Duplication of the vermiform appendix in an adult patient

Abstract

Duplication of the appendix is extremely rare. A 69-year-old woman was admitted with a 2-day history of right lower quadrant abdominal pain. Physical examination was consistent with acute appendicitis. Ultrasonography and colonoscopy gave a clinical impression of an inflammatory appendiceal mucocoele. Operative findings were an enlarged and inflamed appendix with distal cystic changes. Laparoscopic wedge resection of the caecum was performed. A tubular structure with a true lumen was found in the appendix. Haematoxylin and eosin staining and trichrome staining showed both structures had a true mucosa and a muscular layer. The duplication in this case does not belong to any of the previously described types of duplication.

Figure 1

Ultrasonography showing a cystic lesion with a true wall layer and hypervascularity at the tip of the lesion

Figure 2

Colonoscopy revealed a protruding, hyperaemic and oedematous appendiceal orifice (A), and, grossly, there was a tubular structure with a true lumen in the appendix (B, C and D).

Figure 3

Haematoxylin and eosin stain (A) and trichrome stain (B) showing both structures had a true mucosa and a muscular layer (40× magnification)