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WJOLS

10.5005/jp-journals-10007-1107
ORIGINAL ARTICLE Stump Appendicitis: A Bane or Boon of Laparoscopic Appendectomy
Stump Appendicitis: A Bane or Boon of

Laparoscopic Appendectomy

2
1 Sreeramulu PN, Nikhil S Shetty, Mahesh Babu B, Asadulla Baig, Supreeth CS
3
2
2
1 Professor, Department of General Surgery, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
2 Resident, Department of General Surgery, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
3 Assistant Professor, Department of General Surgery, Sri Devaraj Urs Medical College, Kolar, Karnataka, India

ABSTRACT
Appendiceal stump appendicitis is a very rare surgical event, though acute appendicitis is still the most common cause of abdominal
surgeries worldwide. The incidence of appendiceal stump appendicitis is on a gradual rise possibly due to laparoscopic surgeries. In this
study, we report a 54-year-old woman with preoperatively diagnosed stump appendicitis by ultrasound who underwent a laparoscopic
appendectomy 8 years ago.
Keywords: Appendiceal stump appendicitis, Laparoscopic appendectomy.

INTRODUCTION Abdomen was closed in layers. Histopathological
Acute appendicitis is still the most common cause of examination confirmed stump appendicitis.
abdominal surgeries worldwide. Even though the clinical DISCUSSION
features of stump appendicitis do not differ from those of
acute appendicitis, the diagnosis is often not considered Stump appendicitis is a rare clinicopathological entity
due to prior surgical history. characterized by inflammation of appendiceal remnant after
This paper reports a patient with preoperatively incomplete appendectomy. This clinical condition should
diagnosed stump appendicitis by ultrasound who had be considered in differential diagnosis of acute abdominal
undergone a laparoscopic appendectomy 8 years ago. pain and surgery should not be delayed.
Following the first case reported by Rose in 1945, around
CASE REPORT 36 cases have been reported in worldwide medical literature.

A 54-year-old woman was admitted with diffuse abdominal Majority of the patients fall within 11 to 72 years. Clinical
pain, nausea and vomiting since 2 days. There was no presentation of stump appendicitis may be acute or subacute
relevant medical history except a laparoscopic appendec- and can occur as early as 2 months to 50 years after initial
tomy performed 8 years ago. On physical examination, she appendectomy. Appendiceal stump lengths are reported to
had temperature of 39ºC (axillary), blood pressure range from 0.5 to 5.1 cm. Leaving a stump less than
110/70 mm Hg and pulse rate of 100/minute. Her abdomen 3 mm long in the original surgery may prevent stump
was tender and there was a rebound tenderness and guarding appendicitis. In our case, the length of the appendiceal stump
in right iliac fossa.
Routine labortary tests, such as total count was 15,500
with majority of polymorphonuclear leukocytes (PMN)
(73%).
Examination of previous operation records confirmed
laparoscopic removal of suppurative appendicitis. Abdominal
ultrasound revealed small amount of fluid in right iliac fossa
and increased thickness (8 mm) of the residual cecal
appendix. A preoperative diagnosis of stump appendicitis
was made.
Patient was posted for laparotomy procedure. Per-
operative findings were cecal edema, and multiple adhesions
between omentum and cecum. Further exploration revealed
inflammed remnant appendiceal stump measuring around
4 cm (Figs 1 and 2). Stump appendectomy was done. Fig. 1: Inflammed remnant appendiceal stump

World Journal of Laparoscopic Surgery, January-April 2011;4(1):5-6 5