Stump appendicitis – A rare case report

Abstract

Acute appendicitis is perhaps the commonest cause of acute abdomen and the most common operation performed worldwide is appendicectomy. Stump appendicitis is interval re-inflammation of remnant appendix due to incomplete removal of the appendix. Stump appendicitis is rare, only 61 cases were reported in the literature between 1945 and 2005,1 however, it is under recognised and has been estimated to occur in 1:50,000 appendicectomy patients.2 We present the case of a 66-year-old woman with a history of appendicitis with acute perforation treated with appendicectomy who represented 3 years later with the symptoms of an acute abdomen. She did not improve with conservative management and a limited right hemicolectomy was performed. Gross examination showed extensive purulent exudates around the caecum and H&E stained sections from the appendiceal stump revealed transmural inflammation with a neutrophilic abscess extending into the remnant mesoappendix with overlying fibrinous serositis. Although appendicitis is usually dismissed as a cause of an acute abdomen where there is a history of appendicectomy, it is important to be aware of stump inflammation in patients who may re-present years after their original surgery.3