ABSTRACT
Appendectomy is one of the commonest abdominal operation performed all over the world. Stump appendicitis is one of the uncommon complications of appendectomy. The diagnosis of stump appendicitis is delayed due to low index of suspicion by virtue of the fact that an appendectomy has already been done. The clinical presentation exactly simulates acute appendicitis. Contrast enhanced computed tomography is diagnostic. Completion appendectomy either open or laparoscopic is the mainstay of treatment. Awareness regarding the possible aetiology, diagnosis and management is essential for avoiding delay in the diagnosis.
ABSTRACT
Stump appendicitis is one of the rare delayed complications post appendectomy with a reported incidence of 1 in 50,000 cases. Stump appendicitis can present as a diagnostic dilemma if the treating clinician is unfamiliar with this rare clinical entity. The purpose of this paper is to review current data on stump appendicitis and analyse published cases.
ABSTRACT
La apendicitis del muñón es una rara entidad, de la cual se desconoce su incidencia, con alrededor de 100 casos reportados en la literatura médica. Requiere un alto grado de sospecha clínica para su correcta identificación. El tratamiento recomendado es quirúrgico. Se presenta el caso de un paciente de 26 años, con antecedente de apendicectomía hace 17 años, con cuadro de dolor abdominal en fosa iliaca derecha y signos apendiculares positivos en el examen físico. La Tomografía Axial Computarizada demostró una colección con gas y fecalitos en su interior, localizada en fosa iliaca derecha, planteándose un diagnóstico de apendicitis del muñón. Se realizó una laparotomía exploratoria, evidenciándose un muñón apendicular perforado en su tercio proximal, por lo que se completó la apendicectomía del muñón. El informe histopatológico reportó un muñón apendicular con infiltrado mono y polimorfo nuclear, que compromete el espesor de la pared. El paciente fue dado de alta con evolución dentro de parámetros esperados y fue remitido a control y seguimiento por Consulta Externa.
Stump appendicitis is a rare entity, of which its incidence is unknown, with about 100 cases reported in the medical literature, which requires a high degree of clinical suspicion for proper identification. The recommended treatment is surgical. The case of a 26-year-old patient with an appendectomy antecedent 17 years ago, with abdominal pain in right lower quadrant and positive appendicular signs on the physical exam is presented. Computerized Axial Tomography demonstrated a collection of gas and fecalites inside, located in right lower quadrant, considering a diagnosis of stump appendicitis. An exploratory laparotomy was performed, with an appendicular stump perforated in its proximal third, and the stump appendectomy was completed. The histopathological report reported an appendicular stump with mono and polymorph nuclear infiltrate, which compromises the thickness of the wall. The patient is discharged with evolution within expected parameters and is referred to control and follow-up by External Consultation.
Subject(s)
Humans , Male , Female , Adult , Appendectomy , Appendicitis , Laparoscopy , Gastric Stump , Digestive SystemABSTRACT
RESUMEN Introducción: La apendicitis aguda es la causa más común de abdomen agudo, que precisa de tratamiento quirúrgico mediante apendicectomía abierta o laparoscópica. La apendicitis del muñón o recurrente, en la que ocurre la inflamación del remanente apendicular, es una complicación tardía infrecuente de la apendicectomía. Objetivo: Identificar las posibles causas de la apendicitis recurrente, así como las medidas relacionadas con su prevención. Métodos: Se realizó una revisión de la literatura actualizada sobre el tema en formato digital, en publicaciones en idioma inglés y español. Conclusiones: La prevención de la apendicitis del muñón se basa en resecar el apéndice a menos de 0,5 cm de su base; los pacientes, con frecuencia, presentan síntomas análogos a los de antes de la primera cirugía, sin embargo, existe un incremento del riesgo de peritonitis y de graves complicaciones debido al retraso diagnóstico y terapéutico; es una causa poco frecuente de dolor abdominal en pacientes apendicectomizados, por lo que se debe guardar una alta sospecha para su diagnóstico precoz y tratamiento oportuno(AU)
