Stump appendicitis is a rare delayed complication of appendectomy: A case report

Abstract

A 47-year-old male patient presented to the emergency department with a chief complaint of abdominal pain for 6 d. The pain was initially localized around the umbilicus, and subsequently localized at the right lower quadrant. The patient complained of anorexia and nausea after the pain started. He had four or five episodes of watery diarrhea daily for 3 d though he had no vomiting. His surgical history included an appendectomy 20 years ago and surgery for peptic ulcer disease 15 years ago. His axillary temperature was 37.1, rectal temperature 38.4, blood pressure 125/70 mmHg, pulse rate 76 beats/min, and respiratory rate 16 breaths/min. Physical examination of the abdomen revealed healed midline and right lower abdominal (McBurney insicion) surgical scars. A mass without clear borders was found showing tenderness, muscular guarding and rebound in the right lower quadrant during abdominal palpation. Routine laboratory tests included normal electrolyte and blood cell panels except for a white blood cell count of 11700/L. Urinalysis was unremarkable. Abdominal ultrasonography (USG) showed a heterogene hipoechoic mass at the right lower quadrant. There was no abdominal free fluid. No spesific diagnosis could be made. CT scan of the abdomen and pelvis showed a tubular structure extending from the cecum, with an enhanced wall consistent with an inflamed appendical stump (Figure Thickened cecum wall, inflammatory change of mesenteric fat and enlarged lymph nodes could also be seen (Figure Preoperative diagnosis of stump appendicitis was made on the basis of the CT findings.