Incomplete Appendectomy Research Articles

Stump Appendicitis with Diagnostic Dilemma: A Case Report

Stump appendicitis is a rare delayed complication of incomplete appendectomy. The clinical symptoms and signs are like acute appendicitis. The possibility of stump appendicitis is not clear to all clinicians. It represents a diagnostic dilemma with incidence of one in 50,000 cases. We report how we encountered diagnostic dilemma during the management of a 30 years old male patient of acute abdomen with history of appendectomy done for acute appendicitis even years back.

Stump appendicitis in two adolescent boys: Rare presentations and alternative approaches in pediatrics

Abstract Stump appendicitis is a rare complication that results from reinflammation of the residual part of the appendix, after incomplete appendectomy. Factors that may contribute to inadequate identification of appendicular base are subserosal or retrocecal position, extensive inflammation or inadequate surgical exposure. The length of the appendiceal stump after ligation is likely a major predisposing factor. The presentation of stump appendicitis is similar to acute appendicitis, but this diagnosis is often dismissed because of the surgical history. Computed tomography and ultrasonography are the imaging modalities of choice. The usual recommended treatment for stump appendicitis is completion appendectomy. Stump appendicitis must be considered in the differential diagnosis of acute abdomen despite the patient's appendectomy history. A delayed diagnosis may lead to an increase in morbidity. We present two cases of stump appendicitis in adolescents after laparoscopic appendectomies, one being a case of recurrent stump appendicitis. We report two alternative therapeutic approaches: interval appendectomy and non-operative management. We conclude that these alternative approaches may be suitable for some patients with stump appendicitis. A review of the pertinent literature was done.

Laparoscopic Management of Stump Appendicitis

Stump appendicitis is a rare complication reported both after laparoscopic and open appendectomy. Diagnosis of the condition is usually delayed because of previous history of appendectomy and adequate clinical vigilance on part of treating surgeon is required. It results from incomplete appendectomy. Stump appendicitis is inflammation of residual appendix after appen dectomy and has reported incidence of 1 in 50,000. We report a case of 20-year-old male who underwent open appendectomy 7 years back and now presented with features of abdominal wall abscess. The patient was diagnosed with stump appendicitis and laparoscopic completion appendectomy was done.

Laparoscopic Surgery or Conservative Treatment for Appendiceal Abscess in Adults? A Randomized Controlled Trial.

We hypothesized that immediate laparoscopic surgery for appendiceal abscess would result in faster recovery than conservative treatment. On the basis of the retrospective studies, conservative management of appendiceal abscess is recommended as a first line treatment, but some controversy exists. Sixty adult patients diagnosed with appendiceal abscess were randomly assigned to either laparoscopic surgery (n = 30) or conservative treatment (n = 30). Hospital stay, recurrences, additional interventions, and complications within 60 days from randomization were recorded. There was no difference in hospital stay: 4 days (interquartile range: 3-5 days) in the laparoscopy group versus 5 days (3-8) in the conservative group, P = 0.105. Patients in the laparoscopy group had 10% risk for bowel resection and 13% risk for incomplete appendectomy. There were significantly fewer patients with unplanned readmissions in the laparoscopy group: 1 (3%) versus 8 (27%), P = 0.026. Additional interventions were required in 2 (7%) patients in the laparoscopy group (percutaneous drainage) and in 9 (30%) patients in the conservative group (surgery), P = 0.042. Recurrent abscesses and failure to respond to conservative treatment were the main reasons for additional interventions. Open surgery was required in 3 (10%) patients in the laparoscopy group and in 4 (13%) patients in the conservative group. Postoperative complications occurred in 3 patients in laparoscopic group versus 2 patients in the conservative group. The rate of uneventful recovery was 90% in the laparoscopy group versus 50% in the conservative group, P = 0.002. Laparoscopic surgery in experienced hands is safe and feasible first-line treatment for appendiceal abscess. It is associated with fewer readmissions and fewer additional interventions than conservative treatment with comparable hospital stay.

Stump appendicitis: surgical background, CT appearance, and imaging mimics.

Stump appendicitis, also known as remnant appendicitis, is an uncommon entity with little radiologic literature. It is the result of unintentional incomplete appendectomy with subsequent inflammatory changes in the appendiceal remnant. A retrospective review of the radiology and pathology archives at our institution over an 8-year period yielded six surgically/pathologically confirmed cases. Imaging findings at presentation were evaluated, including appendiceal stump length, appendiceal stump diameter, presence or absence of surrounding stranding in the periappendiceal fat, and presence or absence of complication (perforation or abscess). The CT findings of the six cases had an average surgical specimen appendiceal stump length of 3.5 cm (range 2.0-5 cm) and an average appendiceal diameter of 12.3 mm (range 10-16 mm). All six cases demonstrated the presence of periappendiceal inflammatory fat stranding on the CT scan. Range of imaging presentation is reviewed with pictorial examples as well as examples of potential false-positive cases (mimics) including Crohn's disease, residual surgical drain tract, and epiploic appendagitis. Familiarity with stump appendicitis as well as its imaging mimics may lead to earlier diagnosis and treatment and prevent unnecessary complications.

