Appendicitis Without the Appendix? Maybe its Stump Appendicitis
Posted Mar 10 2011 7:27pm
Removal of the appendix (appendectomy) is one of the most commonly performed surgeries in the United States, with >250,000 performed annually. Stump appendicitis is an acute inflammation of the residual appendix, and is an under-reported complication that can occur after open or laparoscopic appendectomy. Stump appendicitis results from obstruction of the lumen of the remaining appendix, usually by a hard piece of stool called a fecalith. This leads to an increase in the pressure of the stump of the appendix. As blood flow is impaired, bacteria overgrow and an infection results. Clinically, it presents similar to the original episode of appendicitis with pain in the lower right side of the abdomen, nausea, vomiting, fever and a decreased appetite. The White Blood Cell Count (WBC), which is a marker of inflammation and infection, is usually elevated.
The diagnosis of stump appendicitis is usually not considered as the cause for right lower quadrant pain in patients with a history of a prior appendectomy. This creates a delay in making the correct diagnosis, and explains why the rate of rupture for stump appendicitis approaches 70%.
To prevent stump appendicitis from occurring, it is important that the surgeon identifies the base of the appendix during surgery and ensures complete removal of the appendix. Some reports have suggested that laparoscopic appendectomy is associated with an increased incidence of stump appendicitis when compared with open appendectomy. However, the most recent studies have shown that this is not the case.
Physicians should always keep the diagnosis of stump appendicitis in mind when a patient with a history of a prior appendectomy presents with clinical signs and symptoms very similar to acute appendicitis. Early recognition of this complication may decrease the high rate of rupture and complications associated with delayed diagnosis.