Department of Surgery, Athens Naval and Veterans Hospital, 11521, Athens, Greece.
Medical School, University of Crete, Heraklion, Crete, Greece.
World J Surg. 2019 Nov;43(11):2756-2761. doi: 10.1007/s00268-019-05101-z.
Stump appendicitis is defined as interval inflammation of any residual appendicular tissue, after an appendicectomy. We present a systematic review of case series and case reports on stump appendicitis, emphasising on risk factors, diagnosis and surgical management.
The English literature (1945-2018) was reviewed, using PubMed, Embase and GoogleScholar, combining the terms "appendix", "appendicitis", "stump", "residual", "recurrent" and "retained". In total, 127 studies were included, describing 164 patients (males 59%, mean age 36 ± 17 years).
Index surgery was open in 59% and laparoscopic in 38%. It was described as "difficult" or "complicated" in 31%. 20% of patients reported episodes of recurrent abdominal pain during the time interval between index and stump appendicitis (range 2 weeks to 60 years, median 2 years). Right lower quadrant pain was the most frequent complain (88%), leukocytosis was found in 56%, whereas 92% of patients underwent imaging testing, which was diagnostic or highly suspicious in 67.5%. Mean delay between beginning of symptoms and surgery was 2.4 ± 2.3 days. The operative approach was open in 61% and laparoscopic in 35% of cases. The operation was characterised as "difficult" or "complicated" in 45%. In the majority (88%), a completion stump appendicectomy was performed, with 11% requiring more extensive procedures. Mean length of resected stump was 3.1 ± 1.6 cm (range 0.5-10 cm).
Stump appendicitis may occur following both open and laparoscopic approach, when the residual stump is > 0.5 cm. Its clinical significance lies in the delayed diagnosis, leading to higher incidence of complications and the need for more extensive surgery.
残株阑尾炎是指阑尾切除术后任何残余阑尾组织的间隔性炎症。我们对残株阑尾炎的病例系列和病例报告进行了系统回顾，重点介绍了危险因素、诊断和手术处理。
检索了 1945 年至 2018 年的英文文献，使用了 PubMed、Embase 和 GoogleScholar，结合了“阑尾”、“阑尾炎”、“残株”、“残余”、“复发”和“保留”等术语。共纳入了 127 项研究，描述了 164 例患者（男性占 59%，平均年龄 36±17 岁）。
指数手术中，开放性手术占 59%，腹腔镜手术占 38%。31%的手术被描述为“困难”或“复杂”。20%的患者在指数手术和残株阑尾炎之间的时间间隔内报告反复发作的腹痛（范围 2 周至 60 年，中位数 2 年）。右下腹痛是最常见的症状（88%），白细胞增多症的发生率为 56%，92%的患者进行了影像学检查，其中 67.5%的检查具有诊断或高度可疑性。症状开始和手术之间的平均延迟时间为 2.4±2.3 天。手术方式为开放性手术的占 61%，腹腔镜手术的占 35%。45%的手术被描述为“困难”或“复杂”。大多数（88%）患者行残株阑尾切除术，11%的患者需要更广泛的手术。切除的残株平均长度为 3.1±1.6cm（范围 0.5-10cm）。
残株阑尾炎可发生在开放性和腹腔镜手术之后，当残余残株长度大于 0.5cm 时。其临床意义在于诊断延迟，导致并发症发生率更高，需要更广泛的手术。
