Stump appendicitis in children

Stump appendicitis is a delayed complication of incomplete appendectomy. Reinflammation of possible residual appendiceal tissue should be considered in patients with right lower quadrant pain and a surgical history of appendectomy. In this report, we present 3 cases of stump appendicitis in children.     

Stump appendicitis: a surgeon's dilemma

Background:

Stump appendicitis is defined by the recurrent inflammation of the residual appendix after the appendix has been only partially removed during an appendectomy for appendicitis. Forty-eight cases of stump appendicitis were identified in the English literature.

Database:

The institutional CPT codes were evaluated for multiple hits of the appendectomy code, yielding a total of 3 patients. After appropriate approval from an internal review board, a retrospective chart review was completed and all available data extracted. All 3 patients were diagnosed with stump appendicitis, ranging from 2 months to 20 years after the initial procedure. Two patients underwent a laparoscopic and the one an open completion appendectomy. All patients did well and were discharged home in good condition.

Conclusion:

Surgeons need a heightened awareness of the possibility of stump appendicitis. Correct identification and removal of the appendiceal base without leaving an appendiceal stump minimizes the risk of stump appendicitis. If a CT scan has been obtained, it enables exquisite delineation of the surrounding anatomy, including the length of the appendiceal remnant. Thus, we propose that unless there are other mitigating circumstances, the completion appendectomy in cases of stump appendicitis should also be performed laparoscopically guided by the CT findings.     

Stump appendicitis: case report and review

The purpose of this study is to review the medical literature regarding the prevalence of appendicitis in patients with previous appendectomy. Stump appendicitis is a real entity not often considered when evaluating patients with right lower quadrant pain and a history of appendectomy. This leads to delays in diagnosis and treatment. An extensive review of the world literature using Medline, MD Consult, and the references of articles found using these methods to gather information regarding stump appendicitis. Results showed 29 cases of stump appendicitis have been reported in the world literature. Herein we review the literature as well as present a case study. Stump appendicitis is a real, yet probably underreported entity. It can occur after either laparoscopic or open appendectomy. Avoidance of a long appendiceal stump is the only suggested means by which to avoid its occurrence.     

Stump appendicitis after laparoscopic appendectomy: case report

Stump appendicitis is a rare delayed complication of appendectomy. The delay in diagnosis is usually because of a prior history of appendectomy. We report a case of stump appendicitis diagnosed pre-operatively with a computerized tomography (CT) scan after laparoscopic appendectomy. An 18-year-old male presented with a one-week history of lower abdominal pain, nausea and vomiting. He had a history of laparoscopic appendectomy for acute appendicitis. Physical examination revealed tenderness and guarding in the lower abdomen. CT scan showed free pelvic fluid with a tubular structure of about 2.5 cm in length and 0.78 cm in diameter located posterior to the ileo-cecal junction. Laparoscopic exploration confirmed the findings. A residual appendiceal stump was found and dissected from the adhesion and removed. Histopathology showed a residual appendix with transmural neutrophilic infiltration associated with multifocal hemorrhagic necrosis. The postoperative period was uneventful. The diagnosis of stump appendicitis can be challenging. CT scan has proven to be a useful tool for the diagnosis of this rare condition.     

Stump appendicitis: a comprehensive review of literature

Appendectomy for appendicitis is one of the most common procedures performed in the United States. Residual tissue left after an initial appendectomy risks the development of stump appendicitis. A comprehensive review of the English-language literature revealed 36 reported cases of stump appendicitis. Typically, patients present with signs and symptoms similar to acute appendicitis; however, due to prior surgery, the diagnosis is difficult and the rate of appendiceal stump perforation is extremely high. Herein, we present a case of a 32-year-old female presenting with right lower quadrant pain, nausea, and fever 5 months after laparoscopic appendectomy. Upon surgery, an appendiceal stump was discovered.     

Stump appendicitis after laparoscopic appendectomy; laparoscopic management and literature review

IntroductionAppendectomy 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 case38-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.DiscussionStump 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.ConclusionsIt 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     

Stump appendicitis 10 years after appendectomy,a rare,but serious complication of appendectomy,a case report

We describe a case of stump appendicitis with the formation of abdominal abscesses in a 41-year-old patient 10 years prior appendectomy. The patient consulted with fever (38.1?°C) and abdominal pain, located at the right iliac fossa. Imaging studies showed signs of abscesses, located at the right iliac fossa, without clear origin of these abscesses. The abscesses were drained through diagnostic laparoscopy, no bowel perforation or clear origin of the abscedation was found during laparoscopy. During postoperative stay, the inflammatory parameters rose and the abscesses reoccurred. Re-laparoscopy was performed, the abscesses were drained and on careful inspection and adhesiolysis, a perforated stump appendicitis was revealed, covered underneath layers of fibrous tissue. Stump appendicitis is a rare complication seen after appendectomy and is generally not considered a possible etiology in patients presenting with fever and right iliac fossa abdominal pain with a history of appendectomy. This often delays the correct diagnosis and results in an associated increased incidence of complications. We describe a case of stump appendicitis occurring 10 years after initial appendectomy.     

Stump overgrowth in juvenile amputees

Stump overgrowth requiring surgical revisions occurred in 58 of 1,015 (5.7%) skeletally immature patients with congenital and acquired amputations. Acquired below-knee amputation was the most common type needing revision (18.5%), and the congenital group not requiring a conversion had the least overgrowth problem (1.7%). When the primary amputation occurred after the age of 12 years or when disarticulation was carried out, revisions were unnecessary. The younger the patient, the greater the incidence of repeated revisions. Study of the histological changes in eight juvenile congenital and acquired amputees revealed two patterns: reactive connective tissue stratification and a bursa.     

