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. 2012;3(11):559-62.
doi: 10.1016/j.ijscr.2012.08.004. Epub 2012 Aug 14.

Acute appendicitis in a duplicated appendix

Grigorios Christodoulidis  1 , Dimitrios Symeonidis, Michail Spyridakis, Georgios Koukoulis, Anastasios Manolakis, Georgios Triantafylidis, Konstantinos Tepetes
Affiliations

Acute appendicitis in a duplicated appendix

Grigorios Christodoulidis et al. Int J Surg Case Rep. 2012.

Abstract

Introduction: Double appendix represents an extremely rare and commonly "missed" diagnosis, often with life threatening consequences.

Presentation of case: In this case report we present an interesting case of operative treatment of acute appendicitis in a doubled vermiform appendix stemming operative pitfalls. A 23-year-old female was admitted to the emergency room department complaining of diffuse abdominal pain, nausea, and vomiting over the past 36h. As soon as the diagnosis of acute appendicitis was established a laparotomy via a McBurney incision was decided. Intraoperative findings included the presence of mild quantity of free fluid and surprisingly a thin non-inflamed appendiceal process. It was the preoperative ultrasound findings suggestive of acute appendicitis that dictated a more thorough investigation of the lower abdomen that led to the discovery of a second retrocecal inflamed appendix. Formal appendectomy was then performed for both processes. The patient had an uneventful recovery and was discharged on the fourth postoperative day.

Discussion: Double appendix represents a challenging clinical scenario in cases of right lower quadrant pain.

Conclusion: Life threatening consequences with legal extensions can arise from the incomplete removal of both stumps.

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Figures

Fig. 1
Fig. 1
The ultrasonographic exam performed with a GE Logic 9 scanner, using a 10 MHz linear transducer. Using the graded compression technique a tubular, incompressible blind ended loop, with a maximal cross-sectional diameter under compression of 11 mm approximately was revealed. The appendix resulted non-perforated, with a small quantity of free fluid surrounding its distal tip (margin).
Fig. 2
Fig. 2
The two surgical specimens.
Fig. 3
Fig. 3
Low-power microscopic view of the vermiform appendix with acute appendicitis and lymphoid follicles with prominent germinal centers. H/E 100×.
Fig. 4
Fig. 4
Low magnification of the second structure. The histologic composition is similar to the appendix. H/E 100×.
See this image and copyright information in PMC

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