外科ジャーナル

Laparoscopic Management of Stump Appendicitis after Open Appendectomy

Abstract

Botianu Petre Vlah Horea, Botianu Ana Maria Voichita and Boeriu Alina

Introduction: Stump appendicitis is a very rare complication after appendectomy with possible serious complications in the absence of a correct diagnosis.

Case Presentation: We present the laparoscopic diagnosis and treatment of an extremely rare complication after open appendectomy (remnant stump appendicitis). We report a female patient with a history of open appendectomy performed 7 months ago in another unit. She presented now with persistent typical signs of acute appendicitis, identical with those encountered before the open appendectomy. Repeated US and CT scans were normal. Due to the persistent complaints, a decision for exploratory laparoscopy was made. Intra-operatively we found some adhesions in the right iliac fossa and a 20 mm length appendicular stump which was adherent to the anterior abdominal wall. The stump was dissected, ligated at the base and removed using a 3 trocars approach and standard laparoscopy instruments. The postoperative course was favorable, resolution of the pain and no recurrence at a 3 years follow-up. The pathologic examination showed the typical histologic structure of an inflamed appendix.

Discussions: The diagnostic of stump appendicitis is a difficult one in the absence of a high index of suspicion. The case is interesting due to the rarity and the use of a laparoscopic approach to treat an incomplete open appendectomy.

Conclusions: Laparoscopy is useful in patients with persistent abdominal symptoms after open appendectomy. If an appendicular stump is present, it allows its identification and safe removal.