A Stumping Experience: An Autobiographical Case Report.

Stump appendicitis, while being well recognized as a delayed complication following an appendectomy, is a relatively under-reported clinical entity, with an even lesser documentation frequency in the subcontinent, from where the author hails. This article recounts his brief yet consequential journey from ill-health to recovery, all the while giving an insight into a multitude of related experiences that served as learning points for the narrator. Additionally, this account of events, having been viewed through a hybrid doctor-patient lens, aspires to be a valuable addition to medical literature.

First case of primary appendiceal tuberculosis presented as stump appendicitis.

Tuberculosis (TB) remains as a significant global public health issue, especially in developing and underdeveloped nations. Extrapulmonary TB comprises 20% of the TB cases; of which 34.4% were in the lymphatics, 25.2% pleural, followed by 12.8% gastrointestinal and 9.4% in the central nervous system. Ileocecal involvement is the most common among gastrointestinal TB. Although it can cause secondary damage to the appendix, primary type of appendicular TB is rare and can occur with no other signs of the disease. A high index of suspicion is necessary for early diagnosis and treatment of TB. Similarly, stump appendicitis (SA) is a rare and delayed complication of appendectomy. Here we report a case of primary appendicular TB in a patient presented to a multi-specialty hospital in Kerala, India, with SA.

Stump appendicitis in children: a systematic review.

BACKGROUND: Stump appendicitis is a rare complication after primary appendectomy and is often not considered in the differential diagnosis of patients who have undergone an appendectomy. With this systematic review, the aim was to identify all cases of stump appendicitis in children in order to gain a better insight into the risk factors, clinical presentation, diagnostics, and treatment. METHODS: Scopus and PubMed databases were searched. The search combinations used the following MeSH and free text terms: [(stump) OR (residual) OR (remaining) OR (retained) OR (recurrent)] AND (append*). Neither search filters nor text analysis tools were used. To be included, the report had to contain information about a patient between the age of 0 and 18 who was treated for stump appendicitis as a result of an inadequately performed appendectomy. RESULTS: Out of the 19,976 articles, 29 of them, with a total of 34 cases, met the inclusion criteria. The mean age at the time of stump appendectomy was 13.32 ± 3.57 years, while the median time between primary and stump appendectomy was 7.5 (2.3 - 24.0) months. The ratio between boys and girls was 3.2: 1. Primary appendectomy was performed laparoscopically in a greater number of cases compared to the open approach (1.5: 1), and according to the available data, no higher proportion of complicated appendicitis was recorded during a primary appendectomy. The median duration of symptoms during stump appendicitis was 2 days, and in most cases, the pain was localized. Stump appendectomy in most cases was performed with an open approach, and in relation to the type of appendicitis, most of them were complicated. The mean value of the length of the stump was 2.79 ± 1.22 cm, and the smallest recorded length was 0.6 cm. CONCLUSIONS: A non-specific clinical presentation with a history of appendectomy usually makes the diagnosis of stump appendicitis challenging for uninformed physicians, and due to untimely treatment, it usually results in complicated forms of stump appendicitis. Complete appendectomy remains the gold standard in the treatment of stump appendicitis.

Appendicoliths, the little giants: A narrative review.

OBJECTIVES: This narrative review aims to collate the data in the existing literature on appendicoliths, by reviewing the available information on appendicoliths that have been previously reported in 24 publications, and providing the information in one article. KEY FINDINGS: Appendicoliths are frequent culprits in causing luminal obstruction of the appendix, leading to appendicitis. They are calcified masses formed as a result of the aggregation of faecal particulates and inorganic salts within the lumen of the appendix. The presence of appendicoliths in an inflamed appendix influences the patient's treatment, as surgery is usually done to avoid appendix perforation and abscess formation, and also to prevent a future recurrence of the disease. Appendicoliths are mostly imaged using CT, Ultrasound, and plain X-rays; however, CT is the most frequently used modality, particularly in the imaging of complications caused by 'retained' appendicoliths. 'Retained' appendicoliths and their consequential abscesses have been reported in the sub-hepatic and intrahepatic regions, pelvic and tubo-ovarian regions, gluteal region, subcutaneous layer, subphrenic region, and through the diaphragm into the chest cavity. CONCLUSION: This review provides useful information on the imaging appearances and complications caused by the presence of appendicoliths in an inflamed appendix, and it also provides information on the clinical implications of 'dropped' appendicoliths during appendectomy. IMPLICATIONS FOR PRACTICE: Based on the findings of this review, it is recommended that the appropriate imaging modality (ultrasound and/or CT) should be considered when imaging appendicoliths and its complications. It is also suggested that retained appendicolith be considered a differential diagnosis when imaging patients with a history of appendectomy due to complicated appendicitis/perforation.

