Page 20 - Delaware Medical Journal - September 2016
P. 20
Stump Appendicitis
Roland M. Dimaya, DO; Novneet Sahu, MD
Stump appendicitis is a delayed complication of appendectomy. Patients present with symptoms similar to an initial presentation for appendicitis. Diagnosis is often delayed as history of appendectomy often precludes focused workup for an appendiceal
source of infection. A 39-year-old female presented to our emergency department with worsening abdominal pain and fever. She
had a past surgical history of a laparoscopic appendectomy approximately 14 months prior to presentation. During her admission, she was diagnosed with ruptured stump appendicitis by computerized tomography (CT) imaging. A percutaneous drain was placed and the patient was discharged with antibiotics. Follow up evaluation revealed clinical improvement, with resolution of peri-appendiceal stump inflammation and subsequent percutaneous drain removal. Completion appendectomy is tentatively scheduled. This case highlights awareness of stump appendicitis as a differential diagnosis for patients with previous appendectomy who present with acute abdominal pain.
IntroductionWith increasing incidence of acute appendicitis in
the United States, from 7.62 to 9.38 per 10,000 between 1993 and 2008,1 appendectomy remains a common procedure for general surgeons, with most recent estimates demonstrating 349,000 appendectomies performed in the US in 2010.2 Postoperative complications include wound infection, bleeding, intraabdominal abscess, small bowel obstruction, and, rarely, appendiceal tissue after appendectomy.3
With its rare incidence, stump appendicitis offers a diagnostic dilemma during workup of a patient with previous appendectomy who presents with acute abdominal pain. This
may result in delays in diagnosis and treatment. Herein, we present a case of stump appendicitis at our institution.
CASE REPORT
A 39-year-old female presented to the emergency department with abdominal pain and nausea. She reported that the pain started three days prior and was intermittently sharp and crampy in nature. She reported associated nausea, with no vomiting.
The patient denied chest pain, shortness of breath, urinary symptoms, diarrhea, or constipation. She had decreased appetite and reported no aggravation or alleviation of her pain with eating. The patient was seen in the emergency department after initial onset of her pain three days prior to the current visit. At
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Del Med J | September 2016 | Vol. 88 | No. 9
Abstract
