Incidental finding of double appendix during laparotomy for intussusception: A case report

Abstract

Introduction: A double caecal appendix is an uncommon anatomical variation with significant surgical implications. A few cases of the double caecal appendix have been reported worldwide, mostly in adults. The diagnosis is, usually incidental, typically made intraoperatively.

Case report: We present the case of a 6-month-old boy with an incidental diagnosis of the double appendix during laparotomy for intussusception.

Discussion: The double appendix can be classified using the Cave-Wallbridge classification, which identifies three types of the duplicated appendix: A, B, and C. The complication of appendiceal duplications includes acute appendicitis, colonic perforation, obstruction, bleeding, pain, failure to thrive, abdominal mass. In the case of abdominal pain with diagnostic uncertainty, with appropriate patient selection (without hemodynamic instability), diagnostic laparoscopy may be offered as an initial intraoperative evaluation, and if the procedure cannot be safely completed laparoscopically, it can be converted to a laparotomy.

Conclusion: Although uncommon, knowledge of appendiceal duplication is of great significance in the surgical patient, as a missed diagnosis or delay in diagnosis in symptomatic patients may result in increased morbidity and possibly mortality secondary to sepsis, with its medico-legal ramifications in today's practice of medicine.

Keywords: Appendiceal duplication; Appendix vermiformis duplex; Caecum; Double caecal appendix.

Fig. 1

A: Intraoperative photo demonstrating an ileo-ileal intussusception (indicated by arrow). B: Intraoperative photo demonstrating a Type B(1) duplication of the appendix, single caecum (labeled) with two appendices (indicated by arrows), each originating at different locations.