appendectomy. Upon surgery, an appendiceal stump was discovered.

Pitfalls in the CT diagnosis of appendicitis

CT evaluation of appendicitis represents an increasingly common emergency room request. While the overall accuracy of CT is high, numerous pitfalls exist which may deceive radiologists, resulting in a missed diagnosis of appendicitis. The inflamed appendix may be unusual in its location, or may appear normal if only a small portion of the distal appendix is involved (tip appendicitis). In a patient with a history of appendectomy, inflammation of the appendiceal stump may be easily missed. Appendicitis may closely mimic small bowel obstruction, or gynaecological disease, especially after perforation has occurred. Even a misleading clinical history may lead the radiologist's eye astray. This pictorial review demonstrates these and other potential radiological pitfalls, and includes important points for the accurate diagnosis of appendicitis.

Stump appendicitis: case report and review

The purpose of this study is to review the medical literature regarding the prevalence of appendicitis in patients with previous appendectomy. Stump appendicitis is a real entity not often considered when evaluating patients with right lower quadrant pain and a history of appendectomy. This leads to delays in diagnosis and treatment. An extensive review of the world literature using Medline, MD Consult, and the references of articles found using these methods to gather information regarding stump appendicitis. Results showed 29 cases of stump appendicitis have been reported in the world literature. Herein we review the literature as well as present a case study. Stump appendicitis is a real, yet probably underreported entity. It can occur after either laparoscopic or open appendectomy. Avoidance of a long appendiceal stump is the only suggested means by which to avoid its occurrence.

Abdominal pain secondary to stump appendicitis in a child

We report a case of an 11-year-old male who presented with abdominal pain and vomiting. The patient had a notable past medical history of having had an appendectomy at our institution 1 year previously. Because of progressive clinical signs of peritonitis, an exploratory laparotomy was performed and the patient was found to have stump appendicitis. The entity of stump appendicitis is always possible when evaluating patients with abdominal pain who have a history of appendectomy.

Stump appendicitis: a case report

Residual appendicitis is a rare event that occurs when there is incomplete resection of the organ. A recent report suggested that this may be a complication of laparoscopic surgery. Following a case of stump appendicitis in a young patient, we thoroughly reviewed the literature and found that most reported cases have occurred in open appendectomy. Awareness of the existence of this uncommon condition will help in the early diagnosis and prompt treatment of this pathology.

Stump appendicitis--a potential problem after laparoscopic appendicectomy

Appendicitis is now commonly diagnosed and treated using laparoscopic techniques. Laparoscopic appendicectomy has the potential to result in incomplete removal of the appendix stump and subsequent risk of stump appendicitis. This article reports such a case, requiring laparotomy 5 months after the original appendectomy.