Stumped by Appendicitis: A Rare Cause of Acute Abdominal Pain.

Acute appendicitis is one of the most common diagnoses in the emergency department. As with other surgical procedures, post-appendectomy complications are numerous and can be either immediate or delayed. Stump appendicitis is an underreported and underrecognized complication that is often diagnosed radiologically while ruling out other diagnoses. We report a case of a 26-year-old male presenting with acute right lower quadrant abdominal pain. Although he initially denied any surgical history, a focused abdominal exam revealed an incisional scar which turned out to be the result of an appendectomy nine years ago. The patient was worked up for alternate causes of right lower quadrant pain. Investigations revealed high inflammatory markers and hematuria. We proceeded with a non-contrast CT scan to rule out vesicoureteric junction stone. Instead, the scan was suggestive of stump appendicitis. The patient was admitted and treated conservatively. Maintaining a high index of suspicion for stump appendicitis, especially in patients with a clinical picture typical of appendicitis but a history of appendectomy, is key to making an early diagnosis and avoiding further complications.

Twice perforated stump appendicitis: a case report.

Stump appendicitis is an acute inflammation of the residual appendix and one of the rare complications after appendectomy. Stump appendicitis is an under-reported and poorly defined condition related to obstruction and inflammation of the residual appendix after an appendectomy, usually by a fecolith. It remains a clinical challenge because of delayed diagnosis and subsequent treatment with increased morbidity or mortality. Herein, we describe the case of a 42-year-old male who presented with periumbilical pain with progression to generalized abdominal pain and signs of peritonitis 14 months post appendectomy. An exploratory laparotomy revealed an inflamed, non-gangrenous perforated appendices stump. We discuss the challenges in the diagnosis and management thereof.

Stump appendicitis.

Stump appendicitis is a rare and late complication following appendectomy and can often be overlooked. Our case details a 42-year-old male who presented to the Emergency Department with right-sided lower abdominal pain, nausea, and vomiting. A computed tomography scan of his abdomen and pelvis demonstrated a tubular, fluid-filled structure with surrounding inflammatory changes at the level of the patient's appendectomy clips with a 2.3-cm calcified intraluminal stone. Findings were concerning for stump appendicitis with appendicolith. He was admitted and taken to the operating room for a laparoscopic stump appendectomy. Stump appendicitis should always be considered in the differential diagnosis to prevent potentially serious complications.

A Case of Stump Appendicitis Secondary to Appendicular Fecolith.

A 32-year-old male patient presented to the emergency department with colicky peri-umbilical abdominal pain and nausea for two days. On examination, there was generalized lower abdominal tenderness with no fever. A computed tomography scan of the abdomen and pelvis revealed signs of acute appendicitis. Upon further questioning, the patient gave a history of appendectomy that took place eight years ago. Although rare, stump appendicitis can occur. A radiologist should always consider stump appendicitis in the differential diagnosis of right lower quadrant pain.

An unusual case of perforated stump appendicitis: A case report.

Introduction and importance: The stump appendicitis is a rare complication with incidence of 1 in 50,000 appendectomy cases. Case presentation: Patient with a history of emergency open appendectomy one year back presented with symptoms as that of acute appendicitis like pain abdomen localized in right iliac fossa, nausea, vomiting and anorexia. Complete blood count showed leukocytosis. Clinical discussion: Aside from classical clinical symptoms similar to acute appendicitis other causes of acute abdominal pain were ruled out with clinical laboratory and radiological investigations. This creates a dilemma and delay in diagnosis if investigations are not done promptly. Conclusion: Due to prior surgical history of appendectomy and low index of suspicion, the diagnosis of stump appendicitis is often delayed which may result in serious complications like stump gangrene, perforation and peritonitis.

High-volume center analysis and systematic review of stump appendicitis: solving the pending issue.

