Role of Conservative Management in Stump Appendicitis: A Case Series

Abstract

Stump appendicitis is a rare, delayed complication of appendectomy. It is seen following both open and laparoscopic appendectomy and may occur weeks to years following the initial appendectomy. We report two cases of stump appendicitis seen at our hospital. Both cases were diagnosed based on radiological findings and successfully managed conservatively with antibiotics. Although the usually recommended treatment for stump appendicitis is completion appendectomy, conservative management may be suitable for some patients. This report highlights the possibility of utilizing a conservative approach in the management of stump appendicitis compared to the recommended operative intervention. Awareness of the possibility of stump appendicitis is crucial for early diagnosis and treatment, to prevent potentially catastrophic complications.

Stumped by a Case of Appendicitis After Appendectomy

“…In addition to the 2 pediatric cases reporting nonoperative management, we found a case series reporting the successful management of stump appendicitis with IV antibiotics and bowel rest in 2 adults. 4,11,12 The patients had no recurrence of symptoms at follow-up, which ranged between 2 weeks and 9 months.…”

“…3 The reason for higher rates of stump appendicitis after open appendectomy is unknown; however, Paudyal et al hypothesized that it is because laparoscopy is a relatively new technology and more cases of open appendectomy have been performed and reported historically. 4 The incidence of stump appendicitis cases following laparoscopic appendectomy has increased since 1990 and is expected to continue to increase as laparoscopic techniques become more prevalent. 3 Our case describes a clinical presentation of stump appendicitis in a pediatric patient and highlights initial nonoperative management, which is not well reported in the literature.…”

“…The other cases of conservative management for stump appendicitis did not report any adverse effects or negative outcomes. 4 , 11 , 12 The evidence for hospital length of stay with conservative management of appendicitis compared to appendectomy is mixed and needs to be further evaluated. 13 , 18 Thus, although nonoperative treatment of stump appendicitis has potential risks, they may be less significant than one might expect.…”

“…In both children and adults, IV third-generation cephalosporins—such as ceftriaxone, cefotaxime, or cefoperazone—plus metronidazole were used in the hospital, and the patients were discharged on an oral second- or third-generation cephalosporin and metronidazole. 4 , 11 , 12 One pediatric patient was placed on additional gentamicin while in the hospital, and his oral antibiotics are unknown. 11 While our patient was started on similar medications, the team broadened his antibiotic coverage from IV ceftriaxone and metronidazole to IV piperacillin-tazobactam because he did not show immediate clinical improvement as expected.…”

“… 3 While conservative management of stump appendicitis has been reported in adults, its role in the pediatric population is less commonly known. 4 We present a case of stump appendicitis in a child who was managed with initial nonoperative treatment and interval appendectomy several weeks later.…”