Description

A 20-year-old male presented to our hospital after 2 days of low-grade fever, right lower abdominal pain and one episode of vomiting. The patient had undergone an appendectomy 2 months earlier. Physical examination showed abdominal rebound. Blood test revealed increased white cell count of 14 000 (leucocytosis).

Ultrasound (US) of abdomen (figure 1) showed, surprisingly, an inflamed stump appendix of 18 mm. CT confirmed the diagnosis of stump appendicitis (figure 2). The patient was treated at this time with intravenous antibiotics and had a good clinical outcome.

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Figure 1

Ultrasound of right lower abdomen showing a thick appendix of 18 mm.

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Figure 2

Abdominal serial axial ct slices at the level of the caecum showing thick inflamed stump of the appendix (white arrows).

Stump appendicitis is a rare complication of postappendectomy with recurrence of 1 in 50 000 cases. It is a challenging condition that is usually diagnosed and confirmed by means of imaging, especially by US and CT. Patients present with signs and symptoms mimicking those of appendicitis or acute abdomen. The time interval for onset of symptoms can range from 2 weeks to 2 years postappendectomy.1

Stump appendicitis usually occurs because of inadequate identification of the appendicular base due to severe local inflammation. It has been reported following open and laparoscopic appendectomy.

CT scan and US of the abdomen are both equally accurate for the diagnosis of stump appendicitis. Imaging findings may be similar to those seen in acute appendicitis. But usually because of rarity of this entity, it is preferable to perform CT to confirm the diagnosis after performing US.

Completion appendectomy is the treatment of choice for stump appendicitis. In our case the surgeon decided to treat the patient with intravenous antibiotics, which followed with a good outcome.