Rarely a patient who has had an appendectomy will present with recurrent appendicitis. This can be a diagnostic challenge (and would probably be missed by most computer-based diagnostic systems).


When should the diagnosis of post-appendectomy appendicitis be considered:

(1) one or more of the following:

(1a) persistent symptoms after appendectomy

(1b) unexplained sepsis after appendectomy

(1c) signs and symptoms of appendicitis following appendectomy

(2) incomplete removal of the appendix at the original surgery


In most cases a small length of the proximal appendix remains ("stump" appendicitis). Clark and Theodorou describe a case which occurred following rupture with abscess, with infection in the distal appendiceal tip.


Differential diagnosis:

(1) adhesions

(2) abscess

(3) other lesion (diverticuli, ovarian cyst, etc.)


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