Recurrent (Stump) Appendicitis

Emergency Physicians are likely to rule out appendicitis when a surgical history of an appendectomy is reported. Stump appendicitis occurs when a remnant of the appendix becomes inflamed, causing a clinical presentation that is indistinguishable to that of appendicitis. Clinicians should have a high index of suspicion for stump appendicitis in patients with a history of previous appendectomy who present with an acute appendicitis-like picture (1,2).

Stump appendicitis can occur after open or laparoscopic appendectomy. Reports suggest that laparoscopic techniques may play a role in its increased incidence (2,3). The potential limitations of laparoscopy such as smaller field of vision, lack of 3-D perspective, and absence of tactile feedback may increase the chances of leaving a longer stump behind. In most cases, an appendiceal stump > 3 mm can be cause for reinflammation (1).

Ultrasound has been recommended as the first-line imaging modality; however, CT is more commonly performed and can establish the diagnosis of stump appendicitis (1).

(1) Rios RE, et al. Am J EM 2014 Aug 27. [Epub ahead of print]
(2) Roberts KE, et al. JSLS 2011;15(3):373-8.
(3) Ismail I, et al. Cases J 2009;2:7415.

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