Stump Appendicitis Secondary to a Faecolith, a Diagnostic Dilemma
EAES Academy. Rana M. 07/05/22; 362979; P022
Dr. Maheen Rana
Contributions
Contributions
Abstract
Aim:
We present an unusual case of a 41 year old lady with stump appendicitis secondary to an impacted fecalith after 30 years of open appendicectomy.
Method:
A 41 year old lady was admitted to our surgical unit with four days history of abdominal pain at the right iliac fossa, and on examination, she was tender at the site. She had an open appendicectomy as a child. Blood investigations showed normal inflammatory markers and Abdominal CT showed a 7mm faecolith in appendix stump without acute inflammatory changes. She underwent a diagnostic laparoscopy due to persistent symptoms. She had a 10mm stump with adhesions between right colon and lateral abdominal wall without any gross evidence of inflammation, intra-abdominal collection or obstruction. The appendiceal stump was resected and histopathology confirmed mild acute inflammatory changes.
Results:
Patient’s symptoms resolved following the resection of the appendiceal stump and she was discharged the following day. She was reviewed in the outpatient clinic six weeks postoperatively, and she remained asymptomatic.
Discussion:
Stump appendicitis is the inflammation of the remnant portion of the appendix. It is an under recognized condition with reported incidence of 1 in 50,000 appendicectomies. The time interval between appendicectomy and stump appendicitis is variable and can range between 1 day to 60 years. Appendiceal stump longer than 25mm is most important factor associated with stump appendicitis as can become the reservoir for faecolith and cause inflammation, though the stump length in this case was 10mm. Stump appendicitis presents with right sided abdomen pain typical of acute appendicitis, however, with history of appendicectomy, diagnosis of stump appendicitis could be difficult and often delayed. This may even go unrecognized in the absence of florid changes on imaging or diagnostic laparoscopy. This prompts the need to consider the diagnosis of stump appendicitis in every individual who present with right sided abdominal pain and has a past history of appendicectomy.
We present an unusual case of a 41 year old lady with stump appendicitis secondary to an impacted fecalith after 30 years of open appendicectomy.
Method:
A 41 year old lady was admitted to our surgical unit with four days history of abdominal pain at the right iliac fossa, and on examination, she was tender at the site. She had an open appendicectomy as a child. Blood investigations showed normal inflammatory markers and Abdominal CT showed a 7mm faecolith in appendix stump without acute inflammatory changes. She underwent a diagnostic laparoscopy due to persistent symptoms. She had a 10mm stump with adhesions between right colon and lateral abdominal wall without any gross evidence of inflammation, intra-abdominal collection or obstruction. The appendiceal stump was resected and histopathology confirmed mild acute inflammatory changes.
Results:
Patient’s symptoms resolved following the resection of the appendiceal stump and she was discharged the following day. She was reviewed in the outpatient clinic six weeks postoperatively, and she remained asymptomatic.
Discussion:
Stump appendicitis is the inflammation of the remnant portion of the appendix. It is an under recognized condition with reported incidence of 1 in 50,000 appendicectomies. The time interval between appendicectomy and stump appendicitis is variable and can range between 1 day to 60 years. Appendiceal stump longer than 25mm is most important factor associated with stump appendicitis as can become the reservoir for faecolith and cause inflammation, though the stump length in this case was 10mm. Stump appendicitis presents with right sided abdomen pain typical of acute appendicitis, however, with history of appendicectomy, diagnosis of stump appendicitis could be difficult and often delayed. This may even go unrecognized in the absence of florid changes on imaging or diagnostic laparoscopy. This prompts the need to consider the diagnosis of stump appendicitis in every individual who present with right sided abdominal pain and has a past history of appendicectomy.
Aim:
We present an unusual case of a 41 year old lady with stump appendicitis secondary to an impacted fecalith after 30 years of open appendicectomy.
Method:
A 41 year old lady was admitted to our surgical unit with four days history of abdominal pain at the right iliac fossa, and on examination, she was tender at the site. She had an open appendicectomy as a child. Blood investigations showed normal inflammatory markers and Abdominal CT showed a 7mm faecolith in appendix stump without acute inflammatory changes. She underwent a diagnostic laparoscopy due to persistent symptoms. She had a 10mm stump with adhesions between right colon and lateral abdominal wall without any gross evidence of inflammation, intra-abdominal collection or obstruction. The appendiceal stump was resected and histopathology confirmed mild acute inflammatory changes.
Results:
Patient’s symptoms resolved following the resection of the appendiceal stump and she was discharged the following day. She was reviewed in the outpatient clinic six weeks postoperatively, and she remained asymptomatic.
Discussion:
Stump appendicitis is the inflammation of the remnant portion of the appendix. It is an under recognized condition with reported incidence of 1 in 50,000 appendicectomies. The time interval between appendicectomy and stump appendicitis is variable and can range between 1 day to 60 years. Appendiceal stump longer than 25mm is most important factor associated with stump appendicitis as can become the reservoir for faecolith and cause inflammation, though the stump length in this case was 10mm. Stump appendicitis presents with right sided abdomen pain typical of acute appendicitis, however, with history of appendicectomy, diagnosis of stump appendicitis could be difficult and often delayed. This may even go unrecognized in the absence of florid changes on imaging or diagnostic laparoscopy. This prompts the need to consider the diagnosis of stump appendicitis in every individual who present with right sided abdominal pain and has a past history of appendicectomy.
We present an unusual case of a 41 year old lady with stump appendicitis secondary to an impacted fecalith after 30 years of open appendicectomy.
Method:
A 41 year old lady was admitted to our surgical unit with four days history of abdominal pain at the right iliac fossa, and on examination, she was tender at the site. She had an open appendicectomy as a child. Blood investigations showed normal inflammatory markers and Abdominal CT showed a 7mm faecolith in appendix stump without acute inflammatory changes. She underwent a diagnostic laparoscopy due to persistent symptoms. She had a 10mm stump with adhesions between right colon and lateral abdominal wall without any gross evidence of inflammation, intra-abdominal collection or obstruction. The appendiceal stump was resected and histopathology confirmed mild acute inflammatory changes.
Results:
Patient’s symptoms resolved following the resection of the appendiceal stump and she was discharged the following day. She was reviewed in the outpatient clinic six weeks postoperatively, and she remained asymptomatic.
Discussion:
Stump appendicitis is the inflammation of the remnant portion of the appendix. It is an under recognized condition with reported incidence of 1 in 50,000 appendicectomies. The time interval between appendicectomy and stump appendicitis is variable and can range between 1 day to 60 years. Appendiceal stump longer than 25mm is most important factor associated with stump appendicitis as can become the reservoir for faecolith and cause inflammation, though the stump length in this case was 10mm. Stump appendicitis presents with right sided abdomen pain typical of acute appendicitis, however, with history of appendicectomy, diagnosis of stump appendicitis could be difficult and often delayed. This may even go unrecognized in the absence of florid changes on imaging or diagnostic laparoscopy. This prompts the need to consider the diagnosis of stump appendicitis in every individual who present with right sided abdominal pain and has a past history of appendicectomy.
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