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VOLUME 1 , ISSUE 3 ( September-December, 2023 ) > List of Articles

CASE REPORT

Abdomen: A Pandora's Box that Never Fails to Surprise Us

Yash K Brahmbhatt, Rignesh Patel, Ketan Patel

Keywords : Case report, Computerised tomography abdomen, Emergency medicine, Pain

Citation Information : Brahmbhatt YK, Patel R, Patel K. Abdomen: A Pandora's Box that Never Fails to Surprise Us. 2023; 1 (3):84-85.

DOI: 10.5005/njem-11015-0021

License: CC BY-NC 4.0

Published Online: 25-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Background: The emergency department (ED) is a place where there is an encounter of various surgical and medical emergencies. However, timely diagnosis and early treatment are paramount for good outcomes. Here we present an interesting case of abdominal pain who underwent laparoscopic appendicectomy later diagnosed with stump appendicitis. Case summary: A 28-year-old male presented to ED with complaints of right lower abdominal pain for 2 days which was sudden in onset, intermittent, colicky, non-radiating, no exacerbating and relieving factors nausea and vomiting. History of laparoscopic appendicectomy one month back. Family and personal history were insignificant. On arrival, the patient was hemodynamically stable with a pain score of 5/10. On examination, abdomen was soft, non-distended, there were scars over the lower abdomen, tenderness in the right iliac fossa without guarding and rigidity, and bowel sounds were present. Laboratory investigations were suggestive of the total count of 19,990 cells/cumm with a neutrophilic predominance and CRP was 24. The plain radiograph of the abdomen as well as ultrasonography were normal. We proceeded with contrast-enhanced computerised tomography (CECT) of the abdomen which was suggestive of stump appendicitis. A surgical reference was done. Discussion: In the case of stump appendicitis, the time interval for the onset of symptoms could range from 2 weeks to years after appendicectomy. Appendicectomy is one of the most commonly performed surgical emergencies. Stump appendicitis is one of the rare and delayed complications after appendicectomy with a reported incidence of 1 in 50,000 cases. The advantage to ongoing reporting on this relatively rare diagnosis is to continue to raise awareness so it is part of the provider's differential. Prompt recognition is important to lead to early treatment, thus avoiding serious complications like intra-abdominal abscess, intestinal perforation, and peritonitis. Clinically, patients present with signs and symptoms mimicking appendicitis or acute abdomen along with the previous history of appendicectomy as seen in our case. Conclusion: By presenting this case, it is highly recommended to consider stump appendicitis as one of the differential diagnoses in patients with a history of appendicectomy who present with abdominal pain to avoid detrimental complications due to missed diagnosis.


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