|LETTER TO THE EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 105-106
Acute appendicitis in a patient with appendiceal duplication
Andrés Lorenzo Mestril, Fernando Karel Fonseca Sosa, Anival Ernesto Ramos Socarrás, Francisco Antonio Vargas La O
Department of General Surgery, “Celia Sánchez Manduley” Hospital, Manzanillo, Granma, Cuba
|Date of Submission||13-Mar-2020|
|Date of Decision||24-May-2020|
|Date of Acceptance||27-May-2020|
|Date of Web Publication||07-Jul-2020|
Dr. Fernando Karel Fonseca Sosa
Esperanza Street #73 between Guadalupe and San Javier, Manzanillo, Granma, Postal Code 87510
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mestril AL, Fonseca Sosa FK, Ramos Socarrás AE, La O FA. Acute appendicitis in a patient with appendiceal duplication. Indian J Med Spec 2020;11:105-6
|How to cite this URL:|
Mestril AL, Fonseca Sosa FK, Ramos Socarrás AE, La O FA. Acute appendicitis in a patient with appendiceal duplication. Indian J Med Spec [serial online] 2020 [cited 2020 Aug 13];11:105-6. Available from: http://www.ijms.in/text.asp?2020/11/2/105/289115
Appendiceal duplication is a rare anomaly that was first described by Bartels in a fetal specimen in 1867. Picoli was the first to publish a case in 1892. The incidence of appendiceal duplication is reported to range from 0.004% to 0.009%. Until now, more than 100 cases have been reported, of which <15 cases were complicated by acute appendicitis.
We present the case of a 39-year-old male who came to the emergency department for abdominal pain that began 1 day ago in the epigastrium and then moved to the lower right quadrant, which intensified progressively, was constant, did not relieve with pain relievers, and increased with the realization of sudden movements. It was accompanied by nausea and vomiting. On physical examination, the patient had tachycardia of 107 beats/minute. Examination of the abdomen revealed reaction peritoneal in the right iliac fossa and McBurney point painful on palpation.
Laboratory tests showed a leukocytosis of 12.8 × 109 / l without left shift, the rest of the tests were normal. In imaging techniques, abdominal ultrasound did not help make the diagnosis. Emergency intervention was performed by infraumbilical right paramedian incision, identifying an appendiceal duplication; one of them was swollen and erythematous [Figure 1]. Rest of the intra-abdominal organs were normal. Double appendicectomy was performed. Histology confirmed the diagnosis of acute catarrhal appendicitis with neutrophilic exudate that affected the mucosa, submucosa, and the muscularis. The second surgical piece showed a normal appendix. The patient evolved satisfactorily and was discharged on the 3rd postoperative day.
|Figure 1: Intraoperative picture showing the appendiceal duplication. The white arrow indicates the inflamed appendix and the black arrow the normal appendix|
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According to the currently accepted Cave–Wallbridge classification, Type A duplications consist of a single cecum that gives rise to a partially duplicated appendix. Type B1 (“bird-like” arrangement) consists of two separate appendices on either side of the ileocecal valve. Type B2 (“tenia coli” variety) has one appendix found in the retrocecal position arising from the convergence of the tenia coli and a smaller second appendix along the anterior tenia at a variable distance from the first. Type C consists of two separate cecum, each with its own appendix. A horseshoe configuration of duplication and triple appendices has also been described. This patient had Type B1 appendiceal duplication.
The diagnosis of appendix duplication is only confirmed when both specimens display an intact structure (including the tip) with lumens that are lined by normal appendiceal mucosa, lymphoid follicles, and two layers of musculature on histological examination.
Type B1 and Type C variations are often associated with other congenital abnormalities, in particular duplications of reproductive organs and imperforate anus. Previous surgery during childhood for congenital abnormalities should therefore raise suspicion. The existence of a cecal appendix duplication is asymptomatic and its diagnosis only comes during investigations on inflammation processes.
Although appendiceal duplication occurs very rarely, awareness of this congenital anomaly and thorough intraoperative inspection are critical to avoid the potential consequences of missing a second appendix, as well as any associated congenital anomalies, and to minimize confusion with other intra-abdominal structures.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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