ABSTRACT Introduction: Acute appendicitis is the most common cause of acute abdomen, which requires surgical treatment by open or laparoscopic appendectomy. Recurrent appendicitis of the stump, in which inflammation of the appendicular remnant occurs, is an infrequent late complication of appendectomy. Objective: To identify the possible causes of recurrent appendicitis, as well as the measures related to its prevention. Methods: A review of the updated literature on the subject was carried out in digital format, in publications in English and Spanish. Conclusions: Prevention of appendicitis of the stump is based on resecting the appendix less than 0.5 cm from its base; Patients frequently present symptoms similar to those before the first surgery, however, there is an increased risk of peritonitis and serious complications due to delayed diagnosis and therapy; It is a rare cause of abdominal pain in appendectomized patients, so high suspicion should be kept for its early diagnosis and prompt treatment(AU)
Subject(s)
Humans , Appendectomy/methods , Appendicitis/diagnosis , Peritonitis/complications , Abdominal Pain/etiology , Review Literature as TopicABSTRACT
Stump appendicitis is an acute inflammation of the residual appendix and is a rare complication after appendectomy. The physician should be aware of the possibility of stump appendicitis in patients with right lower abdominal pain after appendectomy so that delayed diagnosis and treatment can be prevented. Stump appendicitis is usually treated by surgical resection, and endoscopic treatment has not been reported previously. A 48-year-old man who had undergone appendectomy 35 years earlier presented to the hospital because of right lower quadrant discomfort. A computed tomography scan showed a large stone in the residual appendix. Colonoscopic findings revealed a large, smooth, protruding lesion at the cecum with a stone inside the appendiceal orifice. Endoscopic removal after incision of the appendiceal orifice was performed successfully.
Subject(s)
Humans , Middle Aged , Abdominal Pain , Appendectomy , Appendicitis , Appendix , Cecum , Delayed Diagnosis , InflammationABSTRACT
Objetivo: Describir el caso de un paciente con apendicitis del muñón apendicular y realizar una revisión de la literatura. Sede: Hospital Médica Sur. Diseño: Caso clínico. Descripción del caso: Masculino de 38 años de edad con antecedente de apendicitis complicada manejada quirúrgicamente hace 15 años. Cursa 48 horas con dolor abdominal tipo cólico, mal localizado, orientado hacia la mitad inferior del abdomen, durante las primeras 24 horas afebril, no náusea ni vómito; durante las siguientes 12 horas, el dolor se intensifica hasta llegar a ser 10 de 10, en hemiabdomen inferior, con fiebre de 38.5°C, con náusea sin vómito. Se encuentran datos de irritación peritoneal, leucocitosis con neutrofilia, estudios paraclínicos de imagen sugerentes de apendicitis aguda, por lo que se decide laparotomía exploradora. Durante la misma se evidencia, a nivel de ciego, remanente apendicular de aproximadamente 1 cm, con cambios isquémicos y perforación a nivel de la base del ciego. Se realiza hemicolectomía derecha con ileo-transverso anastomosis latero-lateral. El estudio histopatológico confirma apendicitis del muñón. Conclusión: Una complicación rara de la apendicectomía es la apendicitis del muñón apendicular, que se presenta cuando no se realiza una resección apendicular adecuada. Esto se debe a mala identificación de la base apendicular, por diversos motivos, lo que condiciona a dejar un muñón apendicular de más de 5 mm.
Objective: To describe a case of appendiceal stump appendicitis and to perform a literature review. Setting: Hospital Médica Sur (Third level health care private hospital). Design: Case report. Description of the case: Man of 28 years of age, with an antecedent of complicated appendicitis managed surgically 15 years ago. The patient had coursed for the last 48 h with colic-type abdominal pain, not well localized, oriented towards the lower half of the abdomen, he was without fever the first 24 h, he presented no nausea nor vomiting; 12 h later the pain intensified until reaching 10 of 10, in the lower hemiabdomen, with fever of 38.5°C and nausea but no vomiting. Peritoneal irritation data were found, leukocytosis with neutrophilia, imaging studies were suggestive of acute appendicitis; hence, it was decided to perform an exploratory laparotomy. During this, an appendicular remnant of approximately 1 cm was evidenced at the base of the cecum. Right hemicolectomy was performed with ileo-transverse latero-lateral anastomosis. The histopathological study confirmed appendicitis of the stump. Conclusion: Appendicitis of the appendiceal stump is a rare complication of appendicectomy, which occurs when the appendicular resection is not performed adequately. This is due to a wrong identification of the appendicular base, for diverse reasons, which leads to leave an appendiceal stump of more than 5 mm.