Stump Appendicitis, A Surgeon's Dilemma
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
A 35‐year female presented to the hospital with recurrent pain in right lower abdomen for 4 months which had increased in intensity in the last 24 h. She used to have on and off passage of altered blood in stool during previous attacks of pain but absent on this presentation. She had undergone open appendectomy four‐and‐half months back at another hospital.

Physical examination revealed a tender mass in right iliac fossa of 3 × 2 cm2 without evidence of guarding, rebound tenderness, or other peritoneal signs. Routine laboratory studies were remarkable for a WBC count of 10,000/mm3 with 88% neutrophils.

An ultrasound of the abdomen and pelvis was performed which showed invagination of one bowel loop into another bowel loop with characteristic target sign which suggested the preoperative diagnosis of ileocolic intussusception. Exploratory laparotomy with a lower midline incision was performed under general anesthesia.

The operative findings were adhered inflamed omentum forming a lump over the ileocecal junction with inflamed surrounding mesentery and acutely inflamed stump of appendix (~2 cm). Rest of the bowel was normal. completion appendectomy was performed and the postoperative period was uneventful, and on postoperative day 4, the patient was discharged. Her histopathological report showed acutely inflamed appendix, and she is asymptomatic till date.

Key Points:-
1. in this patient, stump appendicitis was an intraoperative diagnosis. Surgeons were misled by the previous history of appendectomy and USG finding of intussusception at this presentation.
2. Stump appendicitis is associated with late diagnosis and therefore has higher rate of perforation with increased morbidity 7. The factors leading to stump appendicitis can be either anatomical or surgical. Anatomically, it can be retrocecal in position posing difficulty.
3. The clinical presentation of stump appendicitis is similar to that of acute appendicitis,
4. It is defined as a rare complication following appendectomy caused by inflammation of the residual portion of the appendix left behind.

Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.781
m●●●●i d●●●●n and 16 others like this8 shares
Like
Comment
Share
Dr. S●●●●●●●●●●a R●o P●●●●●●●●●●i
Dr. S●●●●●●●●●●a R●o P●●●●●●●●●●i Homeopathic Medicine
Rare case
Oct 11, 2019Like