Stump Appendicitis Research Articles

Classic yet challenging case of stump appendicitis: a case report

Introduction: Stump appendicitis is a rare complication of appendectomy in which residual appendiceal tissue becomes inflamed, mimicking acute appendicitis. This case report highlights the classic clinical presentation, diagnosis, and management of stump appendicitis. Case Presentation: A 61-year-old male presented with abdominal pain and a past history of open appendectomy performed four years prior. Clinical examination, laboratory, and radiological findings were highly suggestive of stump appendicitis. Surgical exploration confirmed an inflamed appendiceal stump, which was resected, and the patient had an uneventful recovery post-operatively. Discussion: Stump appendicitis is a rare but important differential diagnosis in patients with a history of appendectomy who present with acute abdominal pain. Delayed diagnosis can result in complications such as perforation and peritonitis. Imaging plays a crucial role in diagnosis, and surgical resection, typically performed through open completion appendectomy, remains the treatment of choice. Conclusion: Although stump appendicitis is rare, it should always be considered in patients with a prior appendectomy who present with acute abdomen. Early recognition and prompt surgical intervention are essential to prevent morbidity and mortality.

Stump Appendicitis: An Update on Current Management: A Narrative Review Article

Stump appendicitis is a rare complication that occurs after an appendectomy and the diagnosis of this condition is usually delayed. The diagnosis is confirmed by either an ultrasound or computerized tomography. The management of stump appendicitis is by performing a completion appendectomy, which can be done as an open or laparoscopic procedure. The delay in diagnosis can often lead to complications like perforation and abscess formation. We have conducted this review article to look at the diagnosis and management of stump appendicitis. The method of stump closure is also discussed by looking at the various methods that are employed.

Stump Appendicitis: A Complication of Post Appendectomy

Stump appendicitis is a rare but serious complication that can occur after an appendectomy, characterized by inflammation and infection of the remaining portion of the appendix (1). Patients typically present with symptoms similar to those of appendicitis, such as abdominal pain, fever, and nausea. However, the diagnosis can be challenging because the patient has previously undergone an appendectomy, potentially leading to delays in treatment and increased risk of complications (1). In this case, a 38-year-old male, who had a smooth recovery following a laparoscopic appendectomy 15 years prior presented to the emergency department with worsening abdominal pain. Despite his initial postoperative recovery, he developed stump appendicitis, as confirmed by a CT scan. The condition was managed with antibiotics and a percutaneous drain, leading to significant improvement. He is now scheduled for a completed appendectomy to remove the remaining appendix stump. This case highlights the critical importance of including stump appendicitis in the differential diagnosis for patients with a history of appendectomy who present with acute abdominal pain. Timely diagnosis and intervention are essential to prevent complications and ensure appropriate management.

Stump Appendicitis: A Rare Late Complication of Appendectomy, a Retrospective Analysis of 9082 Appendectomy Cases

Objective: Appendectomy for appendicitis is one of the most common surgical procedures performed worldwide. The remnant of the appendix stump after the first appendectomy carries the risk of developing stump appendicitis. Stump appendicitis is a rare late complication of appendectomy; inflammation occurs in the remaining appendicular stump. Delayed diagnosis of this condition can cause serious complications. Stump appendicitis is indeed a recognized clinical picture, but is often overlooked when evaluating patients with right lower quadrant abdominal pain, especially those with a history of appendectomy. It remains a clinical challenge because of its often delayed diagnosis and effective treatment, and possible accompanying morbidity or mortality. Material and Methods: Materials and Methods: We retrospectively screened the patients who were hospitalized in our general surgery clinic and diagnosed with stump appendicitis in the hospital for 12 years. There were 11 patients between January 2011 and 2023 Results: The mean age of all 11 patients described was 55 years (range: 20 to 66). 72% of the patients were male (8/11 males and 3/11 females). 63% of the patients had their first operations open, and 36% of them were laparoscopic. The mean white blood cell count on presentation of all reported 11 cases was 11,996 cells/mm3 (range: 5930 to 18,740), the mean fever was 37.82°C (range: 36.8 to 38.6), and the mean CRP count on presentation of all cases was 36.7 (range: 0.4 to 142.91). The most commonly performed radiographic examination used to diagnose stump appendicitis is the abdominal computerized tomography (CT) scan. It was used in 100% (11 cases). Ultrasound was also used in 100% (11 cases). Conclusion: The appendicular base must be accessed prior to undertaking an appendectomy, irrespective of the chosen strategy or technique. It is noteworthy that, apart from open or laparoscopic appendectomy, antibiotic therapy should also be considered as part of the treatment regimen, as documented in the literature series.

