Dr Fragen in the operating room

Appendiceal Duplication


I had a very interesting case the other evening. First, for the uninitiated, it’s usually a bad sign when the surgeon says it was a very _interesting_ case. Generally routine is best.
Anyway, nice 50ish year old female with few days of diffuse abdominal pain now localizing to RLQ. Nausea and vomiting. Anorexia. Acute peritoneal finding in RLQ with percussion. Outside CT reportedly showing acute appendicitis.
I look at the patient. Story is great. Almost sounds like she’s read [Cope][1]. I take her to the OR. I feel a mass on exam after induction. Sorry guys I do open appys. 3 cm McBurney incison and mobile the cecum. There’s a 5cm mass but seems to be mobilizing from the superior aspect of ascending colon not inferiorly. Anyway, I deliver what appears to be an appendiceal phlegmon into the wound and fire a GIA-55 across its base. The base is along a tinea adjacent to the ileocecal valve. Doesn’t look like there’s any free perforation so I irrigate and start to close.
I’ve got a couple of clamps on the peritoneum and then I see a relatively normal looking appendix starting at me. Naturally it comes out.
Patient home in less than 24 hours.
Path report shows:
* appendix – acute appendicitis
* pericecal diverticulum and phlegmon – appendiceal duplication with acute perforating and gangrenous appendicitis
Comment on path report is _duplication based upon the presence of circular muscle around the diverticulum, its location and gross appearance_.
I’ve never seen that one before. All I can say is I’m glad I saw what I considered to be a _relatively_ normal appearing appendix prior to closure.
[1]: http://www.amazon.com/Copes-Early-Diagnosis-Acute-Abdomen/dp/0195175468