An extremely rare appendiceal anomaly: horseshoe appendicitis

Abstract

Appendiceal anomalies are extremely rare malformations that are usually found in adult populations as an incidental finding. Agenesis and duplication of the appendix have been well documented, but we know of only three reported cases of a horseshoe appendix. A 64-year-old woman admitted to the emergency department. A provisional diagnosis of acute appendicitis was made, and the patient was taken to the operating room. While appendectomy was being performed with a standard approach, the distal tip was seen to communicate with the cecum by another stump, or "horseshoe appendix". The aim of this report is to share our experience with this extraordinary finding.Key Words: Appendix vermiformis; horseshoe; malformation.Apendiks anomalileri çoğunlukla erişkin popülasyonda rastlantı sonucu bulunan çok nadir malformasyonlardır. Apendiks agenezis ve duplikasyonu iyi bilinmesine rağ-men, bildirilmiş sadece üç adet atnalı apendiks olgusu bulunduğunu biliyoruz. Acil servise başvuran 64 yaşında kadın hasta akut apandisit ön tanısı ile ameliyathaneye alındı. Standart yaklaşımla apendektomi uygulanırken, "at nalı apendiks" şeklinde distal ucun ikinci bir güdük ile çekumla bağlantılı olduğu görüldü. Buradaki amacı-mız bu sıra dışı bulguyla ilgili deneyimimizi paylaşmak-tır.Anahtar Sözcükler: Appendiks vermiformis; at nalı; malformasyon.doi: 10.5505/tjtes.2013.67424 Appendiceal anomalies are extremely rare malformations that are usually found in adult populations as an incidental finding. Agenesis and duplication of the appendix have been well documented, and the incidences for these anomalies are 0.008% and 0.004%, respectively.[1] However, we know of only three reported cases of a horseshoe appendix. [2][3][4] In this report, we present the fourth case of a horseshoe appendix. CASE REPORTA 64-year-old woman admitted to the emergency department with a two-day history of right lower abdominal pain, nausea, and loss of appetite. The abdominal examination revealed right lower quadrant tenderness, guarding and rebound tenderness at McBurney's point. All laboratory study results were in normal ranges, and plain chest and abdominal radiographs showed no abnormality. Ultrasonographic examination determined pericecal minimal fluid collection. A provisional diagnosis of acute appendicitis was made, and the patient was taken to the operating room. A standard approach was taken with incision over McBurney's point. The cecum was identified, the taenia coli were followed to their confluence, and an appendiceal stump was found. The distal appendiceal tip was seen to extend to the posteromedial cecum, and there were adhesions that complicated mobilization of the appendix. A decision was made to perform retrograde appendectomy. After appendiceal stump and mesoappendix were ligated and divided, the distal tip was seen to communicate with the cecum by another stump, or "horseshoe appendix" (Figs. 1a, b). Appendectomy was completed. The patient made an uneventful recovery and was discharged two days later.

Congenital abnormalities and anatomical variations of the vermiform appendix and mesoappendix

“…Muhstaque et al 23 Male 16 B2 One of the appendices gangrened. Oruç et al 29 Female 64 D Presence of adhesions that hinder the mobilization of the appendix. Bulut et al 30 Male 52 D Local inflammation.…”

Appendiceal Duplication: A Comprehensive Review of Published Cases and Clinical Recommendations

“…Horseshoe [8,[90][91][92][93][94] To date there have been six reports of a horseshoe appendix, the first having been described by Mesko in 1989 after incidentally finding one following laparotomy for perforated sigmoid diverticular disease. The median age of these patients was 43 years (range 20-64) with none having congenital abnormalities.…”

Horseshoe Appendix is an Extremely Rare Cause of Acute Appendicitis

“…Clinical findings of horseshoe appendicitis are different, such as acute appendicitis, perforated appendicitis, mesenteric incarceration, and bowel obstruction, which are discovered incidentally during colon adenocarcinoma operation. [3][4][5][6][7] Horseshoe appendix was classified as a shape anomaly of the appendix and included two different types: frontal or sagittal disposal. 3 Unfortunately, no specific radiologic and clinical findings and no abnormal computed tomography and ultrasonography findings have been observed for horseshoe appendicitis.…”