Surgery
Published October 21, 2025 | Version v1
Journal article Open

Post-appendectomy stump appendicitis case report

Authors/Creators

  • 1. University Hospital Lozenetz, Sofia, Bulgaria

Description

Introduction: Appendicitis is a very prevalent pathology and appendectomy is one of the most common procedures worldwide. The exact cause of appendicitis is not fully understood, however multifactorial associations have been associated. 
Stump appendicitis is the inflammation of the residual appendix, it is a rare complication, mimicking acute appendicitis and leading to delayed diagnosis and increased morbidity. We present a case of a patient who developed stump appendicitis after an open appendectomy.
Case presentation: A 48-year-old male presented with 24-hour right iliac fossa pain, nausea, and distension, complicated by prior emergency left hemicolectomy with appendectomy for perforated sigmoid colon. Relevant history included left renal agenesis, multiple trauma sequelae and substance use disorder in remission. Examination revealed right lower quadrant tenderness, leucocytosis with neutrophilia, and elevated CRP -  a typical clinic for appendicitis. CT confirmed a 20×22 mm inflamed appendiceal stump, subsequently resected via open surgery. 
Conclusion: Stump appendicitis, though rare, necessitates consideration in patients with right lower quadrant pain, even post-appendectomy. Prompt diagnosis and resection are optimizing outcomes.

Abstract (Bulgarian)

Увод: Апендиситът е широко разпространена патология и апендектомията е една от най-често извършваните операции в световен мащаб. Точната причина за апендисита не е напълно изяснена, но са описани многофакторни връзки. Апендиситът на чукана на апендикса представлява възпаление на остатъчния апендикс – рядко усложнение, което имитира остър апендисит и води до забавена диагноза и повишена заболеваемост. Представяме клиничен случай на пациент, развил апендисит след отворена апендектомия.
Представяне на клиничен случай: 48-годишен мъж постъпва с 24-часова болка в дясната илиачна област, гадене и подуване на корема, усложнени от предходна лява хемиколектомия с апендектомия по повод перфорация на сигмоидния колон. В анамнезата: агенезия на ляв бъбрек, последствия от множество травми и зависимост към наркотици в миналото. При прегледа – болезненост в долен десен коремен квадрант, левкоцитоза с неутрофилия и повишен CRP – типична клинична картина за апендисит. Компютърната томография потвърждава възпален остатъчен апендикс с размери 20×22 мм, който впоследствие е резециран чрез лапаротомия.
Заключение: Апендиситът на остатъчния апендикс, макар и рядък, трябва да се има предвид като диагноза при пациенти с болка в дясната илиачна област на корема, дори и след апендектомия. Навременната диагностика и оперативно лечение оптимизират изхода на заболяването.

Files

surgery-v89i3-12.pdf

Files (571.6 kB)

Name Size Download all
md5:921a65779fc8b730c66b1144abe3c4b7
571.6 kB Preview Download

