Page 44 - World Journal of Laparoscopic Surgery

WJOLS

Vivek Aery et al 10.5005/jp-journals-10033-1280
CaSe RepORt

Laparoscopic Management of Stump Appendicitis

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1 Vivek Aery, Kishore V Alapati, V Pavan Kumar
2
ABSTRACT a history of open appendectomy 7 years back and was
Stump appendicitis is a rare complication reported both after symptom-free until last week. On physical examination
laparoscopic and open appendectomy. Diagnosis of the condition vitals were stable, McBurney scar was visible, and 2 × 3 cm
is usually delayed because of previous history of appendectomy inflammation and tender swelling was visible lateral to
and adequate clinical vigilance on part of treating surgeon is scar with positive fluctuation and no mass palpable. Labs
required. It results from incomplete appendectomy. Stump
appendicitis is inflammation of residual appendix after appen- showed Hb of 12.5 gm%, total leukocyte count 12,610,
dectomy and has reported incidence of 1 in 50,000. We report platelet 3.28 lac, and electrolytes were normal. Contrast-
a case of 20-year-old male who underwent open appendectomy enhance computed tomography (CT) of abdomen revealed
7 years back and now presented with features of abdominal wall stump appendicitis with 14 × 13 mm appendicolith at the
abscess. The patient was diagnosed with stump appendicitis and tip of appendix with localized collection of 63 × 28 mm
laparoscopic completion appendectomy was done.
Keywords: Completion appendectomy, Incomplete appendec- and external subcutaneous tracking of collection.
tomy, Stump appendicitis. The patient was planned for laparoscopic completion
How to cite this article: Aery V, Alapati KV, Kumar VP. appendectomy with abscess drainage. Operative findings
Laparoscopic Management of Stump Appendicitis. World J revealed that right colon and terminal ileum was adhered
Lap Surg 2016;9(2):92-93. to parieties and appendix stump of approximately 3 cm
Source of support: Nil was seen with faecolith at the tip adhered to right flank
Conflict of interest: None along with pus in anterior abdominal wall. Blue stapler of
60 mm was fired at the base of appendix, pus was drained
INTRODUCTION out laparoscopically, followed by small skin incision at an
external point to break loculi; internal defect was closed.
Stump appendicitis is inflammation of residual appendix Postoperatively, the patient improved symptomatically
after appendectomy and has reported incidence of 1 in and was discharged under satisfactory condition.
50,000. Stump appendicitis is a rare and underreported
entity, and a thorough review of literature revealed DISCUSSION
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87 cases reported till now. Stump appendicitis needs to
be diagnosed urgently because of increased incidence Appendectomy is one of the common surgeries per-
of complications like perforation, abscess, and sepsis formed in emergency scenario worldwide. Claudius
associated with the condition. Amyand performed first appendectomy in the year 1735,
but Rose (1945) first reported stump appendicitis as an
CASE REPORT entity in two patients who had undergone previous sur-
2
gery. Various risk factors as described in the literature
A 20-year-old male admitted with the complaint of that include a stump longer than 5 mm, severe inflam-
pain in right iliac fossa with swelling and redness since mation, location of appendix (retrocecal/subcecal), and
1 week associated with low-grade fever, no chills. The surgeon’s inexperience. In various reports, it has been
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patient was diagnosed with abdominal wall abscess and shown that incidence is following more laparoscopic
was managed with antibiotics at some hospital. After procedure as compared to open due to lack of tactile
no resolution of symptoms, the patient was referred to feedback and limited view leading to long stump left
our hospital for further management. The patient had behind in cases with inflammation. It is recommended
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to verify the base of appendix for residual length which
should be kept below 3 mm.
1,3 Registrar, Consultant
2
1,3 Department of Surgical Gastroenterology, Global Hospital Apart from stump appendicitis, another identity
Hyderabad, Telangana, India called “duplicated appendix” can confuse the surgeon.
2 Department of Colorectal Surgery, Apollo Hospitals, Hyderabad This has been reported in the literature at a frequency of
Telangana, India 0.004%. Three types of duplicated appendix have been
Corresponding Author: Vivek Aery, Registrar, Department described by Wallbridge: (1) Type A, incomplete dupli-
of Surgical Gastroenterology, Global Hospital, Hyderabad cation with both appendices having common base; (2)
Telangana, India, Phone: +919849910055, e-mail: vivekaery one of type B appendix is at usual location and another
1983@gmail.com
one anywhere along the colon, and (3) type C, complete
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