Stump appendicitis is a rare condition that can occur after surgical removal of the appendix, known as an appendectomy. It involves the inflammation of a small remnant of the appendix left behind.
What is Stump Appendicitis?
Stump appendicitis arises when a small segment of the appendix, referred to as the appendiceal stump, remains in the body after an appendectomy and subsequently becomes inflamed or infected. This can occur due to various factors, including technical difficulties encountered during the initial surgery, such as severe inflammation obscuring the base of the appendix, or anatomical variations in the patient’s body. A longer remaining stump increases the risk of inflammation.
Recognizing Symptoms
The symptoms of stump appendicitis often closely resemble those of acute appendicitis, making diagnosis challenging. Individuals may experience abdominal pain, commonly localized in the lower right side of the abdomen. This pain can be accompanied by nausea, vomiting, fever, and a general loss of appetite.
A distinguishing feature of stump appendicitis is the timing of symptom onset. Unlike initial appendicitis, these symptoms can manifest weeks, months, or even many years after the original appendectomy. Some reported cases indicate symptoms appearing from as early as two months to as late as fifty-two years following the initial surgery. The delayed and sometimes intermittent nature of these symptoms can contribute to diagnostic uncertainty.
Diagnosis
Diagnosing stump appendicitis involves a thorough evaluation by healthcare professionals, considering the patient’s medical history, particularly any prior appendectomy. A physical examination will assess for tenderness and other signs in the abdominal area. Blood tests are routinely performed to check for indicators of infection and inflammation, such as an elevated white blood cell count or increased C-reactive protein levels.
Imaging studies play an important role in confirming the diagnosis. Computed tomography (CT) scans are highly effective in visualizing the inflamed appendiceal stump and surrounding inflammatory changes. Ultrasound can also be used to identify a thickened or inflamed stump. These imaging techniques help differentiate stump appendicitis from other conditions that might present with similar abdominal pain.
Is Stump Appendicitis Dangerous?
Stump appendicitis can indeed be dangerous if it is not promptly diagnosed and treated. The primary concern stems from the potential for severe complications that can arise from the inflamed remnant. Untreated inflammation can lead to the rupture or perforation of the appendiceal stump, similar to what occurs in acute appendicitis.
Perforation allows infectious material to leak into the abdominal cavity, potentially causing peritonitis, a widespread and severe inflammation of the lining of the abdomen. This can lead to the formation of abscesses, which are localized collections of pus within the abdomen. In more severe cases, infection can spread throughout the bloodstream, leading to sepsis, a life-threatening response to infection. Studies indicate that perforation occurs in a significant percentage of cases, ranging from 16% to 70% at presentation, often due to delayed diagnosis. Surgical intervention, typically a completion appendectomy to remove the remaining stump, is the primary treatment to prevent these serious outcomes.