S3409 Exploring Non-Surgical Options for Stump Appendicitis: Colonoscopy-Guided Fecalith Removal as an Effective Solution

S3409 Exploring Non-Surgical Options for Stump Appendicitis: Colonoscopy-Guided Fecalith Removal as an Effective Solution

314 Isolated Tuberculosis of Appendix: A Case Report

Abstract Introduction Stump appendicitis is a rare and delayed complication of appendectomy. In India, abdominal tuberculosis (TB) represents about 10% of the extra pulmonary TB and the appendix is involved in only about 1%. A combined occurrence of both conditions is very rare. Case Presentation A 24-year-old male presented to the General Surgery outpatients’ clinic with a 2-week history of right iliac fossa pain with no other associated symptoms. The patient had undergone an open appendectomy for perforated appendicitis 3 months prior to the current presentation. Per abdominal examination showed tenderness at the McBurney’s point. A CT abdomen revealed thickened and enhanced stump appendix along with adjacent fat stranding and multiple mesenteric nodes, suggestive of stump appendicitis. In light of the upward trend seen in white blood cell count, the patient was planned for a diagnostic laparoscopy and pre-anesthesia clearance was obtained. Intra-operatively, adhesiolysis of dense bowel and omental adhesions were performed. About 3.5 cm appendicular stump was resected. Micro-nodular peritoneal nodules were resected. The specimens were sent for histo-pathology examination. Results The postoperative period was uneventful with symptomatic relief. The biopsy of the stump described morphological features of caseating granulomatous inflammation, suggesting the possibility of tuberculosis while the peritoneal nodules showed infiltration of inflammatory cells. The patient was started on specific anti-tubercular treatment. Conclusions Appendicular TB is rare and of uncertain physiopathological etiology. The peculiarity of our case was the finding of abdominal TB presented as stump appendicitis. This may even be the first report with similar findings.

O056 The impact of surgical risk factors on the development of stump appendicitis

Abstract Introduction Stump appendicitis (SA) is a post-operative complication where inflammation occurs in the residual appendix following incomplete excision. Diagnosis is delayed due to the history of appendectomy, leading to a higher risk of complications such as perforation and peritonitis. This study aimed to investigate the incidence of SA and the surgical risk factors contributing to its development. Methods A literature review was conducted using Ovid Medline and Embase to evaluate the literature surrounding SA. A retrospective study was conducted at our centre to investigate the incidence of SA between June 2012 and June 2022. Results Literature review revealed 43/12,989 (0.33%) patients with SA. In the local cohort of 5401 patients who underwent appendectomy or right hemicolectomy for appendicitis, 15 developed SA (0.28%). Laparoscopic appendectomy was identified as a risk factor, with 66.67% of SA patients in Cardiff undergoing laparoscopic surgery for their primary appendicitis. Complicated primary appendicitis was reported in 53.33% of SA patients compared to 19.33% of the wider cohort. An appendicolith was present in 33.33% of SA patients compared to 12.11% of the total cohort. Residual stump length above 1.5cm was also acknowledged as a risk factor with a stump length ≥1.5cm reported in all local SA patients. Conclusion SA is associated with modifiable and non-modifiable risk factors. Care should be taken to identify the appendiceal base clearly at primary operation. Complicated appendicitis and the limitations of laparoscopic appendectomy present challenges in identifying the appendiceal base, thus contributing to the development of SA.

Stump appendicitis: challenging diagnosis with serious complication: a case report

Stump appendicitis is a rare complication of appendectomy because of recurrent inflammation of the residual appendix. The diagnosis is often delayed because of low index of suspicious, which may result in serious complications. Twenty-three-year-old male patient presented with right lower quadrant abdominal pain after 7month of appendectomy done at a hospital. On physical examination, he has right lower quadrant tenderness and rebound tenderness. Abdominal ultrasound was done with finding of blind-ended tubular noncompressible 2cm long part of appendix with wall-to-wall diameter of 10mm. There is also focal defect with surrounding fluid collection. With this finding, perforated stump appendicitis was diagnosed. He was operated with similar intra operative finding. The patient discharged improved after 5days of hospital. This is first reported case in Ethiopia as far as our search is concerned. Despite past medical history of appendectomy, the diagnosis was made by means of ultrasound scan. Stump appendicitis is a rare but important complication of appendectomy, often misdiagnosed. Prompt recognition is important to avoid serious complications. This pathologic entity should always be kept in mind in case of right lower quadrant pain in patient with previous history of appendectomy.