Stump cancer following gastric surgery

This paper reviews the literature regarding the development of gastric cancer in the stomach remnant following gastric resection. Although there is as yet little supporting experimental evidence, clinical studies suggest that the risk of developing gastric cancer is increased, perhaps as much as 6-fold, following partial gastrectomy for benign lesions. It also appears that the risk of developing cancer is greatest if the lesion for which the gastrectomy was originally performed was a gastric ulcer rather than a duodenal ulcer. The type of gastrectomy does not seem to influence this increased risk. Hypotheses are reviewed concerning the role of changes in gastric morphology following partial gastrectomy in the development of cancer.

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Résumé Revue de la littérature concernant le développement d'un cancer dans le moignon gastrique après gastrectomie subtotale. Malgré l'absence de preuve expérimentale, les études cliniques suggèrent que le risque d'apparition d'un cancer est accru, peutêtre jusqu'à 6 fois, après gastrectomie pour lésion bénigne. Le risque semble être également plus élevé après gastrectomie pour ulcère gastrique que pour ulcère duodénal. Le type de résection gastrique n'a aucune influence. Diverses hypothèses ont été émises concernant les altérations postopératoires de la morphologie gastrique et leur rôle possible dans le développement du cancer: ces hypothèses sont revues.

     

Stump resections resulting from incomplete operations

Stump viscera caused by an incomplete operation can present the same symptoms as before the first operation. Furthermore, as an acute clinical event, these incomplete resections may sometimes cause acute abdomen and may need emergency surgical intervention. A 34-year-old woman with a history of laparoscopic cholecystectomy 5 days before was admitted with acute abdominal symptoms. Abdominal exploration revealed that she had undergone incomplete resection of the gallbladder. Another patient, a 21-year-old man, was admitted with complaints of fluid drainage from his appendectomy incision scar. He was diagnosed as having enterocutaneous fistula. Abdominal exploration revealed a stump appendix fistulizing to the abdominal wall. The third patient was a 32-year-old man with an appendectomy scar who was admitted with complaints of acute appendicitis. The patient was diagnosed as having acute appendicitis and underwent an appendectomy. A stump appendix was removed during the operation. Surgeons should be aware of stump pathologies and keep in mind a possible incomplete operation to prevent delayed diagnosis and treatment.     

Stump consolidation after video-assisted thoracoscopic segmentectomy

Pulmonary segmentectomy by video-assisted thoracic surgery (VATS) is used for minimally invasive surgery for removal of small lung neoplasms, and stump consolidation is one of the potential postoperative complications. The objective of the present study is to clarify the incidence of stump consolidation and its predictive factors by assessing patients who underwent VATS segmentectomy in our department. Stump consolidation was defined as atelectatic lesions along the surgical stump with >10 mm thickness in horizontal sectional view by computed tomography, at least 3 months after surgery. Between February 2007 and September 2010, 70 patients (38 men and 32 women) with primary lung cancer (43 patients) and metastatic pulmonary tumor (27 patients) underwent VATS segmentectomy. Stump consolidations were seen in 7 patients. Univariate analysis showed the significant difference for the period of performed operation. Left-sided operation, especially segmentectomy of left S(1+2), was another predictive factor, though not significant. Stump consolidation after VATS segmentectomy can be deueloped by conbined workspace for stapling and misidentification of intersegmental plane. When division of the intersegmental plane is difficult, open thoracotomy should be undertaken to prevent such compliance.     

Stump fractures in lower extremity amputees

A series of 23 above-knee and below-knee amputees who sustained an ipsilateral lower extremity fracture was qualitatively evaluated with respect to the nature of the injuries sustained, associated problems, and results of fracture treatment. The overall incidence of these fractures was 3% in a population of lower-extremity amputees. The stump fractures encountered were distal femur fractures and fractures about the hip. More than one fourth of these fractures had an initially missed or 'delayed' diagnosis. Most femur fractures were successfully treated by nonoperative means, and most of the hip fractures were treated operatively. The final rehabilitated status of the dysvascular amputees was the poorest: one half of those who were previous household ambulators remained wheelchair confined postinjury.     

Acute appendicitis

Acute appendicitis is inflammation of the vermiform appendix. It is the most common general surgical emergency in children and young adults, yet its diagnosis can still confound the most skilled surgeon. This difficulty arises because the presentation of appendicitis is highly variable, with less than 50% of patients exhibiting classical features. Taking a detailed history and performing a careful examination remains the cornerstone of diagnosis. Urinalysis and blood test, particularly CRP are useful adjuncts and are performed routinely. Radiological imaging, commonly US and CT scans, also have a role when the diagnosis is unclear and/or other common conditions need to be excluded such as gynaecological pathology in young females. Nevertheless, 20% of appendices removed in UK are histologically normal. Appendicitis scoring systems may further assist in stratifying risk and increasing the accuracy of diagnosis. Recently, there has been growing interest in non-surgical management of appendicitis. Antibiotics alone have been used to successfully treat uncomplicated appendicitis, i.e. without perforation, abscess or gangrene, thereby potentially avoiding the risks of surgery. However, nearly 40% of these cases eventually require appendicectomy. Therefore surgery, usually laparoscopic appendicectomy, remains the treatment of choice for acute appendicitis and non-operative management is reserved for specific cases.