Stump Appendicitis After Appendectomy: Case Report

Introduction Stump appendicitis is a rare complication post-appendectomy due to inflammation of the remaining part of the appendix [1]. 66% of stump appendicitis cases happen after open surgeries. Respectively 34% of cases are linked to laparoscopic appendectomies [2]. Case Presentation An 18-year-old man presented with lower right side abdominal pain lasting more than 24 hours and a subfebrile temperature. Anamnesis revealed an appendectomy performed 10 years ago. During physical examination, tenderness to palpation in the right lower quadrant and a rigid abdomen were found. Laboratory analysis of a blood test showed elevated inflammatory markers. CRP was found 148 mg/l, WBC 11,4 x 10*9/l, neutrophilia with the left shift. No acute findings were identified in the abdominal ultrasound; however, a computed tomography scan revealed a 0,7 cm hyperdense structure (coprolite/calcinate) surrounded by 0,9 cm confined edema located in the right iliac region medial to the caecum. With a diagnosis of periappendicular infiltration, conservative treatment with antibiotic therapy was indicated for 7 to 10 days. A follow-up abdominal ultrasound was required after 2-3 months. The ultrasound revealed localised fluid accumulations, indicative of an ongoing infectious process requiring elective surgical treatment - diagnostic laparoscopy. Histologic examination showed no inflammation in the stump. Macroscopically, the stump was 2 cm in length, 0,7 cm in diameter, and had a wall thickness of 0,3 cm. Discussion Stump appendicitis occurs in approximately 1 out of every 50 000 cases of appendectomies [2]. It may develop anytime from 2 weeks to 60 years following an appendectomy, typically around 2 years. The main risk factor is a remaining appendix stump ≥0.5 cm, which can trap fecal matter, causing obstruction and inflammation [3]. Antibiotics are used for uncomplicated acute appendicitis with a relapse rate reaching 43% [4]. The preferred treatment of choice for stump appendicitis is a complete removal of the appendix either through open surgery or laparoscopically [2]. Conclusions Treating physicians must consider stump appendicitis being a complication of appendectomy. The correct length of stump residual must be taken into account while performing the surgery. The golden standard for treating this condition is laparoscopic appendectomy.