Stump Appendicitis Seven Years after Appendectomy

A 15-year-old boy was admitted to our hospital with abdominal pain and a surgical history of videoassisted transumbilical appendectomy for a gangrenous appendicitis 7 years back. The small stump was closed without purse-string suture. The postoperative period was complicated by an intraperitoneal abscess treated with antibiotics. Later on he experienced multiple episodes (thrice a year) of self limiting intermittent abdominal pain with pallor, sweating and diarrhea. During current admission, the abdominal pain started 3 days back. It was described as colic, getting worse and associated with pallor and sweating. There was no fever, vomiting, diarrhea, or urinary symptoms. Vital signs were normal. Physical examination revealed a subumbilical scar and peritoneal irritation in the right lower quadrant; no palpable masses were appreciated and genitourinary examination was unremarkable. The abdomen was not distended but bowel sounds were decreased.