The Case Files: A Diagnostic Pitfall: Stump Appendicitis

Irvine, Scott D. MD; Neltner, Kurt A. MD; Shellman-White, Sondra A. MD; Zimmer, Brandi L. MD Acute abdomen is one of the most common surgical emergencies encountered by emergency physicians, and appendicitis is the most common cause requiring emergent surgical consultation and surgery. Stump appendicitis is a rare complication occurring after an incomplete appendectomy, and can be defined as an acute inflammation of the residual remnant of the appendix. Many physicians are unaware that stump appendicitis is a real entity, but it is so rare that they may not include it in their differential diagnosis, leading to possible delay in diagnosis and treatment.   A 25-year-old man presented to the emergency department with a chief complaint of abdominal pain for four hours that woke him from sleep at 1 a.m. The patient initially described the pain as diffuse abdominal pain that became more localized to the right lower quadrant during his stay in the ED. The patient reported nausea and vomiting, but denied fevers, chills, dysuria, hematuria, constipation, and diarrhea.   The patient's past medical history was significant for untreated hypertension and acute appendicitis, for which the patient had a laparoscopic appendectomy performed 14 months prior at our institution. He denied taking any medications and had no known drug allergies.   He was alert and did not appear to be in distress. The initial vital signs were pulse 74 beats/min, blood pressure 156/96 mm Hg, respirator...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research