Bifid appendix: a case report
A 21-year-old female patient presented to the emergency department complaining of abdominal pain that started 12 hours ago. The pain started gradually as a stabbing pain around the umbilicus with eventual shift towards the right iliac fossa. She had loss of appetite and persistent nausea that was occasionally accompanied by vomiting. She denied any change in bowel habit or history of similar pain in the past. She had regular periods with no gynecological complaint. The patient was otherwise healthy with no previous past medical or surgical history.

On physical examination, the patient looked ill and tired. She had tachycardia but was afebrile. Examination of the abdomen revealed sever localized tenderness at the right iliac fossa, no guarding or rigidity. Blood tests were within normal values.

Abdominal ultrasonography was performed and revealed a distended appendix measuring 10 mm with appendicolith seen at the base and increased echogenicity surrounding fatty planes. A diagnosis of acute appendicitis was made based on the Ultrasonography findings and the patient was planned to undergo laparoscopic appendectomy. Initial diagnostic laparoscopy showed a small amount of free fluid in the abdomen and a swollen and slightly erythematous partially duplicated ‘bifid’ appendix. A traditional laparoscopic appendectomy was performed by dissecting the mesoappendix and ligating the base of the appendix. The appendix was then exteriorized and sent for histopathology which showed acute inflammation in the two lumens that were lined by appendiceal mucosa and two layers of musculature due to fecalith impaction which is consistent with true duplication of the appendix.

The post-operative course was uneventful and the patient had a full recovery without complications and was discharged on the second postoperative day.

Source: Journal of Surgical Case Reports, Volume 2019, Issue 4, April 2019, rjz132

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