2. CASE PRESENTATION :
A 30-year-old woman with history of appendicectomy 10 months ago,
consulted the emergency departement suffering with fever, abdominal pain
and vomiting for 2 days.
Abdominal examination showed tenderness in right iliac fossa during
abdominal palpation in the proximity of a well-healed McBurney’s
incision scar. Abdominal distension is diffuse swelling or enlargement
of the abdomen.
Base line investigations showed white blood cells 14500/mmc with slight
neutrophilia at 10450/mmc and C-reactive protein 102 mg/dL.
Abdominal computed tomography (CT) showed distension of the small
intestine, infiltration of the peri-appendicular region, and the
presence of a blind-ending image mimicking acute appendicitis (Figure
1).
A laparoscopic exploration was performed, it showed a 2cm appendicular
stump with a gangrenous tip and a flange enveloping the terminal ileum
with distension of the small bowel (Figure 2). A complementary
appendectomy with section of the flange was performed. The postoperative
recovery was uneventful and the patient was discharged on postoperative
day 2.
Pathological analysis of the spiecemen confirmed that it was a vestigial
appendix, with a length of 2.3 cm, and a width of 1.0 cm, with active
inflammation.
Figure 1 : CT findings
Figure 2 : per-operative imaging (laparoscopic view)