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Dar DS. A Stumping Experience: An Autobiographical Case Report. Cureus 2023; 15:e45625. [PMID: 37868566 PMCID: PMC10588960 DOI: 10.7759/cureus.45625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Stump appendicitis, while being well recognized as a delayed complication following an appendectomy, is a relatively under-reported clinical entity, with an even lesser documentation frequency in the subcontinent, from where the author hails. This article recounts his brief yet consequential journey from ill-health to recovery, all the while giving an insight into a multitude of related experiences that served as learning points for the narrator. Additionally, this account of events, having been viewed through a hybrid doctor-patient lens, aspires to be a valuable addition to medical literature.
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Bašković M, Zaninović L, Čizmić A, Žganjer M. Stump appendicitis in children: a systematic review. Pediatr Surg Int 2023; 39:199. [PMID: 37188869 DOI: 10.1007/s00383-023-05475-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Stump appendicitis is a rare complication after primary appendectomy and is often not considered in the differential diagnosis of patients who have undergone an appendectomy. With this systematic review, the aim was to identify all cases of stump appendicitis in children in order to gain a better insight into the risk factors, clinical presentation, diagnostics, and treatment. METHODS Scopus and PubMed databases were searched. The search combinations used the following MeSH and free text terms: [(stump) OR (residual) OR (remaining) OR (retained) OR (recurrent)] AND (append*). Neither search filters nor text analysis tools were used. To be included, the report had to contain information about a patient between the age of 0 and 18 who was treated for stump appendicitis as a result of an inadequately performed appendectomy. RESULTS Out of the 19,976 articles, 29 of them, with a total of 34 cases, met the inclusion criteria. The mean age at the time of stump appendectomy was 13.32 ± 3.57 years, while the median time between primary and stump appendectomy was 7.5 (2.3 - 24.0) months. The ratio between boys and girls was 3.2: 1. Primary appendectomy was performed laparoscopically in a greater number of cases compared to the open approach (1.5: 1), and according to the available data, no higher proportion of complicated appendicitis was recorded during a primary appendectomy. The median duration of symptoms during stump appendicitis was 2 days, and in most cases, the pain was localized. Stump appendectomy in most cases was performed with an open approach, and in relation to the type of appendicitis, most of them were complicated. The mean value of the length of the stump was 2.79 ± 1.22 cm, and the smallest recorded length was 0.6 cm. CONCLUSIONS A non-specific clinical presentation with a history of appendectomy usually makes the diagnosis of stump appendicitis challenging for uninformed physicians, and due to untimely treatment, it usually results in complicated forms of stump appendicitis. Complete appendectomy remains the gold standard in the treatment of stump appendicitis.
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Affiliation(s)
- Marko Bašković
- Department of Pediatric Surgery, Children's Hospital Zagreb, Ulica Vjekoslava Klaića 16, Zagreb, 10000, Croatia.
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, 10000, Croatia.
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, Šalata 3, Zagreb, 10000, Croatia.
| | - Luca Zaninović
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, 10000, Croatia
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, Šalata 3, Zagreb, 10000, Croatia
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, Petrova 13, Zagreb, 10000, Croatia
| | - Ante Čizmić
- Department of Pediatric Surgery, Children's Hospital Zagreb, Ulica Vjekoslava Klaića 16, Zagreb, 10000, Croatia
| | - Mirko Žganjer
- Department of Pediatric Surgery, Children's Hospital Zagreb, Ulica Vjekoslava Klaića 16, Zagreb, 10000, Croatia
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Manatakis DK, Antonopoulou MI, Tasis N, Agalianos C, Tsouknidas I, Korkolis DP, Dervenis C. Critical View of Safety in Laparoscopic Cholecystectomy: A Systematic Review of Current Evidence and Future Perspectives. World J Surg 2023; 47:640-648. [PMID: 36474120 DOI: 10.1007/s00268-022-06842-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Critical View of Safety (CVS) has been increasingly recognised as the standard method for identification of the cystic structures, to prevent vasculobiliary injuries during laparoscopic cholecystectomy, however, its adoption has been anything but universal. A significant proportion of surgeons has a poor understanding of the three requirements. To bridge this gap between theory and practice, we aimed to summarise the available evidence on CVS, emphasising on current debates and future perspectives. METHOD We systematically reviewed the literature (1995-2021), to identify studies reporting on the CVS. Eligible articles were classified according to methodology and key idea. A quantitative analysis was performed to evaluate effectiveness of the CVS in preventing bile duct injury (BDI). RESULTS 150 relevant articles were identified, focusing on six main points, (1) safety and effectiveness, (2) intraoperative documentation, (3) complementary imaging techniques, (4) bail-out alternatives, (5) adoption among surgeons, and (6) education and training. The quantitative analysis included 11 studies, with 10,938 cases. Overall, the CVS was achieved in 92.5%. Conversion rate was 4.8%. CVS-related BDI was 0.09% (0.05% technical errors and 0.04% misidentification errors). CONCLUSION Routine application of the CVS reduces BDI, but does not eliminate them altogether. Besides operative notes, the CVS should be documented by an imaging modality of sufficient quality. When the CVS cannot be safely established, the threshold for bail-out alternatives or complementary imaging should be low. Adoption by the surgical community worldwide shows great variability and focus should be placed on training through structured educational modules.