Additional details

Additional titles

Translated title (Bulgarian)
Възпаление на остатъчния апендикс след апендектомия

Identifiers

ISSN
3033-151X
URL
https://bgss.eu/index.php/surgery/article/view/63

Dates

Issued
2025-10-21

References

  • 1. Menteş O, Zeybek N, Oysul A, Onder SC, Tufan T. Stump appendicitis, rare complication after appendectomy: report of a case. Ulus Travma Acil Cerrahi Derg. 2008 Oct;14(4):330-2. PMID: 18988060.
  • 2. Larner AJ. The aetiology of appendicitis. Br J Hosp Med. 1988 Jun;39(6):540-2. PMID: 2840156.
  • 3. Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006 Sep 9;333(7567):530-4. doi: 10.1136/bmj.38940.664363.AE. PMID: 16960208; PMCID: PMC1562475.
  • 4. Atri S, Zaiem A, Sebai A, Mariem BB, Haddad A, Kacem M. Stump appendiceal abscess after appendicectomy: A case report. Int J Surg Case Rep. 2024 Dec;125:110354. doi: 10.1016/j.ijscr.2024.110354. Epub 2024 Sep 26. PMID: 39503095; PMCID: PMC11543889.
  • 5. BAUMGARDNER LO. Rupture of appendiceal stump 3 months after uneventful appendectomy with repair and recovery. Ohio State Med J. 1949 May;45(5):476. PMID: 18126050.
  • 6. Durgun AV, Baca B, Ersoy Y, Kapan M. Stump appendicitis and generalized peritonitis due to incomplete appendectomy. Tech Coloproctol. 2003 Jul;7(2):102-4. doi: 10.1007/s10151-003-0018-4. PMID: 14605929.
  • 7. Partecke LI, Kessler W, Diedrich S, von Bernstorff W, Heidecke CD, Patrzyk M. Stadiengerechte Versorgung der Appendixbasis im Rahmen der laparoskopischen Appendektomie [Disease-adapted closure of the appendicular stump in laparoscopic appendectomy]. Zentralbl Chir. 2013 Jun;138(3):262-9. German. doi: 10.1055/s-0031-1283908. Epub 2012 Mar 16. PMID: 22426966.
  • 8. Leff DR, Sait MR, Hanief M, Salakianathan S, Darzi AW, Vashisht R. Inflammation of the residual appendix stump: a systematic review. Colorectal Dis. 2012 Mar;14(3):282-93. doi: 10.1111/j.1463-1318.2010.02487.x. PMID: 21054746.
  • 9. Fitz RH. Perforating inflammation of the vermiform appendix. Am J Med Sci. 1886;92:321–346.
  • 10. Bhangu A, Nepogodiev D, Matthews J, Morley G, Naumann D, Ball A, et al. Evaluation of appendicitis risk prediction models in adults with suspected appendicitis. Br J Surg. 2020;107:73–86. doi: 10.1002/bjs.11440.
  • 11. van Rossem CC, Bolmers MDM, Schreinemacher MHF, van Geloven AAW, Bemelman WA, Acker GJD, et al. Prospective nationwide outcome audit of surgery for suspected acute appendicitis. Br J Surg. 2016;103:144–151. doi: 10.1002/bjs.9964.
  • 12. Stewart B, Khanduri P, McCord C, Ohene-Yeboah M, Uranues S, Rivera FV, et al. Global disease burden of conditions requiring emergency surgery. Br J Surg. 2014;101:e9–22. doi: 10.1002/bjs.9329.
  • 13. Almström M, Svensson JF, Svenningsson A, Hagel E, Wester T. Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987–2013. Bjs Open. 2018;2:142–150. doi: 10.1002/bjs5.52.
  • 14. Wagner M, Tubre DJ, Asensio JA. Evolution and current trends in the management of acute appendicitis. Surg Clin North Am. 2018;98(5):1005-1023. doi: 10.1016/j.suc.2018.05.006
  • 15. Livingston EH, Fomby TB, Woodward WA, Haley RW. Epidemiological similarities between appendicitis and diverticulitis suggesting a common underlying pathogenesis. Arch Surg. 2011;146(3):308-314. doi: 10.1001/archsurg.2011.2
  • 16. Margenthaler JA, Longo WE, Virgo KS, et al. Risk factors for adverse outcomes after the surgical treatment of appendicitis in adults. Ann Surg. 2003;238(1):59-66. doi: 10.1097/01.SLA.0000074961.50020.f8
  • 17. Sammalkorpi HE, Mentula P, Leppäniemi A. A new adult appendicitis score improves diagnostic accuracy of acute appendicitis—a prospective study. BMC Gastroenterol. 2014;14:114. doi: 10.1186/1471-230X-14-114
  • 18. Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V. Changing epidemiology of acute appendicitis in the United States: study period 1993-2008. J Surg Res. 2012;175:185–190. doi: 10.1016/j.jss.2011.07.017.
  • 19. Sahm M, Koch A, Schmidt U, et al. Akute Appendizitis - Klinische Versorgungsforschung zur aktuellen chirurgischen Therapie. Zentralbl Chir. 2013;138:270–277. doi: 10.1055/s-0031-1283947.
  • 20. Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004 Jan;91(1):28-37. doi: 10.1002/bjs.4464. PMID: 14716790.
  • 21. Douglas CD, Macpherson NE, Davidson PM, Gani JS. Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ. 2000 Oct 14;321(7266):919-22. doi: 10.1136/bmj.321.7266.919. PMID: 11030676; PMCID: PMC27498.
  • 22. Horton MD, Counter SF, Florence MG, Hart MJ. A prospective trial of computed tomography and ultrasonography for diagnosing appendicitis in the atypical patient. Am J Surg. 2000 May;179(5):379-81. doi: 10.1016/s0002-9610(00)00372-x. PMID: 10930484.
  • 23. Barger RL Jr, Nandalur KR. Diagnostic performance of magnetic resonance imaging in the detection of appendicitis in adults: a meta-analysis. Acad Radiol. 2010 Oct;17(10):1211-6. doi: 10.1016/j.acra.2010.05.003. Epub 2010 Jul 15. PMID: 20634107.