Thickness of subcutaneous fat in the right iliac fossa as a predictor of surgical site infection in open appendicectomy- a single centre prospective study

Background: Acute appendicitis is the acute inflammation of appendix accounting to 7-10% of acute abdomen cases. The complications vary from surgical site infection to enterocutaneous fistula and stump appendicitis. The surgical site infections after appendicectomy are postoperative nosocomial infections affecting the incision site, deeper tissues and organs at the operative site within 30 days of surgery. The study was aimed at predicting subcutaneous fat thickness causing surgical site infection in open appendicectomy wounds. Methods: This prospective study was conducted in Trichy SRM Medical College Hospital and Research Centre, Tamil Nadu from January to June 2021 in 82 patients. Patients who underwent open appendicectomy for uncomplicated acute appendicitis were included. Patients underwent preoperative Ultrasound abdomen to measure the subcutaneous fat thickness in right iliac fossa and was correlated with post operative surgical site infection for 1 month. The subcutaneous fat thickness was divided into three groups; I- 5.5 mm and below, II- 5.5 to 7.5 mm and III- more than 7.5 mm. Results: The results show that there was an increased association of surgical site infection in patients with increased subcutaneous fat thickness at incision site with mean of 6.25 and SD of 1.49. Conclusions: The study showed that subcutaneous fat thickness is a predictor for development of surgical site infection in open appendicectomy wounds. The subcutaneous fat thickness association in causing surgical site infection in open appendicectomy wounds is of linear association.

Role of Conservative Management in Stump Appendicitis: A Case Series.

Stump appendicitis is a rare, delayed complication of appendectomy. It is seen following both open and laparoscopic appendectomy and may occur weeks to years following the initial appendectomy. We report two cases of stump appendicitis seen at our hospital. Both cases were diagnosed based on radiological findings and successfully managed conservatively with antibiotics. Although the usually recommended treatment for stump appendicitis is completion appendectomy, conservative management may be suitable for some patients. This report highlights the possibility of utilizing a conservative approach in the management of stump appendicitis compared to the recommended operative intervention. Awareness of the possibility of stump appendicitis is crucial for early diagnosis and treatment, to prevent potentially catastrophic complications.

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.

Twice perforated stump appendicitis: a case report

Stump appendicitis is an acute inflammation of the residual appendix and one of the rare complications after appendectomy. Stump appendicitis is an under-reported and poorly defined condition related to obstruction and inflammation of the residual appendix after an appendectomy, usually by a fecolith. It remains a clinical challenge because of delayed diagnosis and subsequent treatment with increased morbidity or mortality. Herein, we describe the case of a 42-year-old male who presented with periumbilical pain with progression to generalized abdominal pain and signs of peritonitis 14 months post appendectomy. An exploratory laparotomy revealed an inflamed, non-gangrenous perforated appendices stump. We discuss the challenges in the diagnosis and management thereof.

The role of laparoscopy in gynaecological practice for diagnosis of stump appendicitis as a rare cause of chronic pelvic pain

No abstract available

Stump appendicitis - a systematic analysis.

<b>Aim:</b> The study was conducted to analyze stump appendicitis which is a long-term complication of appendectomy - the otherwise commonest general surgical procedure conducted in the world. </br></br> <b>Methods:</b> 48 cases included from 36 articles published in the peer reviewed journals of repute were evaluated for eight variables including: (I) age of the patient, (II) gender, (III]) duration of symptoms, (IV) imaging, (V) interval time since initial operation, (VI) details of initial operation, (VII) management, (VIII) stump length if managed by operation. </br></br> <b> Results:</b> 48 cases (27 males and 19 females) ranging in age from 2 to 72 years reported after a wide range of time (3 days - 46 years) after primary appendectomy. The duration of symptoms ranged from 1 day to 7 months. As many as 31 (64.5%) cases had inflamed stump appendix whereas 17 (33.5%) had perforation. Twenty-one (43.7%) had undergone laparoscopic primary appendectomy and 27 (56.3%) had undergone open appendectomy. Management of the retained stump included stump appendectomy in 42 (87.5%), right hemicolectomy in 2 (4.2%) and conservative in 4 (8.3%) cases. In the 44 cases managed by surgical intervention, the approach was open in 27 (61.4%) and laparoscopic in 17 (38.6%) cases. The length of the retained appendix stump ranged from 0.5 cm to 6.5 cm (mean 2.14 cm). </br></br> <b>Conclusion:</b> Stump appendicitis is an entity that a physician needs to suspect if a patient reports with features of appendicitis even after appendectomy had been conducted. Management is generally surgical and aimed at removal of the retained appendiceal stump.

