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Mohammed NA, Dukandar M. Stumped by Appendicitis: A Rare Cause of Acute Abdominal Pain. Cureus 2023; 15:e50557. [PMID: 38222226 PMCID: PMC10787942 DOI: 10.7759/cureus.50557] [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: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
Acute appendicitis is one of the most common diagnoses in the emergency department. As with other surgical procedures, post-appendectomy complications are numerous and can be either immediate or delayed. Stump appendicitis is an underreported and underrecognized complication that is often diagnosed radiologically while ruling out other diagnoses. We report a case of a 26-year-old male presenting with acute right lower quadrant abdominal pain. Although he initially denied any surgical history, a focused abdominal exam revealed an incisional scar which turned out to be the result of an appendectomy nine years ago. The patient was worked up for alternate causes of right lower quadrant pain. Investigations revealed high inflammatory markers and hematuria. We proceeded with a non-contrast CT scan to rule out vesicoureteric junction stone. Instead, the scan was suggestive of stump appendicitis. The patient was admitted and treated conservatively. Maintaining a high index of suspicion for stump appendicitis, especially in patients with a clinical picture typical of appendicitis but a history of appendectomy, is key to making an early diagnosis and avoiding further complications.
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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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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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