Perforated anterior tenia coli-type appendicitis in a case of vermiform appendix duplex in a toddler: a case report

Abstract

Duplication of the vermiform appendix is a rare anomaly observed in patients undergoing appendectomy. A 27-month-old male toddler presented with a 9-day history of abdominal pain, vomiting, and diarrhea, progressing to an acute abdomen with signs of severe peritonitis. Intraoperative findings revealed a periappendicular infiltrate from a perforated vermiform appendix of the tenia coli type. A second, inflamed appendix was incidentally discovered in its typical location during the procedure. Vermiform appendix duplication presents a clinical challenge due to its rarity and potential for complications. According to the Cave-Wallbridge classification, this case represents Type B2, or the tenia coli variant, characterized by a perforated appendix originating at the tenia coli convergence and a smaller, secondary appendix in a retrocecal position. This case emphasizes the importance of thorough distal and proximal exploration during initial appendectomy when this anomaly is suspected, particularly in cases of Type B2.

Keywords: appendix vermiform duplication; case report; perforated appendicitis; small child.

Figure 1

(A) Contrast-enhanced abdominal CT in coronal and axial scans showed an irregularly shaped mass in the right abdomen (labeled) in the form of extensive inflammatory mass which is in the close contact with the inferior liver surface, involving parts of ascending colon, cecum, and terminal ileum. (B) Retrocecal tubular structure (labeled) inseparable of dorsal wall of coecum which can correlate to the operative findings of second appendix.

Figure 2

Histopathology confirmed a fragmentary finding of severe acute transmural appendicitis and thick fibrinopurulent deposits in one specimen (A, B) and secondary inflammation of appendiceal tissue with fibrinopurulent deposits on the serosa in the other (C, D) (hematoxylin and eosin/H&E/stains, magnification 10×).

Figure 3

Postoperatively analyzed preoperative contrast-enhanced sagittal abdominal CT scan detected a retrocecal 24.1 mm long tubular structure (a smaller second secondary inflamed appendix) with a transverse diameter of 5.6 mm and a wall thickness of 1.8 mm adherent to/inseparable from the dorsal wall of the cecum (labeled).