Stump Appendicitis after Open Appendicectomy: Judicious Surgical Approach

Abstract

Background: Incomplete appendectomy may predispose to the development of stump appendicitis. Stump appendicitis, the interval re-inflammation of the residual appendiceal tissue, is a rare complication of appendectomy. Stump appendicitis should be considered in the differential diagnosis of any patient with a previous history of appendectomy who presents with signs and symptoms of appendicitis. Case History: A 15 yr old girl, class 10 student presented with on & off right lower quadrant pain, vomiting and anorexia since 5months i.e. one week post appendicectomy surgery. Ultrasound examination revealed an inflamed residual stump with periappendicular edema. Completion open appendicectomy performed safely & patient got relieved of her symptoms fully. Conclusion: Stump appendicitis is a rare but real complication after appendectomy surgery. Diagnosis of stump appendicitis certainly requires a high clinical suspicion and one should be aware of this uncommon phenomenon. Ultrasonogram & CT scan are proven useful tools in establishing the diagnosis. Completion appendicectomy either by open/laparoscopic surgery is the standard treatment to avoid lot of morbidity. Regardless of the surgical technique used, identification of the appendiceal base by tracing the taenia coli down to the appendix is crucial in preventing such a complication.