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Affiliation(s)
- Dimitrios K Manatakis
- Department of Surgery, Athens Naval and Veterans Hospital, Deinokratous 70, 11521, Athens, Greece. .,Department of Surgical Oncology, St Savvas Cancer Hospital, Athens, Greece.
| | | | - Nikolaos Tasis
- Department of Surgery, Athens Naval and Veterans Hospital, Deinokratous 70, 11521, Athens, Greece
| | - Christos Agalianos
- Department of Surgery, Athens Naval and Veterans Hospital, Deinokratous 70, 11521, Athens, Greece
| | - Ioannis Tsouknidas
- Department of Surgery, Stony Brook University Hospital, Stony Brook, USA
| | | | - Christos Dervenis
- Department of Hepatobiliary and Pancreatic Surgery, Metropolitan Hospital, Piraeus, Greece
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Williams MD, Page N, Sullivan GA, Shah AN, Sarran MA. A Practical Guide to Stump Appendicitis. Am Surg 2022; 88:1546-1548. [PMID: 35387503 DOI: 10.1177/00031348221083937] [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)
- Michael D Williams
- Department of Surgery, 2468Rush University Medical Center, Chicago, IL, USA
| | - Niel Page
- Department of Surgery, 2468Rush University Medical Center, Chicago, IL, USA
| | - Gwyneth A Sullivan
- Department of Surgery, 2468Rush University Medical Center, Chicago, IL, USA
| | - Ami N Shah
- Department of Surgery, 2468Rush University Medical Center, Chicago, IL, USA
| | - Marc A Sarran
- Department of Surgery, 2468Rush University Medical Center, Chicago, IL, USA
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Hadrich Z, Mroua B, Zribi S, Bouassida M, Touinssi H. Stump appendicitis, a rare but serious complication of appendectomy: A case report. Clin Case Rep 2021; 9:e04871. [PMID: 34584721 PMCID: PMC8457410 DOI: 10.1002/ccr3.4871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/22/2021] [Accepted: 09/12/2021] [Indexed: 12/26/2022] Open
Abstract
Stump appendicitis is a rare delayed post-appendectomy complication. This diagnosis must be considered in case of right iliac fossa pain in a patient with a history of appendicectomy.
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Affiliation(s)
- Zied Hadrich
- Department of surgeryMohamed Taher Maamouri HospitalNabeulTunisia
- Faculty of Medicine of SfaxTunisia
| | - Bassem Mroua
- Department of surgeryMohamed Taher Maamouri HospitalNabeulTunisia
- Faculty of Medicine of TunisTunisia
| | - Slim Zribi
- Department of surgeryMohamed Taher Maamouri HospitalNabeulTunisia
- Faculty of Medicine of TunisTunisia
| | - Mehdi Bouassida
- Department of surgeryMohamed Taher Maamouri HospitalNabeulTunisia
- Faculty of Medicine of TunisTunisia
| | - Hassan Touinssi
- Department of surgeryMohamed Taher Maamouri HospitalNabeulTunisia
- Faculty of Medicine of TunisTunisia
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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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Hein M, Ng ZQ, O'Neill P, Pirasteh S, Navadgi S. A retroperitoneal cyst arising from an appendix fragment. ANZ J Surg 2021; 92:245-247. [PMID: 34008299 DOI: 10.1111/ans.16946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Martin Hein
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Zi Qin Ng
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Paul O'Neill
- PathWest Anatomical Pathology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Shadi Pirasteh
- PathWest Anatomical Pathology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Suresh Navadgi
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
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Fenwick AKC, Hartery A. Appendicitis and beyond: a pictorial review of various appendiceal abnormalities. Emerg Radiol 2021; 28:651-664. [PMID: 33517502 DOI: 10.1007/s10140-021-01908-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/20/2021] [Indexed: 12/14/2022]
Abstract
Acute appendicitis is the most common disease of the appendix. However, the differential diagnosis for an abnormal appendix includes other conditions that often present with symptoms and imaging features that overlap with acute appendicitis. In this pictorial essay, we review the normal anatomy of the appendix and outline the pathogenesis, clinical manifestations, and imaging findings that are characteristic of acute appendicitis and other less common appendiceal abnormalities. Inflammatory/non-neoplastic processes including appendiceal diverticulitis, stump appendicitis, foreign body appendicitis, Crohn's appendicitis, and appendiceal hernias are discussed. Neoplastic considerations include appendiceal neuroendocrine tumors, mucinous and non-mucinous (colonic type) epithelial neoplasms, and lymphoma. It is important for the radiologist to be able to differentiate these alternative diagnoses for the purpose of directing appropriate patient management.
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Affiliation(s)
- Andrew K C Fenwick
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Angus Hartery
- Department of Diagnostic Radiology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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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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Ferreira de Lima S, Patena Forte J, de Castro M, Morão S, Alves R. Stump appendicitis in two adolescent boys: Rare presentations and alternative approaches in pediatrics. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2019.101334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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