Clinical Communications: Adult| Volume 57, ISSUE 2, P232-234, August 2019

Recurrent Appendicitis Caused by a Retained Appendiceal Tip: A Case Report



      Acute appendicitis is one of the most common surgical emergencies, and it is treated definitively with appendectomy. Recurrent appendicitis is a rare entity, being reported after approximately 1 in 50,000 appendectomies. It is typically caused by inflammation of the appendiceal stump. Inflammation of a retained appendiceal tip is a unique entity that can also cause recurrent appendicitis and presents similarly to primary appendicitis.

      Case Report

      We present a case of a 50-year-old man who had undergone laparoscopic appendectomy 1 year earlier and who subsequently presented with a chief complaint of right lower quadrant abdominal pain. The diagnosis of recurrent appendicitis caused by a retained appendiceal tip was made after a computed tomography scan. The patient underwent successful laparoscopic removal of the retained appendiceal fragment.

      Why Should an Emergency Physician be Aware of This?

      The etiology of recurrent appendicitis is separate from the stump appendicitis that has been well described in the literature. Retained tip appendicitis poses a diagnostic dilemma because it is uncommon and, if missed, can lead to complications, such as perforation and severe sepsis. Recurrent appendicitis must be in the differential diagnosis for patients who are post-appendectomy and who present with right lower quadrant abdominal pain.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Wagner M.
        • Tubre D.J.
        • Asensio J.A.
        Evolution and current trends in the management of acute appendicitis.
        Surg Clin North Am. 2018; 98: 1005-1023
        • Schumpelick V.
        • Dreuw B.
        • Ophoff K.
        • Prescher A.
        Appendix and cecum. Embryology, anatomy, and surgical applications.
        Surg Clin North Am. 2000; 80: 295-318
        • Addiss D.G.
        • Shaffer N.
        • Fowler B.S.
        • Tauxe R.V.
        The epidemiology of appendicitis and appendectomy in the United States.
        Am J Epidemiol. 1990; 132: 910-925
        • Watkins B.P.
        • Kothari S.N.
        • Landercasper J.
        Stump appendicitis: case report and review.
        Surg Laparosc Endosc Percutan Tech. 2004; 14: 167-171
        • Hendahewa R.
        • Shekhar A.
        • Ratnayake S.
        The dilemma of stump appendicitis - a case report and literature review.
        Int J Surg Case Rep. 2015; 14: 101-103
        • Essenmacher A.C.
        • Nash E.
        • Walker S.K.
        • Pitcher G.J.
        • Buresh C.T.
        • Sato T.S.
        Stump appendicitis.
        Clin Pract Cases Emerg Med. 2018; 2: 211-214
        • Rios R.E.
        • Villanueva K.M.
        • Stirparo J.J.
        • Kane K.E.
        Recurrent (stump) appendicitis: a case series.
        Am J Emerg Med. 2015; 33: 480.e1-480.e2
        • O’Leary D.P.
        • Myers E.
        • Coyle J.
        • Wilson I.
        Case report of recurrent acute appendicitis in a residual tip.
        Cases J. 2010; 3: 14
        • Parthsarathi R.
        • Jankar S.V.
        • Chittawadgi B.
        • et al.
        Laparoscopic management of symptomatic residual appendicular tip: a rare case report.
        J Minim Access Surg. 2017; 13: 154-156
        • Dikicier E.
        • Altintoprak F.
        • Ozdemir K.
        • et al.
        Stump appendicitis: a retrospective review of 3130 consecutive appendectomy cases.
        World J Emerg Surg. 2018; 13: 22