Appendicitis in double cecal appendix: Case report

Abstract

Double cecal appendix is a rare anatomical variation. Approximately 100 cases have been reported worldwide. It is usually diagnosed incidentally during emergency appendectomies due to inflammatory processes in the cecal appendix. Case presentation: male, white, 36 years old, obese, presenting with pain in the lower abdomen for 24 h followed by nausea, vomiting and mild fever. He was subjected to additional tests, with the leukogram showing leukocytosis and abdominal ultrasonography depicting cecal appendix with thickened wall, locally associated with small quantities of liquid and intestinal loop obstruction. He underwent laparotomy, revealing acute appendicitis. Another intestinal loop obstruction was identified next to the ileum, leading to recognizing another cecal appendix after local dissection. Double appendectomy and segmental iliectomy were performed although not needed. Results of the anatomopathological examination of the surgical samples showed acute inflammation in the two cecal appendices. So, performing a routine retroperitoneal release and a complete cecum evaluation during such surgical procedures is recommended and suggested due to the possibility of not identifying a second cecal appendix.

Keywords: Appendix; Anatomic variation; Appendicitis; Appendectomy; General surgery

Core tip: Double cecal appendix is a rare (about 100 cases reported worldwide) anatomical variation often incidentally diagnosed in the face of inflammation in the organ. The current paper presents the first case reported in South America. The case is extremely important for the study of this possible anatomical variation since the lack of a diagnosis in a second cecal appendix can cause further complications for the patient and the physician. Moreover, it is associated with the presence of other anatomical variations, such as intestinal, genitourinary and bone. Such variations will be investigated in cases of the aforementioned diagnosis.