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Society for Pediatric Radiology – Poster Archive
Final ID: Poster #: EDU-099
Stumped? It could be stump appendicitis.
Purpose or Case Report: The purpose of this educational exhibit poster is to increase the awareness of stump appendicitis using two case examples.
Stump appendicitis is rare, with sixty-one cases identified in the literature between 1945 and 2005. Of the two common techniques of appendicectomy, ligation and invagination, the former can leave a residual stump with a potential lumen for the pathophysiological process of appendicitis to recur. Remnant stump lengths of greater than 5 mm are considered to have a higher risk of leading to stump appendicitis, acting as a potential reservoir for a faecolith. Whilst ultrasound has been commonly used to diagnose acute appendicitis for over 30 years, its utility in pre-operative identification of stump appendicitis in patients post-appendicectomy has only been documented more recently. Traditional sonographic criteria for diagnosing acute appendicitis have been applied to the appendiceal stump, with a transverse diameter greater than 6 mm, non-compressibility and wall hyperaemia all being concerning for stump appendicitis. Secondary sonographic signs of acute appendicitis, such as echogenic peri-appendiceal mesentery, can also indicate stump inflammation.
Two case examples are presented, both in patients who are nine years old. One patient had surgically confirmed stump appendicitis. The second had sonographic features of stump appendicitis which settled with antibiotics without requiring surgery.
Inflammation of the base or stump of a surgically removed appendix is an uncommon, and likely under-recognised condition in both children and adults. The majority of cases have had previous open appendicectomy, which is in contrast to a theory that laparascopic surgery is a potential factor in incomplete removal of the appendix due to poor visualisation of the appendiceal base. Both methods of appendicectomy, ligation or invagination, have been associated with stump appendicitis. Suspicion of the condition and prompt diagnosis can potentially reduce the risk of serious complications due to delayed treatment (perforation, abscess formation), or misdiagnosis (constipation, gastroenteritis).
Whilst the possibility of appendicitis is usually dismissed in patients with a history of appendicectomy, sonographers should be aware of stump inflammation in such patients that present with RIF pain from weeks to decades after surgery.
Methods & Materials:
Results:
Conclusions:
Stump appendicitis is rare, with sixty-one cases identified in the literature between 1945 and 2005. Of the two common techniques of appendicectomy, ligation and invagination, the former can leave a residual stump with a potential lumen for the pathophysiological process of appendicitis to recur. Remnant stump lengths of greater than 5 mm are considered to have a higher risk of leading to stump appendicitis, acting as a potential reservoir for a faecolith. Whilst ultrasound has been commonly used to diagnose acute appendicitis for over 30 years, its utility in pre-operative identification of stump appendicitis in patients post-appendicectomy has only been documented more recently. Traditional sonographic criteria for diagnosing acute appendicitis have been applied to the appendiceal stump, with a transverse diameter greater than 6 mm, non-compressibility and wall hyperaemia all being concerning for stump appendicitis. Secondary sonographic signs of acute appendicitis, such as echogenic peri-appendiceal mesentery, can also indicate stump inflammation.
Two case examples are presented, both in patients who are nine years old. One patient had surgically confirmed stump appendicitis. The second had sonographic features of stump appendicitis which settled with antibiotics without requiring surgery.
Inflammation of the base or stump of a surgically removed appendix is an uncommon, and likely under-recognised condition in both children and adults. The majority of cases have had previous open appendicectomy, which is in contrast to a theory that laparascopic surgery is a potential factor in incomplete removal of the appendix due to poor visualisation of the appendiceal base. Both methods of appendicectomy, ligation or invagination, have been associated with stump appendicitis. Suspicion of the condition and prompt diagnosis can potentially reduce the risk of serious complications due to delayed treatment (perforation, abscess formation), or misdiagnosis (constipation, gastroenteritis).
Whilst the possibility of appendicitis is usually dismissed in patients with a history of appendicectomy, sonographers should be aware of stump inflammation in such patients that present with RIF pain from weeks to decades after surgery.
Methods & Materials:
Results:
Conclusions:
More abstracts on this topic:
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Poster____EDU-099.pdf
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