Stump appendicitis: preoperative imaging findings in four cases

Appendiceal stump appendicitis is a rare entity caused by inflammation of the appendiceal remnant after incomplete appendectomy. We describe four patients with inflammations of the appendiceal stump, which were preoperatively diagnosed using ultrasonography and/or multidetector computed tomography. Stump appendicitis is a complication that should be taken into consideration when patients with a history of appendectomy present with right lower quadrant pain. Imaging techniques play a key role in the diagnosis.

Stump appendicitis and chorioamnionitis due to incomplete appendectomy: A case report

Acute appendicitis represents the most common non-obstetric indication for surgical intervention in pregnant women, with a reported incidence of 1 in 1440 pregnancies. Stump appendicitis is a rare clinical situation when there is incomplete appendectomy. A rare case occurred of stump appendicitis and chorioamnionitis complicating after incomplete appendectomy. In this way the literature review suggests that only a few cases have been reported so far. We report a case of stump appendicitis and chorioamnionitis occurring three weeks after an appendectomy performed in another medical center. This will involve the discussion of clinical presentation, diagnosis, surgical management and literature review.

Stump appendicitis in children

Stump appendicitis is a delayed complication of incomplete appendectomy. Reinflammation of possible residual appendiceal tissue should be considered in patients with right lower quadrant pain and a surgical history of appendectomy. In this report, we present 3 cases of stump appendicitis in children.

Retention mucocele of distal viable remnant tip of appendix: An unusually rare late surgical complication following incomplete appendectomy

A 67-year old man was presented with a 6-mo history of recurrent right lower quadrant abdominal pain. On physical examination, a vague mass was palpable in the right lumbar region. His routine laboratory tests were normal. Ultrasonography showed a hypoechoic lesion in the right lumbar region anterior to the right kidney with internal echoes and fluid components. Abdominal contrast-enhanced computed tomography (CECT) showed a well-defined hypodense cystic mass lesion lateral to the ascending colon/caecum, not communicating with the lumen of colon/caecum. After complete open excision of the cystic mass lesion, gross pathologic examination revealed a turgid cystic dilatation of appendiceal remnant filled with the mucinous material. On histopathological examination, mucinous cyst adenoma of appendix was confirmed. We report this rare unusual late complication of mucocele formation in the distal viable appendiceal remnant, which was leftover following incomplete retrograde appendectomy. This unusual complication is not described in the literature and we report it in order to highlight the fact that a high index of clinical and radiological suspicion is essential for the diagnosis of mucocele arising from a distal viable appendiceal remnant in a patient who has already undergone appendectomy presenting with recurrent abdominal pain.

Stump appendicitis and generalized peritonitis due to incomplete appendectomy

Stump appendicitis is a rare clinical situation when there is incomplete appendectomy. A wide spectrum of diseases in the differential diagnosis of right lower quadrant pain of the abdomen and presence of appendectomy operation in a patient's history delay the diagnosis. We report such a case of perforated stump appendicitis and generalized peritonitis occurring eight months after appendectomy.

Residual Appendicitis Following Incomplete Laparoscopic Appendectomy

Growing popularity of laparoscopic interventions must bring along a thorough knowledge of possible complications inherent to the laparoscopic technique. With these two cases of residual appendicitis following incomplete appendectomy, the authors want to warn for this complication. Surgeons should be aware of residual appendicitis as a possible cause of acute abdomen at any time following a laparoscopic appendectomy.

Residual appendiceal stump

1. 1. Persistent or recurrent symptoms of acute appendicitis after appendectomy may be due to a residual appendiceal stump. 2. 2. Incomplete appendectomy may result if the appendix is removed prophylactically during another operation. Poor visualisation through a distant incision is the most likely cause of this incomplete removal. 3. 3. Inadequate removal of an appendix which is surrounded by an abscess may leave a residual stump. 4. 4. A single case of residual appendiceal stump is described.

Recurrent Appendicitis

The treatment of appendicitis is appendectomy. The opportunity to study patients, not subjected to appendectomy after appendicitis, is therefore unusual and ordinarily relegated to those patients with an appendiceal abscess in which the appendix could not be removed safely and to those with inadvertent, incomplete appendectomy. In order to reevaluate the necessity for elective interval appendectomy after appendicitis not treated with appendectomy, we have reviewed the charts of 586 patients treated for acute appendicitis at St. Vincent's Hospital in the past five years. In 49 patients there was localized abscess: the incidence was therefore 8.4% in our series. In 15 of these patients (30%) the appendix could not be excised; only an incision and drainage being performed. One patient was treated expectantly. Ten of the 16 patients returned for their scheduled interval appendectomy; five of the appendices of these patients showed acute or subacute inflammation, four were normal or chronically