Stump appendicitis. A case report

Background: Stump appendicitis is a rare postoperative complication characterized by inflammation of residual appendiceal tissue remaining after an appendectomy. This entity is challenging to recognize because clinicians often exclude appendicitis in patients with a prior appendectomy. We report a case of a twenty‑four‑year‑old man with a history of open appendectomy six months earlier who presented with persistent right lower quadrant pain, fever, nausea and vomiting. He initially received treatment for nephrolithiasis and an acute diarrheal syndrome without symptom relief. Upon referral to a regional hospital, ultrasonography of the right iliac fossa yielded no abnormalities. A subsequent contrast‑enhanced computed tomography scan, performed to exclude diverticulitis, demonstrated a small peri‑appendiceal fluid collection adjacent to the appendiceal stump with associated inflammatory fat stranding, compatible with stump appendicitis. The patient underwent conservative management with intravenous broad‑spectrum antibiotics and analgesics, leading to complete resolution of his symptoms. This case highlights the importance of maintaining a high index of suspicion for stump appendicitis in postoperative patients presenting with right lower quadrant pain, as delayed diagnosis is associated with higher perforation rates. The case also underscores the critical role of cross‑sectional imaging in differentiating this condition from other causes of abdominal pain, such as diverticulitis or cecal diverticulitis. Review of the literature indicates that stump appendicitis occurs in approximately one per fifty thousand appendectomies, though underreporting may mean it is more common. Awareness of this rare entity and ensuring complete appendiceal resection during the initial procedure are essential steps toward preventing morbidity and reducing postoperative complications risk overall.

Keywords: appendiceal stump inflammation; post‑appendectomy complication; right lower quadrant pain.