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Morgan Melnick
Heather McHale
ENGL101
March 29, 2016
Uninformed Medicine
Id like to address the general population, not only physicians and those in the
medical field but, anyone and everyone who has a human body. Appendicitis is an
ailment that can happen to anyone and vary in severity ranging from; removing the
appendix pre-appendicitis in order to prevent having the condition to having a ruptured
appendix. In any case, an appendectomy requires surgery, rehabilitation, and possible
complications that follow the procedure. There is one complication that not many
individuals, including doctors, know about: stump appendicitis. Knowing this is a real
complication that can follow an appendectomy is something that everyone should be
aware of in order to avoid a misdiagnosis and other possible sequential consequences that
follow, due to a lack of this knowledge. With this awareness, a patient with SA (stump
appendicitis) may be able to suggest a diagnosis and a physician may be better able to
treat a SA patient.
Saying that you have had your appendix removed is nothing special; its actually
quite common. Saying that you have had your appendix removed twice? That seems
impossible seeing as humans are born with only one of these vestigial organs, however;
over the years, doctors have begun to accept having to remove an individuals appendix
for a second time to be a reality. Seems strange, doesnt it? Hi, I am one of the lucky few

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individuals to have had stump appendicitis and I doubt you will ever meet anyone else
who can say that.
This condition was not recognized by the majority of the medical community at
the time in which I had my operation but; I was lucky enough to have a physician whom
was informed, or at least had some idea, on the subject. Still, the majority of doctors do
not know about this possible side effect caused by an appendectomy. Some physicians are
aware of this complication and believe it strikes the unlucky few, others believe that the
advancement of laparoscopic surgeries are leading to an increase in stump appendicitis,
and others still fail to recognize stump appendicitis and do not know such a thing exists.
But, what causes it?
Appendectomies are one the most, if not the most common surgical procedure
preformed. The WebMD article, Appendicitis Symptoms, lists the possible symptoms of
appendicitis as being: a dull pain near the navel or upper or lower abdomen that becomes
a sharp pain in the lower right abdomen, loss of appetite, nausea or vomiting, an
increased bodily temperature, constipation or diarrhea with gas, severe cramps, painful
urination and/or the inability to pass gas. These are the same symptoms stump
appendicitis presents with as well. As also stated in the WebMD article:
Appendicitis occurs when the appendix becomes blocked, often by stool, a
foreign body, or cancer. Blockage may also occur from infection, since the
appendix swells in response to any infection in the body.
Complications for an appendectomy include wound infection, periappendicular or
intra-abdominal abscess and postoperative adhesions. (Durgun 1) The appendix seems to
be a pesky, little vestigial organ that serves hardly any purpose but can cause severe

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problems for our bodies. In the United States alone, more than 25,000 appendectomies
are preformed each year. (Johnson 1) Stump Appendicitis has struck in only 1 out of
50,000 of these cases, thats the same as one case of SA occurring every other year.
(Kumar 173) As stated in the Awe, Solimon, and Gourdies case report, Stump
Appendicitis, in the year 2013, there were only 36 cases of stump appendicitis recorded
in the English language literature. In Johnson, Myers, and Williams article, stump
appendicitis is defined as, an uncommon entity with little radiologic literature. My
physician had described it as the reinflammation of the residual appendicular stump.
Stump appendicitis can occur within a few weeks of the initial operation or even in one
case, fifty years later (Johnson 1). The presence of stump appendicitis is not debated,
what causes it is becoming clearer with time but; the problem is that most physicians are
not informed about this rare clinical entity.
As stated in Agi and Delibegovis case report, the first case of stump
appendicitis was recorded by Rose in 1945. Kumar makes the claim that an
appendicular stump shorter than 5 mm reduces the risk of stump appendicitis. Those
who believe that SA occurs to the unlucky few either believe it maybe caused by surgical
error or simply occur due to natural factors. Those who see surgical error as the cause
blame the incomplete removal of the appendix i.e. not having cut the residual stump to a
short enough length. (Johnson 1) These individuals push for the length of the
appendicular stump to be made even shorter. As Durgun states in his case report, Stump
appendicitis is a rare clinical situation when there is an incomplete appendectomy. thus,
pinning the blame on the surgeons. Those who see natural reason for the development of
SA may point to the patient having had a ruptured appendix followed by other surgical

