Acute Stump Appendicitis Complicated by an Abscess, Two Months after Laparoscopic Appendectomy: A Case Report

Abstract

Introduction: Stump appendicitis is an uncommon complication of appendicectomy caused by inflammation of residual appendiceal tissue. Its clinical presentation may resemble acute appendicitis, and previous appendicectomy may contribute to diagnostic uncertainty. We describe a case of early stump appendicitis complicated by a localised abscess following laparoscopic appendicectomy. Case Presentation: A 24-year-old man presented with a four-day history of fever and right iliac fossa pain, two months after laparoscopic appendicectomy for uncomplicated acute appendicitis. Examination revealed localised tenderness, while laboratory investigations showed a white blood cell count of 16,000 cells/mm³ and a C-reactive protein concentration of 200 mg/L. Ultrasonography demonstrated a non-compressible appendiceal stump measuring 8 mm in diameter. Computed tomography confirmed stump inflammation, measuring 9 mm in diameter, associated with a residual faecal stone measuring 12.5 mm. Neither investigation demonstrated an organised collection. Repeat laparoscopy revealed an inflamed appendiceal stump approximately 2 cm long, surrounded by a localised abscess. Complete resection of the residual stump, abscess aspiration, irrigation and drainage were performed. Histopathological examination confirmed acute appendicitis. Postoperative recovery was uneventful, and the patient was discharged on postoperative day three. At three-week follow-up, he remained asymptomatic. Conclusion: Stump appendicitis may develop within months of appendicectomy and may be complicated by localised abscess formation despite the absence of an organised collection on preoperative imaging. Clinical suspicion remains important when evaluating recurrent right iliac fossa pain after appendicectomy.