Arthur Berg, Elizabeth Verrico, Jenna Gillen, Steven Shikiar, General Surgeon, John Davis, Program Director. Hackensack Meridian Health Center
Introduction: Stump appendicitis is a rare post-operative complication, with an incidence reported in the literature around 1 in 50,000 cases. It poses a diagnostic challenge and can mimic benign non-surgical causes of abdominal pain. Our patient presented with perforated stump appendicitis seen on CT imaging which was treated laparoscopically. A significant majority of cases in the literature have completion appendectomies performed in the open fashion. We discuss our successful laparoscopic approach as well as review management and risk factors of stump appendicitis in the literature.
Case Report: Our patient is a 22-year-old female with past medical history of Laparoscopic Appendectomy in the year prior presenting with sharp right lower quadrant abdominal pain. Of note, she had two readmissions for stump appendicitis in a span of 6 months since her appendectomy however elected for non-operative management. She was found to have perforated stump appendicitis on CT and intra-operatively was found to have purulent peritonitis. Partial cecectomy was performed including the segment of stump appendix. She did well post-operatively and was discharged on POD 3.
Discussion: Stump appendicitis is a rare post-operative complication with an incidence reported in the literature around 1 in 50,000 cases. The incidience of stump appendicitis is rising likely secondary to increased used of laparoscopy and the lack of tactile sensation while feeling for an appendiceal stump. Other risk factors include anatomical variations, presence of faecolith, and stump length greater than 5mm. Aside from stump appendicitis, another danger of a long residual stump is the risk of harboring a small bowel cancer or carcinoid. The possibility of a duplicated appendix must be ruled out as well.
A large majority of cases in the literature have completion appendectomies performed in the open fashion. In our case, laparoscopy allowed us to have a global inspection of the abdomen while avoiding the need for a laparotomy incision or ileocolic resection, however there are no long-term studies on the outcomes between laparoscopic and open approaches.
Conclusion: Stump appendicitis is a rare post-operative complication of laparoscopic appendectomy. Given that it can mimic non-surgical causes of abdominal pain and its incidence is on the rise, a high index of suspicion is needed by clinicians to make an accurate diagnosis. The surgical management of perforated stump appendicitis is underreported in the literature and typically performed in an open fashion. We report a successful case of laparoscopic completion appendectomy of perforated stump appendicitis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93984
Program Number: P030
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster