Stump Appendicitis: A Surgeon's Dilemma

Abstract

The authors make the point that completion appendectomy in cases of stump appendicitis should be performed laparoscopically when possible guided by CT scan findings.

Stump appendicitis in a 2 year-old patient. Case report and literature review

“…This pathology has a very similar picture to that of acute appendicitis, characterized by abdominal pain (may be predominant in the lower right quadrant), anorexia, vomiting and fever (2, 3,5,10,15). About 70% of the cases are associated with perforations generated as complications of the pathology (16), in contrast to 16 to 30% of the perforations caused by acute appendicitis (19).…”

“…The length of the appendicular stump (11,12) is considered as a predisposing factor, when the length is equal to or greater than 6 mm (6,13,14). This pathology can appear from 4 days (6,7,15) to 50 years after appendectomy, at any age (1). The review by Bing Tang et al, shows that, until 2010, there were only 10 cases reported in the English literature regarding the pediatric population, ranging between ages 8 and 15, and with an onset of symptomatology between 2 months and 5 years after surgery (13).…”

“…In some cases, the condition may present subacute abdominal pain; Roberts et al concluded, after reviewing different case reports, that abdominal pain is the main symptom and that it occurs in up to 77% of cases (15). Diagnosis is based on clinical suspicion, and the use of diagnostic imaging may help increase certainty (17).…”

“…Since this diagnosis is associated with a high rate of complications, it is best to prevent by leaving a stump smaller than 5 mm, since a greater length may cause a fecolith (15,18).…”

Appendicitis of appendiceal stump complicated by anaerobic peritonitis and retroperitoneal phlegmon

“…В качестве фактора риска осложнения считается оставление культи длиной более 5 мм: по данным A. Mangi и D. Berger, длина культи на по-вторных операциях по поводу АК составляла от 5 до 65 мм [5]. Основным методом неинвазивной диа-гностики является компьютерная томография, по-зволяющая установить воспалительные изменения в культе аппендикса и окружающих тканях [3,4,6].…”