Appendicitis in double cecal appendix: Case report

Abstract

male, white, 36 years old, obese, presenting with pain in the lower abdomen for 24 h followed by nausea, vomiting and mild fever. He was subjected to additional tests, with the leukogram showing leukocytosis and abdominal ultrasonography depicting cecal appendix with thickened wall, locally associated with small quantities of liquid and intestinal loop obstruction. He underwent laparotomy, revealing acute appendicitis. Another intestinal loop obstruction was identified next to the ileum, leading to recognizing another cecal appendix after local dissection. Double appendectomy and segmental iliectomy were performed although not needed. Results of the anatomopathological examination of the surgical samples showed acute inflammation in the two cecal appendices. So, performing a routine retroperitoneal release and a complete cecum evaluation during such surgical procedures is recommended and suggested due to the possibility of not identifying a second cecal appendix.

Congenital abnormalities and anatomical variations of the vermiform appendix and mesoappendix

“…In two cases, the appendix was gangrenous 23,28 ( Table 2). The study by Alves et al 17 reported inflammation in both appendices, while Bulut et al 6 observed inflammation of the cecal region. This review also retrieved the first records of cases of Type A appendix duplication with removal of 35.56 cm of necrotic intestine 32 and another case of appendix duplication associated with diverticulitis in the Meckel's diverticulum, suggesting complete exploration of the cecum.…”

“…González et al 32 Female 7 A Volvulus of the appendix Necrosis of the intestine. Alves et al 17 Male 36 B Both appendices were swollen. Nazir et al 22 Female 33 B2 Only one inflamed appendix.…”

“…Albeit rare, partial or complete duplication of the vermiform appendix is among the most frequently found congenital anomalies, with 100 cases already reported worldwide. 17 The term "alimentary tract duplication" comprises a set of congenital anomalies characterized by the presence of a well developed smooth muscle lining, epithelial lining, and association between duplicate structure and part of the gastrointestinal tract. A case of appendix duplication was reported in 1892 by Picolli.…”

Caso inusual de duplicación apendicular complicado con apendicitis

“…Esto representa claramente un reto pues, por su rareza, en la práctica médica no se suele buscar; además, porque los estudios de imaginología para el dolor abdominal tienen poca sensibilidad para detectar estas malformaciones, y se han reportado pocos casos diagnosticados mediante tomografía o ecografía 19 . La importancia de un mal diagnóstico radica en que un segundo apéndice no resecado puede acarrear consecuencias clínicas y médico-legales graves, debido al alto riesgo de perforación y necesidad de reintervención, lo cual aumenta la morbimortalidad en estos pacientes 11,20 .…”

“…En general, es más comúnmente diagnosticada en adultos asintomáticos, como un hallazgo incidental durante el acto quirúrgico por otras causas o en estudios imaginológicos, como el presentado por Mahmood, et al, de una bifurcación apendicular detectada por tomografía y el de Peddu, et al, quienes detectaron una duplicación apendicular mediante un enema de bario [8][9][10] . Sin embargo, también se ha descrito en niños, generalmente asociada con otras malformaciones, como las intestinales o genitourinarias 11 .…”