PURPOSE: Stump appendicitis (SA) is a rare long-term complication after laparoscopic appendectomy (LA) that can be associated with high morbidity due to delayed diagnosis. We aimed to determine the incidence, risk factors, diagnosis, and management of SA by reviewing our large cohort of LA and performing a systematic review of the literature. METHODS: We retrospectively reviewed data of all patients who developed SA after LA between 2006 and 2020. Demographics, peri-operative variables, and postoperative outcomes were analyzed. A systematic review of the PubMed/MEDLINE, Embase and GoogleScholar bibliographic databases was also performed to identify publications regarding SA following LA. RESULTS: A total of 2,019 patients underwent LA; 5 (0.25%) developed SA after a median of 292 days. The most common symptom at presentation was right lower quadrant pain. Four SA (80%) occurred in patients with a history of complicated appendicitis at index operation. All patients were diagnosed with computed tomography and underwent completion stump appendectomy by laparoscopy. No postoperative complications were recorded. A total of 55 studies with 76 cases of SA after LA were identified in the systematic review. Most SA (98.7%) underwent surgery: 52% by laparoscopic approach and 36% through an open approach. Stump appendectomy was performed in 94.4% cases and an extended resection in 5.6%. CONCLUSION: Although SA is a rare complication after LA, a high index of clinical suspicious and imaging studies are key for early diagnosis and treatment. A laparoscopic resection of the inflamed appendiceal stump is feasible, safe, and highly effective. A minority of patients with severe cecum compromise may need extended resections or conversion to open surgery.

Stump appendicitis, a rare but serious complication of appendectomy: A case report.

Stump appendicitis is a rare delayed post-appendectomy complication. This diagnosis must be considered in case of right iliac fossa pain in a patient with a history of appendicectomy.

Stump appendicitis after laparoscopic appendectomy; laparoscopic management and literature review.

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.

Is appendectomy a simple surgical procedure?

OBJETIVO: La apendicitis aguda es uno de los procedimientos quirúrgicos más aplicados en todo el mundo. Una de las complicaciones de la apendicectomía es la apendicitis del muñón. El diagnóstico de apendicitis del muñón suele retrasarse. MÉTODOS: En nuestro estudio recopilamos casos de apendicitis del muñón tras apendicectomía. Todos los casos con apendicectomía abierta y laparoscópica fueron incluidos en nuestro estudio. RESULTADOS: Entre 2008 y 2020 se examinaron 5620 pacientes apendicectomizados que fueron operados en la clínica de cirugía general. Se realizó apendicectomía en 5 pacientes por apendicitis del muñón. Uno de los pacientes con apendicitis del muñón presentó síntomas de peritonitis generalizada, otro con síntomas de íleo, el otro con síntomas de hernia de incisión encarcelada en la incisión de Mc Burney y los otros dos pacientes con síntomas de apendicitis aguda. CONCLUSIONES: Como se desprende de nuestro estudio, si bien la apendicectomía es el procedimiento quirúrgico más común y fácil de ver en la práctica quirúrgica general, es un procedimiento que aumenta la morbilidad como vemos en los pacientes con apendicitis del muñón. La tomografía abdominal parece ser el estándar de oro en el diagnóstico de la apendicitis del muñón. Los cirujanos definitivamente deben sospechar apendicitis del muñón en pacientes cuyos síntomas han mejorado, incluso con cicatrices de apendicectomía abierta. OBJECTIVE: Acute appendicitis is among the most applied surgical procedures around the world. One of the complications of appendectomy is stump appendicitis. The diagnosis of stump appendicitis is usually delayed. MATERIAL AND METHOD: In our study, we compiled cases with stump appendicitis after appendectomy. All cases with open and laparoscopic appendectomy were included in our study. RESULTS: Between 2008 and 2020, 5620 appendectomy patients who were operated in the general surgery clinic were examined. Appendectomy was performed in five patients due to stump appendicitis. One of the patients with stump appendicitis presented with symptoms of generalized peritonitis, another with symptoms of ileus, the other with symptoms of incarcerated incision hernia at the McBurney incision, and the other two patients with symptoms of acute appendicitis. CONCLUSION: As it can be understood from our study, although appendectomy is the most common and easily seen surgical procedure in general surgical practice, it is a procedure that increases morbidity as we see in patients with stump appendicitis. Abdominal tomography appears to be the gold standard in diagnosis in stump appendicitis. Surgeons should definitely suspect stump appendicitis in patients whose symptoms have improved, even with open appendectomy scarring.

Stump appendicitis - a systematic analysis.

