A Case of Stump Appendicitis Secondary to Appendicular Fecolith

Abstract

A 32-year-old male patient presented to the emergency department with colicky peri-umbilical abdominal pain and nausea for two days. On examination, there was generalized lower abdominal tenderness with no fever. A computed tomography scan of the abdomen and pelvis revealed signs of acute appendicitis. Upon further questioning, the patient gave a history of appendectomy that took place eight years ago. Although rare, stump appendicitis can occur. A radiologist should always consider stump appendicitis in the differential diagnosis of right lower quadrant pain.

Stumped by Appendicitis: A Rare Cause of Acute Abdominal Pain

“…Stump appendicitis (SA) is defined as interval inflammation of residual appendicular tissue after appendectomy [ 5 ]. First described in 1945 by Rose, its incidence has since been slowly rising [ 2 ].…”

“…Ultimately, surgical technique and operator experience play a role in the complication rate of any procedure. Other risk factors include a retro-colic position of the appendix, poor blood supply, and appendicolith formation [ 5 ].…”

“…The vast majority of reported cases have cited a completion appendectomy as the treatment of choice for SA, with the open approach being preferred to laparoscopic surgery [ 6 ]. This may be due to the fact that a delayed diagnosis leads to more complicated presentations, such as stump gangrene, perforation, and peritonitis [ 5 ]. One review cited a perforation rate as high as 70% [ 14 ].…”

“…Stump appendicitis can occur as soon as two months and as late as 50 years post-appendectomy [ 4 ]. It is often diagnosed radiologically on an abdominal CT scan performed to rule out other diagnoses [ 5 ]. A lack of awareness by the ED physician can lead to delayed diagnosis, which inadvertently leads to delayed treatment and an increased complication rate [ 6 ].…”