Rare appendicular anomaly of horseshoe appendix diagnosed intra-operatively during laparoscopic appendectomy: case report

Abstract

Acute appendicitis is the most common cause of lower abdominal pain among patients presented to the Emergency Department. Appendicular anomalies in general are rare, and the horseshoe appendix is considered the rarest, with few reported cases in the literature. We are presenting a young female patient, medically and surgically free, who presented to the Emergency Department with persistent right lower quadrant, associated with vomiting for 2 days. Vitally was stable, and labs were remarkable for leukocytosis and neutrophil shift. Abdomen CT scan showed a dilated appendix up to 1 cm with mural edema and hyperenhancement surrounded by mild fat stranding, minimal free fluid, and thickened adjacent peritoneal reflection. In conclusion, routinely performed surgeries can surprise the surgeon with unusual findings. Knowing the anatomy and possible associated anomalies is a cornerstone for any surgery. Even with the rarity of these anomalies, a high index of suspicion and careful recognition are required.

Keywords: appendicitis; appendicular anomaly; horseshoe appendix.

Figure 1

(a) Axial view and (b) coronal view showed a dilated appendix up to 1 cm with mural edema and hyperenhancement surrounded by mild fat stranding, subcentimeter reactive lymph nodes, minimal free fluid, and thickened adjacent peritoneal reflection.

Figure 2

Intra-operative findings of the appendix with two bases connected to the cecum and forming a horseshoe appearance, which is an anomaly of the appendix.