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)