<b>Aim:</b> The study was conducted to analyze stump appendicitis which is a long-term complication of appendectomy - the otherwise commonest general surgical procedure conducted in the world. </br></br> <b>Methods:</b> 48 cases included from 36 articles published in the peer reviewed journals of repute were evaluated for eight variables including: (I) age of the patient, (II) gender, (III]) duration of symptoms, (IV) imaging, (V) interval time since initial operation, (VI) details of initial operation, (VII) management, (VIII) stump length if managed by operation. </br></br> <b> Results:</b> 48 cases (27 males and 19 females) ranging in age from 2 to 72 years reported after a wide range of time (3 days - 46 years) after primary appendectomy. The duration of symptoms ranged from 1 day to 7 months. As many as 31 (64.5%) cases had inflamed stump appendix whereas 17 (33.5%) had perforation. Twenty-one (43.7%) had undergone laparoscopic primary appendectomy and 27 (56.3%) had undergone open appendectomy. Management of the retained stump included stump appendectomy in 42 (87.5%), right hemicolectomy in 2 (4.2%) and conservative in 4 (8.3%) cases. In the 44 cases managed by surgical intervention, the approach was open in 27 (61.4%) and laparoscopic in 17 (38.6%) cases. The length of the retained appendix stump ranged from 0.5 cm to 6.5 cm (mean 2.14 cm). </br></br> <b>Conclusion:</b> Stump appendicitis is an entity that a physician needs to suspect if a patient reports with features of appendicitis even after appendectomy had been conducted. Management is generally surgical and aimed at removal of the retained appendiceal stump.

Recurrent stump appendicitis.

Acute appendicitis is one of the most common reasons for abdominal surgery. Stump appendicitis, one of the rare complications of appendicitis surgery, is an inflammation that develops in the remaining part of the appendix following surgery and occurs at a rate of 1/50.000 in cases with appendectomy. Although patients manifest the same findings as those with acute appendicitis on physical examination and laboratory tests, the history of previous appendectomy may cause delays in diagnosis.. Complications such as perforation and peritonitis can develop if an early diagnosis cannot be made. In this article, we present the first case of recurrent stump appendicitis reported in the literature as far as we are aware.

Stump Appendicitis: Clinical and CT Findings.

OBJECTIVE. Recurrent inflammation of the appendiceal stump after appendectomy is rare; published case series have included no more than six patients. The purpose of this study was to report the clinical and CT findings in a larger original series. MATERIALS AND METHODS. A combined PACS and electronic medical record search identified the cases of 14 patients (nine men, five women; mean age, 42.8 years) with a confident diagnosis of stump appendicitis evaluated at CT. In seven cases, CT images obtained at the initial presentation of appendicitis were available for review. Relevant clinical and CT findings were reviewed by three abdominal radiologists in consensus. RESULTS. The mean time interval between initial appendectomy and stump appendicitis was 5.1 years (range, 5 weeks-17.5 years); seven cases occurred within 1 year of appendectomy. Ten (71%) of initial appendectomies were performed by a laparoscopic approach. CT showed the mean appendiceal stump length was 3.2 cm (range, 1.3-7.0 cm); residual stump length measured 2 cm or longer in all but one case. Appendicoliths were identified at the stump in seven (50%) cases; the mean diameter was 0.9 cm and mean maximal attenuation, 247 HU. Extensive inflammatory changes surrounded the appendiceal stump at CT in all cases, including peristump abscess in four (29%) cases. Seven of the 14 patients (50%) went on to open surgical management with either remnant appendectomy or partial ileocecectomy. CONCLUSION. Stump appendicitis has a characteristic CT appearance and may occur within the first year after appendectomy or many years later. A long (≥ 2 cm) appendiceal stump from laparoscopic appendectomy and retained appendicolith may predispose adult patients to recurrent obstruction and inflammation.

Adenocarcinoma of Stump Appendicitis: An Extremely Rare Pathology - A Literature Review.

Emergency appendectomy for acute appendicitis is the most common emergency surgical procedure performed all over the world. While amputating the appendix from the cecum, a small (usually less than 5 mm) stump is left behind. Below this, the suture or stapler is applied to secure the base of the appendix, which is now known as a stump. Stump appendicitis, the inflammation of appendiceal remnant after an appendectomy, is a rare phenomenon. Additionally, the incidence of adenocarcinoma in the stump of the appendix is also extremely rare and can present with the symptoms of appendicitis. Adenocarcinoma in stump appendectomy patients can present from 5-43 years after the index appendectomy surgery. The majority of patients present with symptoms similar to that of appendicitis, with right lower quadrant abdominal pain, usually diagnosed via CT scans, after which they undergo stump appendectomy. The diagnosis of adenocarcinoma is only made on the histopathology report. We engaged in a review of the relevant literature published in the English language for the last 100 years. This was conducted by reviewing Google Scholar, PubMed, and MEDLINE® databases, as well as references to all related articles. There are only six cases reported in the literature, which shows the rarity of this condition. Regarding the appropriate treatment for this rare entity, multi-disciplinary team discussions should be carried out for optimum management of the individual patients. Right hemicolectomy is the recommended procedure for all patients, and prognosis depends on the staging of the disease.

