Recurrent/Stump Appendicitis

The residual remnant or “stump” of the appendix after an initial appendectomy may become inflamed causing what is commonly referred to as stump appendicitis. The incidence of stump appendicitis is estimated to be 1 in 50, 000 cases, making the diagnosis exceedingly rare. This uncommon disease coupled with a prior history of appendectomy can lead to a delay in diagnosis. While no single cause has been identified, there is evidence to suggest that the length of the residual stump after resection has an influence on recurrent infection. The difficulty in the diagnosis of the disease lies in its ambiguous presentation in the setting of a presumed completely resected appendix. Unfortunately, giving the often nonspecific vital signs and inconclusive laboratory results as the initial available data, a physician will need to maintain a high clinical suspicion in order to make the correct diagnosis. The use of computed tomography (CT) scans has reduced the need for more invasive diagnostic techniques and aids in the physician’s ability to expeditiously diagnose stump appendicitis. Ultrasonography has also been demonstrated to aid in the diagnosis of stump appendicitis, particularly where CT scans are not as readily available. Treatment with antibiotics may be attempted as an alternative to surgery; however, the vast majority of cases require definitive surgical excision of the remnant appendix. Stump appendicitis is a problematic disease with an underestimated prevalence. Delays in diagnosis can lead to significant patient morbidity and more complex surgical procedures. Keeping this disease in the differential is important in reducing complications associated with delayed diagnosis.