Stump appendicitis after laparoscopic appendectomy; laparoscopic management and literature review

Abstract

Introduction Appendectomy is one of the most common surgical procedures performed worldwide There are different etiologies for acute appendicitis such as obstruction of the appendiceal lumen by fecalith, lymphoid hyperplasia, or neoplasm. Laparoscopic appendectomy has become the treatment of choice for both complicated and uncomplicated appendicitis; common postoperative complications include wound infection, bleeding, intraabdominal abscess. Stump appendicitis is defined as the interval repeated inflammation of remaining residual appendiceal tissue after an appendectomy. Presentation of case 38-Year-old female patient with a history of laparoscopic appendectomy performed in 2016 for acute uncomplicated appendicitis. She arrived to the emergency room due to abdominal pain 7 out of 10, located in the periumbilical region, later with migration to the right lower quadrant, abdominal CT scan evidenced the presence of a cecal and pericecal inflammatory process as well as the base and residual proximal portion of the cecal appendix laparoscopic stump appendectomy was performed. Discussion Stump appendicitis (SA) is defined as the inflammation of the remnant of the cecal appendix after an appendectomy, whether due to impaction of a fecalith or secondary to an ischemic process, the probability of developing SA is estimated to be about 1/50,000 cases throughout life. The most frequently used treatment is exploratory laparotomy to complete the previous appendectomy; however, there are 5 reported cases of stump appendicitis, where surgical resolution was performed through laparoscopic surgery. Conclusions It is important to keep this entity in mind when evaluating a patient with acute abdomen with previous history of appendectomy, since the delay in diagnosis and treatment increases morbidity and mortality; laparoscopic stump appendectomy has been shown to be a safe treatment (Agha et al., 2020 [14] ). 1

Apendicite De Coto: O Enigma Da Dor Em Fossa Ilíaca Direita Pósapendicectomia

“…Está estabelecido na literatura que o comprimento do coto residual é um fator de risco para o desenvolvimento desta rara patologia, tendo assim como recomendação um coto menor que 0,5cm pós apendicectomia 4 . Apresenta uma incidência de 1 em 50.000 casos e caracteriza-se pela inflamação do apêndice cecal remanescente após uma apendicectomia, seja por obstrução do lúmen apendicular por um fecalito ou secundário a um processo isquêmico 2,4 .…”

“…Os prováveis fatores causais para AA são: obstrução do lúmen do apêndice por fecalito, neoplasias e hiperplasia linfoide 2 . O diagnóstico é através do exame clínico, imaginológico associados a exames laboratoriais.…”

Stumped by Appendicitis: A Rare Cause of Acute Abdominal Pain

“…Epidemiologically, the diagnosis is made in patients ranging from eight to 80 years, with a median age of 33 years, and a male-to-female ratio of 1.1:1 [ 14 ]. Abdominal imaging is often needed to confirm the diagnosis, with computerized tomography (CT) being the gold standard [ 15 ]. Compared to ultrasound scans, CT is more sensitive and specific and can simultaneously exclude other abdominopelvic disease entities [ 8 ].…”

Role of Conservative Management in Stump Appendicitis: A Case Series

“…Stump appendicitis is defined as the interval repeated inflammation of remaining residual appendiceal tissue after an appendectomy, either due to impaction of a fecolith or secondary to an ischemic process. 3 Rose, in 1945, was the first to describe stump appendicitis in two patients who had previously undergone appendectomy for acute appendicitis. 4 It is a rare occurrence with a reported incidence of 1 in 50000 cases but the real incidence is expected to be much higher as this condition is often underestimated.…”