Dimitrios K Manatakis1,2, Vasileios Aheimastos3, Maria-Ioanna Antonopoulou3, Christos Agalianos3, John Tsiaoussis4, Evanghelos Xynos5. 1. Department of Surgery, Athens Naval and Veterans Hospital, 11521, Athens, Greece. medp2011862@med.uoc.gr. 2. Medical School, University of Crete, Heraklion, Crete, Greece. medp2011862@med.uoc.gr. 3. Department of Surgery, Athens Naval and Veterans Hospital, 11521, Athens, Greece. 4. Medical School, University of Crete, Heraklion, Crete, Greece. 5. Creta Interclinic Hospital, Heraklion, Crete, Greece.
Abstract
BACKGROUND: Stump appendicitis is defined as interval inflammation of any residual appendicular tissue, after an appendicectomy. We present a systematic review of case series and case reports on stump appendicitis, emphasising on risk factors, diagnosis and surgical management. METHODS: The English literature (1945-2018) was reviewed, using PubMed, Embase and GoogleScholar, combining the terms "appendix", "appendicitis", "stump", "residual", "recurrent" and "retained". In total, 127 studies were included, describing 164 patients (males 59%, mean age 36 ± 17 years). RESULTS: Index surgery was open in 59% and laparoscopic in 38%. It was described as "difficult" or "complicated" in 31%. 20% of patients reported episodes of recurrent abdominal pain during the time interval between index and stump appendicitis (range 2 weeks to 60 years, median 2 years). Right lower quadrant pain was the most frequent complain (88%), leukocytosis was found in 56%, whereas 92% of patients underwent imaging testing, which was diagnostic or highly suspicious in 67.5%. Mean delay between beginning of symptoms and surgery was 2.4 ± 2.3 days. The operative approach was open in 61% and laparoscopic in 35% of cases. The operation was characterised as "difficult" or "complicated" in 45%. In the majority (88%), a completion stump appendicectomy was performed, with 11% requiring more extensive procedures. Mean length of resected stump was 3.1 ± 1.6 cm (range 0.5-10 cm). CONCLUSIONS: Stump appendicitis may occur following both open and laparoscopic approach, when the residual stump is > 0.5 cm. Its clinical significance lies in the delayed diagnosis, leading to higher incidence of complications and the need for more extensive surgery.
BACKGROUND:Stump appendicitis is defined as interval inflammation of any residual appendicular tissue, after an appendicectomy. We present a systematic review of case series and case reports on stump appendicitis, emphasising on risk factors, diagnosis and surgical management. METHODS: The English literature (1945-2018) was reviewed, using PubMed, Embase and GoogleScholar, combining the terms "appendix", "appendicitis", "stump", "residual", "recurrent" and "retained". In total, 127 studies were included, describing 164 patients (males 59%, mean age 36 ± 17 years). RESULTS: Index surgery was open in 59% and laparoscopic in 38%. It was described as "difficult" or "complicated" in 31%. 20% of patients reported episodes of recurrent abdominal pain during the time interval between index and stump appendicitis (range 2 weeks to 60 years, median 2 years). Right lower quadrant pain was the most frequent complain (88%), leukocytosis was found in 56%, whereas 92% of patients underwent imaging testing, which was diagnostic or highly suspicious in 67.5%. Mean delay between beginning of symptoms and surgery was 2.4 ± 2.3 days. The operative approach was open in 61% and laparoscopic in 35% of cases. The operation was characterised as "difficult" or "complicated" in 45%. In the majority (88%), a completion stump appendicectomy was performed, with 11% requiring more extensive procedures. Mean length of resected stump was 3.1 ± 1.6 cm (range 0.5-10 cm). CONCLUSIONS:Stump appendicitis may occur following both open and laparoscopic approach, when the residual stump is > 0.5 cm. Its clinical significance lies in the delayed diagnosis, leading to higher incidence of complications and the need for more extensive surgery.
Authors: Gurdeep S Mannu; Maria K Sudul; Joao H Bettencourt-Silva; Elspeth Cumber; Fangfang Li; Allan B Clark; Yoon K Loke Journal: Cochrane Database Syst Rev Date: 2017-11-13
Authors: Mollie Ferris; Samuel Quan; Belle S Kaplan; Natalie Molodecky; Chad G Ball; Greg W Chernoff; Nij Bhala; Subrata Ghosh; Elijah Dixon; Siew Ng; Gilaad G Kaplan Journal: Ann Surg Date: 2017-08 Impact factor: 12.969