Page 48 - World Journal of Laparoscopic Surgery

CASE REPORT
An Early Presentation of Stump Appendicitis Following

Laparoscopic Appendectomy: A Rare Diegesis

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Banabihari Mishra , Jyotirmaya Nayak , Parikshita Dalai , Ashish Kumar Behera , Pratyush Kashyap Panda 5
Received on: 19 September 2022; Accepted on: 20 February 2023; Published on: 05 September 2023
AbstrAct
Laparoscopic appendectomy is now the standard surgery of choice for acute and recurrent appendicitis. Development of stump appendicitis
after 3 days of laparoscopic appendectomy is a very rare incidence.
Presenting a case report of a 19-year-old male who underwent laparoscopic appendectomy for acute appendicitis, and on postoperative
day 4, developed sudden onset of high-grade fever, pain over the right iliac fossa, vomiting, localized features of peritonitis, and raised total
leukocyte count (TLC). On contrast-enhanced computed tomography (CECT), abdomen and pelvis revealed stump appendicitis with minimal
pelvic collection. The patient underwent exploratory laparotomy, and a stump of size 1.5 cm was found with features of inflammation and
surrounding minimal adhesion. A stump appendectomy was done.
Stump appendicitis presentation immediately after appendectomy is very uncommon. Though the incidence of stump appendicitis is rare but
should be kept as a differential diagnosis in a previously operated appendectomy patient. Awareness of such cases initiates early diagnosis and
advocates proper intervention at the right time to prevent unnecessary morbidity and mortality.
Keywords: Appendectomy, Appendicitis, Case report, Laparoscopic, Stump appendicitis.
World Journal of Laparoscopic Surgery (2023): 10.5005/jp-journals-10033-1545

IntroductIon 1–5 Department of Surgery, SCB Medical College and Hospital, Cuttack,
Acute appendicitis is one of the common surgical emergencies Odisha, India
encountered, incidence being the highest in the 2nd and 3rd Corresponding Author: Jyotirmaya Nayak, Department of Surgery,
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decade of life. Laparoscopic appendectomy is the standard SCB Medical College and Hospital, Cuttack, Odisha, India, Phone:
treatment of choice now. Stump appendicitis is an uncommon +91 9438037714, e-mail: drjmnayak@gmail.com
complication post appendectomy, usually present lately and How to cite this article: Mishra B, Nayak J, Dalai P, et al. An Early
thought to be due to interval-repeated inflammation of the Presentation of Stump Appendicitis Following Laparoscopic
incompletely excised stump of the appendix (<0.5-cm stump Appendectomy: A Rare Diegesis. World J Lap Surg 2023;16(1):47–48.
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length). Only very few cases are being reported in the literature. 4 Source of support: Nil
We report a case of early presentation of stump appendicitis, Conflict of interest: None
diagnosed in the postoperative period, which is very unusual. Patient consent statement: The author(s) have obtained written
informed consent from the patient for publication of the case report
cAse descrIptIon details and related images.
A 19-year-old male presented to the Emergency Department
with pain in the right iliac fossa and fever since 2 days. Fever
subsided after taking antipyretics. On examination, the patient was tenderness in the lower abdomen with rebound tenderness in the
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febrile, tachycardic, BP – 118/82 mm Hg, the abdomen was soft, RIF and localized guarding. Total leukocyte count was 18.6 × 10 /µL.
tenderness in the right iliac fossa (RIF) was present, and rebound Contrast-enhanced computed tomography revealed inflamed
tenderness was also present. Total leukocyte count was 13.2 × appendicular stump of caliber 6 mm noted in RIF suggestive of acute
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10 /µL. Alvarado score was 6. On ultrasonography (USG), abdomen appendicular stumpitis with pelvic collection (Fig. 1). The patient did
and pelvis revealed a blind-ended tubular structure with 7 mm not improve with expectant management.
diameter, and probe tenderness was there. Compiling clinical, On postoperative day 7, he was planned for exploration with
radiological, and biochemical reports, acute appendicitis was lower midline incision. Intraoperatively, the stump of the appendix
diagnosed. The patient underwent laparoscopic appendicectomy was found, of length 1.5 cm, which was inflamed with pelvic
for the same. collection of pus (Fig. 2). After thorough toileting with warm saline,
Postoperative days 1, 2, and 3 were uneventful. stump appendectomy was done (Fig. 3), and the abdomen was
On postoperative day 4, the patient developed pain in the closed by putting an ADK drain. Postoperatively fever subsided, TLC
lower abdomen followed by high-grade fever (102.3°F), and was in the declining trend. The drain was removed after 48 hours.
multiple bouts of vomiting, despite of being on antibiotics and The postoperative period was uneventful. Histopathology showed
paracetamol infusion. On postoperative day 5, he had four episodes a remnant appendix with neutrophilic transmural infiltration. On
of watery diarrhea. Physical examination of the abdomen showed follow-up, the patient has no complaints till now.

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