Acute appendicitis in twin appendices: case report

Abstract

<p class="abstract">A double appendix is a rare congenital malformation with a frequency ranging from 0.004 to 0.009% and only a small percentage of instances presenting as appendicitis. Although the cause of appendiceal duplication is unknown, it poses a difficult clinical picture in patients with right lower quadrant pain. In this case report, we presented two cases of operative treatment of acute appendicitis in a doubled vermiform appendix in 4 and 17 years old male patients. Both cases did not have any pertinent prior medical condition and presented with shifting right lower quadrant (RLQ) abdominal pain associated with nausea, vomiting and anorexia. Clinical exam, laboratory investigations as well as imaging findings were consistent with features of acute appendicitis. In both patients, the diagnosis of the duplicated appendices was unsuspected until two tubular structures arising from the cecal wall were discovered intraoperatively and confirmed on histopathological examination after appendectomy of the two appendices was performed. Hence, in all situations where acute appendicitis is suspected clinically and radiologically, surgeons must maintain a high level of suspicion for the potential of duplicated appendices to avoid missing the duplication and resulting post-operative difficulties and medicolegal concerns.</p>