Description

Stump appendicitis is a rare but clinically significant complication that occurs when inflammation develops in the residual appendiceal tissue left behind after an appendectomy. Because appendectomy is among the most common emergency surgeries performed worldwide, stump appendicitis can pose a diagnostic challenge, as patients and physicians may not initially suspect appendiceal pathology after the appendix has already been removed. The advancement of minimally invasive surgery has made laparoscopic management of stump appendicitis the preferred approach in modern surgical practice. Etiology and Pathophysiology Stump appendicitis results when a small portion of the appendiceal base remains after incomplete appendectomy. Retained tissue may become obstructed by fecaliths, lymphoid hyperplasia, or adhesions, leading to recurrent inflammation. Risk factors include: Inadequate visualization of the appendiceal base during initial surgery. Difficult anatomical variations (retrocecal or subserosal appendix). Emergency appendectomy with limited operative exposure. Clinical Presentation Patients present with symptoms similar to acute appendicitis, including: Right lower quadrant abdominal pain. Nausea, vomiting, and fever. Guarding, tenderness, or rebound on examination. Importantly, a history of prior appendectomy often delays diagnosis. Imaging, particularly CT scan or ultrasonography, plays a crucial role in identifying the inflamed stump. Role of Laparoscopy Laparoscopic surgery is the gold standard in the management of stump appendicitis for several reasons: Diagnostic Advantage: Laparoscopy allows direct visualization of the ileocecal junction and appendiceal stump. This is particularly useful when radiology is inconclusive. Therapeutic Management: The inflamed appendiceal stump is dissected carefully. Adhesiolysis is often required, as previous surgery may have led to dense adhesions. The base of the appendix is identified at the cecum, and the remaining stump is excised completely. Staplers, endoloops, or bipolar cautery may be used to secure the appendiceal base. Advantages over Open Surgery: Smaller incisions, reduced pain, and faster recovery. Shorter hospital stay. Lower risk of wound-related complications. Superior cosmetic outcomes. Challenges in Laparoscopic Management Dense adhesions from previous surgery can make dissection difficult. Identifying the exact site of the appendiceal base requires skill and anatomical precision. Surgeons must avoid injury to the cecum or ileum while excising the residual stump. Postoperative Outcomes Most patients recover uneventfully after laparoscopic stump appendectomy. Complication rates are low, and recurrence is almost nonexistent if the stump is completely excised. Early mobilization, resumption of diet, and minimal postoperative pain contribute to excellent patient satisfaction. Conclusion Stump appendicitis, though rare, is a diagnostic challenge that should always be considered in patients with right lower quadrant pain and a history of appendectomy. Laparoscopic management has emerged as the safest and most effective treatment modality. With its diagnostic and therapeutic benefits, laparoscopy not only ensures complete removal of the appendiceal stump but also minimizes morbidity, providing patients with rapid recovery and long-term relief.