Coexistence of Stump Appendicitis and Ovarian Fibro-Thecoma in a Young Women with Recurrent Right Iliac Fossa Pain During Pregnancy; A Rare Case Report

Ovarian Fibro-thecoma is a rare, benign, sex cord-stromal neoplasm, with a typically unilateral location in the ovary, characterized by mixed features of both fibroma and thecoma. Ovarian Fibro-thecoma is Uncommon tumor of gonadal stromal cell origin accounting for 3-4% of all ovarian tumors. We describe a rare case of Fibro-thecoma in a 27- year women with a history of recurrent right iliac fossa pain during pregnancy associated with fever and vomiting with previous history of laparotomy for appendicular abscess 10 years back. She presented to us during pregnancy with this complain for which she was managed conservatively. She did not maintain her follow up regularly at our hospital and visited again after delivery of her baby with a still birth outcome with a newly diagnosed complex bilateral ovarian cyst demonstrated on ultrasound and computed tomography showed inflammatory Right sided tubo-ovarian mass along with inflammatory thickening of ileum in right lower quadrant adjacent to right ovarian mass lesion. The patient underwent laparotomy for this with the removal of mass along with the removal of appendicular stump for appendicular stump appendicitis which was diagnosed intraoperatively. The finding from histopathological examination of the mass was consistent with the diagnosis of Fibro-thecoma.

High-volume center analysis and systematic review of stump appendicitis: solving the pending issue.

Stump appendicitis (SA) is a rare long-term complication after laparoscopic appendectomy (LA) that can be associated with high morbidity due to delayed diagnosis. We aimed to determine the incidence, risk factors, diagnosis, and management of SA by reviewing our large cohort of LA and performing a systematic review of the literature. We retrospectively reviewed data of all patients who developed SA after LA between 2006 and 2020. Demographics, peri-operative variables, and postoperative outcomes were analyzed. A systematic review of the PubMed/MEDLINE, Embase and GoogleScholar bibliographic databases was also performed to identify publications regarding SA following LA. A total of 2,019 patients underwent LA; 5 (0.25%) developed SA after a median of 292days. The most common symptom at presentation was right lower quadrant pain. Four SA (80%) occurred in patients with a history of complicated appendicitis at index operation. All patients were diagnosed with computed tomography and underwent completion stump appendectomy by laparoscopy. No postoperative complications were recorded. A total of 55 studies with 76 cases of SA after LA were identified in the systematic review. Most SA (98.7%) underwent surgery: 52% by laparoscopic approach and 36% through an open approach. Stump appendectomy was performed in 94.4% cases and an extended resection in 5.6%. Although SA is a rare complication after LA, a high index of clinical suspicious and imaging studies are key for early diagnosis and treatment. A laparoscopic resection of the inflamed appendiceal stump is feasible, safe, and highly effective. A minority of patients with severe cecum compromise may need extended resections or conversion to open surgery.

Endoscopic retrograde appendicitis therapy: new approach in the treatment of stump appendicitis.

Endoscopic retrograde appendicitis therapy: new approach in the treatment of stump appendicitis.

From Diagnosis to Management; Mucocele of Stump Appendicitis, Extremely Rare Finding in an Uncommon Surgical Disease: Literature Review.

Mucocele of the appendix is the accumulation of mucoid material in the appendiceal lumen. Although the terminology is imprecise, as it does not differentiate between the benign and malignant nature of the condition, preoperative recognition is imperative as spillage of the mucus during surgical handling can result in grave complications like pseudomyxoma peritonei. Mucocele developing in a stump of the appendix, i.e., a remnant of appendiceal tissue after surgical removal of an inflamed organ, is an extremely uncommon phenomenon, as not many cases are reported in the literature. In this review, all cases reported in English literature are discussed.

Appendicitis and beyond: a pictorial review of various appendiceal abnormalities.

Acute appendicitis is the most common disease of the appendix. However, the differential diagnosis for an abnormal appendix includes other conditions that often present with symptoms and imaging features that overlap with acute appendicitis. In this pictorial essay, we review the normal anatomy of the appendix and outline the pathogenesis, clinical manifestations, and imaging findings that are characteristic of acute appendicitis and other less common appendiceal abnormalities. Inflammatory/non-neoplastic processes including appendiceal diverticulitis, stump appendicitis, foreign body appendicitis, Crohn's appendicitis, and appendiceal hernias are discussed. Neoplastic considerations include appendiceal neuroendocrine tumors, mucinous and non-mucinous (colonic type) epithelial neoplasms, and lymphoma. It is important for the radiologist to be able to differentiate these alternative diagnoses for the purpose of directing appropriate patient management.

Appendicitis after Appendectomy: A Rare Case

Acute appendicitis is the most common surgical emergency encountered in daily practice setting and appendectomy is most familiar surgical intervention performed in surgical emergency department. The correct diagnose remain tricky even though there are many options available for diagnosis. It becomes very difficult for surgeons to reach on exact diagnose when the patient gave history of previous history of appendectomy. Stump appendicitis is a very rare complication after appendectomy and leading causes of morbidity among children. Stump appendicitis is defined as acute infection of residual appendix. Stump appendicitis is very difficult to diagnose and required a competent surgical tool to quickly evaluate after appendectomy. Instead of having advancement in the field of technology and imaging sciences still the condition is prone to threat and cases of stump appendicitis have been underreported and undiagnosed.