'Stump appendicitis': postappendectomy appendicitis.

To cite: Zachariah SK. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014208544 DESCRIPTION A 58-year-old woman presented with acute abdominal pain and vomiting of 3 days duration. She had undergone laparotomy for appendicular perforation 25 years earlier. She had recurrent episodes of abdominal pain for the past 5 years and was being treated as a case of adhesive intestinal colic. Clinical examination revealed a distended and tender abdomen with an infra umbilical midline scar and maximal tenderness in the right iliac fossa associated with guarding and rigidity. Her pulse rate was 110/min; blood pressure 110/60 mm Hg and temperature was 100°F. Total white cell count was 18 400 mm (85% neutrophils). Urine analysis was unremarkable. Ultrasonography showed interloop fluid and dilated bowel loops in the right iliac fossa. Abdominal CT scan showed features of an inflammatory mass in the right iliac fossa with pericaecal fat stranding, a thickened caecal wall, dilated small bowel loops and fluid. Diagnostic laparoscopy revealed purulent peritoneal fluid, dense adhesions between omentum and laparotomy scar along with an inflammatory mass in the right iliac fossa. Laparoscopic dissection was difficult; hence the procedure was converted to a laparotomy. After meticulous dissection, the bowel loops were separated. The distal ileum adherent to the caecal wall was meticulously separated to reveal a small residual appendicular stump that was oedematous, inflamed and about 2 cm long (figure 1). The stump was excised after transfixing the base close to the caecal wall (figure 2). The postoperative period was uneventful. Histopathological report was confirmatory of appendicitis. The patient has been on regular follow-up for 1 year and is asymptomatic. Learning points