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complications as both the individual singled out in Johnsons article, Stump Appendicitis,
and I experienced. I have noticed that there is a fair chance that this case study and I are
one in the same due to many of the details surrounding our cases to be exceedingly
similar.
These individuals also argue that stump appendicitis is more common in open
appendectomies, occurring in 66% of patients who experienced stump appendicitis and
only occurring in individuals who underwent laparoscopic surgery 34% of the time. (Awe
3) However, with laparoscopic surgeries becoming more and more popular amongst
surgeons, one would think that stump appendicitis is even less of a threat. This may not
be the case, as recent years have shown an increase in stump appendicitis cases. What
could be causing this? Environmental/natural factors? Surgeons with whom are poorly
skilled?
Or, is it that the laparoscopic approach to the removal of an appendix actually
leads to a greater chance in developing stump appendicitis? In 2003, a study documented
in Agi and Delibegovis case report, in Bosnia and Herzegovina concluded that the
laparoscopic approach led to a greater chance in developing stump appendicitis due to a
smaller field of vision, lack of three-dimensional perspective and absence of tactile
feedback thus potentially leading to a longer stump. (Agi 60) However, in this case
report and many of the pervious mentioned reports, the argument for laparoscopic versus
open appendectomy is left open ended, offering minimal data. Do laparoscopic surgeries
increase the chance of developing stump appendicitis or did we just get better at
identifying it over time?

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The issue is, we dont know. The medical field has a decent idea about the
possible causes of stump appendicitis but many physicians lack any knowledge of it,
leaving studying the SA phenomena difficult and with little data to support any one
argument. The data is limited due to the rarity of this complication and the inability for
physicians to identify it. Varnada Karriem-Norwood, MD reviewed the WebMD
information mentioned earlier and still there was no discussion of stump appendicitis to
be seen in the list of possible complications of an appendectomy. In fact, the following
was stated:
If you have symptoms of appendicitis, but your appendix has already been
removed; you may have pelvis inflammatory disease, diverticulitis, a tubal
pregnancy, gastroenteritis, Crohns disease, or colorectal cancer.
This is yet another example of misinformation. Stump appendicitis is a real possibility,
rare it may be, but it is a possibility and should be treated as such. Karriem-Norwood
whom, again, reviewed this information failed to point SA out as a possibility.
The presence of an appendectomy scar does not rule out the possibility of stump
appendicitis. (Kumar 175) Stump appendicitis is real, trust me Ive experienced it first
hand. Ive had my appendix removed twice, have had drainage tubes shoved into my
abdomen, and have had a three foot long Pic-line threaded through my veins into my
heart not once but, twice.
Medicine is a science. Science is formed of countless hypotheses that may one
day prove to be correct. Stump appendicitis exists but, why does it occur and why dont
more physicians know about it? Does it happen by chance? Maybe a surgical error? Is the
advancement of laparoscopic surgeries to blame or did we simply keep a poor record? Do

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people choose to ignore stump appendicitis and not even consider it due to its rarity or are
rising physicians simply uninformed on the matter?
I dont see myself as unique or special, just lucky. Lucky to have had a physician
who happened to know about stump appendicitis when his team of doctors hadnt had a
clue what he was talking about. What if it were you? What if you knew something was
wrong but everyone, even your doctor, was saying that they didnt know what was wrong
with you? What if you were misdiagnosed? Stump appendicitis is an incredibly rare yet
understated complication to a simple, and incredibly common surgical procedure. I got
lucky and I have the scars to prove it.

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Work Cited
Agi, Mirha, and Samir Delibegovi. "Stump Appendicitis Following Laparoscopic
Appendectomy." BH Surgery 3.1 (2013): 58-60. Academic Search Complete. Web.
20 Mar. 2016.
"Appendicitis Symptoms, Causes, Surgery, and Recovery." WebMD. WebMD, 2014.
Web. 27 Mar. 2016.
Awe, J. A. A., A. M. Soliman, and R. W. Gourdie. "Stump Appendicitis: An Uncompleted
Surgery, A Rare But Important Entity With Potential Problems." Case Reports In
Surgery (2013): 1-4. Academic Search Complete. Web. 19 Mar. 2016.
Durgun, A. V., et al. "Stump Appendicitis And Generalized Peritonitis Due To Incomplete
Appendectomy." Techniques In Coloproctology 7.2 (2003): 102-104. Academic
Search Complete. Web. 19 Mar. 2016.
Johnston, Jennifer, Daniel Myers, and Todd Williams. "Stump Appendicitis: Surgical
Background, CT Appearance, And Imaging Mimics." Emergency Radiology 22.1
(2015): 13-18. Academic Search Complete. Web. 20 Mar. 2016.
Kumar, Abhinav, et al. "Stump Appendicitis: A Rare Clinical Entity." Journal Of Minimal
Access Surgery 9.4 (2013): 173-176. Academic Search Complete. Web. 19 Mar.
2016.