Stump Appendicitis

There has been a recent increase in interest in stump appendicitis with the rapid development of laparoscopic appendectomy. The objective of this study is to determine the frequency, management, and prevention of stump appendicitis in a retrospective review of 2185 cases of appendectomy and right colectomy at the Massachusetts General Hospital from 1960 to 1998. Three patients with stump appendicitis were identified. Patients presented with epigastric or periumbilical pain that radiated to the right lower quadrant. All had focal abdominal signs and a mild to moderate leukocytosis, and all underwent right colectomy. Pathology noted appendiceal stumps 5 mm deep. Two additional patients with chronic abdominal pain had cecal filling defects on barium enema. Endoscopically, these appendiceal stumps were 7 mm deep with impacted fecaliths and pathologic changes consistent with early inflammation. The stumps were resected by snare electrocautery. Stump appendicitis is a very rare entity. Its incidence may be minimized with accurate visualization of the appendiceal base and creation of an appendiceal stump less than 3 mm in depth. There is no correlation between simple ligation or inversion of the stump and stump appendicitis. There should not be a sudden increase in the incidence of this entity if laparoscopic appendectomy is performed properly.