Stump appendicitis, a case report and a review of the literature. Is it as uncommon as it is thought?

INTRODUCTION: Acute appendicitis (AA) is the most common cause of acute surgical abdomen. Complications from surgical appendectomy include intraabdominal abscess, bleeding, surgical site infections, ileus, and stump appendicitis (SA). This last one is one of the least common ones with a reported incidence of 1:50.000. METHODS: We present a case and review 132 cases of SA reported in the literature. Demographic and clinical characteristics were evaluated, as well as details of the surgical treatment. Categorical variables are presented as quantities and proportions, and continuous variables with median and interquartile range. Additionally, we calculate an incidence from 3 papers reported in the literature and our own. RESULTS: We analyzed 132 cases, 60.3 % were male with a median age at SA of 33 years. There was a wide range time interval between the episode of AA and SA from 1 day to 60 years. Initial open appendectomy was reported in 62 cases. From all the patients with SA 51 % reported complications. The median length of the appendiceal stump was 3 cm. The incidence of SA fluctuated between 0.22-1.37 in 1.000 cases of appendectomies. DISCUSSION: SA is usually underrated, and which are the risk factors for this condition are not clear. The data available suggest that a primary laparoscopic appendectomy is not related to SA, but the length of the stump left in the first surgery might be associated. The incidence of SA seems to be higher than the one reported of 1 in 50.000.

Stump appendicitis occurred two and half years after first laparoscopic appendectomy for perforated appendicitis with abscess: A report of a case.

INTRODUCTION: The management of appendiceal abscess or phlegmon is a clinical important issue. Immediate appendectomy in these cases may be technically demanding because of the distorted anatomy and difficult to close the appendiceal stump because of the inflammation. PRESENTATION OF CASE: A 32-year-old female was referred to our hospital with abdominal pain. Enlarged appendix and abscess were recognized on CT scan. Preoperative diagnosis was perforated appendicitis with abscess and laparoscopic surgery was performed. The appendix was perforated and cut by stapler, but complete resection was impossible. Endoscopic transrectal drainage was performed for a pelvic abscess on the 10th POD and the patient's condition improved. Thirty months after the surgery, however, the patient was again referred to our hospital for abdominal pain. CT scan revealed an enlarged remnant appendix. Preoperative diagnosis was stump appendicitis after the incomplete first appendectomy. Emergent second appendectomy and partial resection of the cecum were performed. The postoperative course was uneventful. DISCUSSION: In the first operation, we mistakenly thought that the base of the appendix was cut. It was not cut, however and it remained, which was lead to stump appendicitis. Furthermore, postoperative abdominal abscess was also occurred. Immediate appendectomy for perforated appendicitis with abscess is associated with a higher morbidity. Nonsurgical treatment with drainage and/or antibiotics should be selected. Laparoscopic drainage is the useful options when CT-guided drainage is impossible. CONCLUSION: It is crucial to understand the correct management of perforated appendicitis with abscess to avoid serious complications.

History of appendectomy? An atypical case of recurrent abdominal pain.

Acute appendicitis is a common condition emergency physician encounter during pediatric emergency visits. With a reported incidence of 1 in 50,000 appendectomies, stump appendicitis, an acute inflammation of the residual appendicular tissue, is a rare post-operative complication. The diagnosis of stump appendicitis is time-critical to prevent associated morbidities of abscess formation, perforation and sepsis. Another atypical presentation of appendicitis includes recurrent appendicitis, which is recognized as one or more previous episodes of similar clinical presentation as acute appendicitis, but symptoms subside within 24 to 48 hours. Intervals between attacks may vary from weeks to years during which the patient may be asymptomatic. Although recurrent appendicitis is rare, emergency physicians should be aware of this possibility and to not assume that previous appendectomy precludes recurrent appendicitis. This case highlights the importance of considering such unusual condition in a patient presenting with recurrent right-sided abdominal pain.