The grumpy stumpultrasound and stump appendicitis

T Reddan, JA Corness, K Mengersen, FA Harden.

Australasian Sonographers Association23rd International ConferenceMelbourne 13-15 May 2016

• 9 year-old male

• 13 days post laparoscopic appendectomy

• Histologically confirmed acute appendicitiso no evidence of perforation

• Focal right iliac fossa pain for past 6 dayso Afebrileo CRP <2.0 mg/Lo WCC 4.4 x 109/L

Case presentation

• Two common appendectomy techniques:– invagination(tucking stump into caecum)

– ligation (this case)(tie/clip stump at base)

• Residual stump can permit recurrence of appendicitis pathogenic process through obstruction of stump lumen

Background

• 12-5 MHz Linear transducer

• Graded compression technique

• Identified caecum and terminal ileum

• Recognised appendiceal stump and surgical clips

Ultrasound examination

Ultrasound examination

Appendiceal stump in transversewith colour Doppler

Appendiceal stump in transverse withlinear echogenecity representing asurgical clip (electronic calipers)

• Stump appendicitis is rare: published 61 cases in 60 years1

• Ultrasound has been used since 19942 with the first diagnostic case published in 20003

• Use established sonographic criteria for acute appendicitis applied to the residual stump4

• Secondary sonographic signs of acute appendicitis5 have also been demonstrated in cases of stump appendicitis6

• Appendicitis is usually dismissed in patients with a history of appendectomy.

• Sonographers should be aware of stump appendicitis in post-appendectomy patients that present with right iliac fossa pain.

Stump appendicitis

1. Subramanian A, Liang MK. A 60-year literature review of stump appendicitis: The need for a critical view. Am J Surg. 2012;203(4):503–7.

2. Kanona H, Al Samaraee A, Nice C, Bhattacharya V. Stump appendicitis: A review. Int J Surg. 2012;10(9):425–8.

3. Baldisserotto M, Cavazzola S, Cavazzola LT, Helena M, Lopes I, Mottin CC. Acute Edematous Stump Appendicitis Diagnosed Preoperatively on Sonography. AJR Am J Roentgenol. 2000;175(August):503–4.

4. Gasmi M, Fitouri F, Sahli S, Jemaï R, Hamzaoui M. A stump appendicitis in a child: a case report. Ital J Pediatr. 2009;35(1):35.

5. Reddan T, Corness J, Mengersen K, Harden F. Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding. J Med Radiat Sci. 2016;63(1):59–63.

6. Martínez Chamorro E, Merina Castilla A, Muñoz Fraile B, Koren Fernández L, Borruel Nacenta S. Stump appendicitis: Preoperative imaging findings in four cases. Abdom Imaging. 2013;38(6):1214–9.

• The authors declare no conflict of interest. Informed written consent was obtained.• All images acquired and/or created by primary author.

Tristan Reddan1,2* BAppSc, GDAppSc, AMSDr Jonathan Corness1 BA, MBBS, FRANZCRProf Kerrie Mengersen2 BA(Hons), PhDDr Fiona Harden2 BSc(Hons), PhD

1. Lady Cilento Children’s Hospital, Brisbane, Australia2. Queensland University of Technology, Brisbane, Australia* Corresponding primary author: Tristan.Reddan@health.qld.gov.au

References and authorship

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