BRAG PhD Student Tristan Reddan attended the 23rd Annual International Conference of the Australasian Sonographers Association ASA2016 Melbourne and presented a poster
The conference provides sonographers with a fantastic opportunity to present to their peers. Awards are offered to encourage and celebrate excellent contributions to the profession and Tristan was awarded the prize for Best poster/case report
Best poster – sponsored by AoN
Presenter: Tristan Reddan
Title of presentation: The grumpy stump – ultrasound and stump appendicitis
The grumpy stump – ultrasound and stump appendicitis
T Reddan1, 2, J Corness1, K Mengersen2, F Harden2
1Medical Imaging and Nuclear Medicine, Lady Cilento Children’s Hospital, South Brisbane 2Science and Engineering Faculty, Queensland University of Technology, Brisbane
Background: Stump appendicitis, the inflammation of an incompletely removed appendix, is a rare clinical presentation. Sonography can be useful in the diagnosis of the condition; by either directly visualising the inflamed stump, or by identifying signs of peri-caecal inflammation that can raise suspicion of the condition.
Summary of work: A potential case of stump appendicitis was identified. This prompted a review of literature focused on the incidence of stump appendicitis, utility of ultrasound to identify an inflamed appendiceal stump, and surgical techniques used in appendectomy.
Summary of results: Stump appendicitis is rare, with as few as 61 cases identified in literature during the last 60 years1. Of the two common techniques of appendectomy, which are ligation and invagination, the former can sometimes leave a residual stump that acts as a potential lumen for the pathophysiological process of appendicitis to recur. Established sonographic criteria for appendicitis also apply to the residual stump. Sonographic secondary signs that suggest the presence of acute appendicitis2 have also been demonstrated in cases of stump appendicitis3, even in the absence of an identifiable stump.
Discussion and conclusions: Appendicitis is usually dismissed in patients with a history of appendectomy. Though uncommon, sonographers should be aware of stump appendicitis in post-appendectomy patients that present with right iliac fossa pain from months to decades later.
1 A 60-year literature review of stump appendicitis: The need for a critical view. Am J Surg; 2012;203(4):503–7., .
2 Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding. J Med Radiat Sci. 2015;DOI: 10.1002/jmrs.154, , , .
3 Stump appendicitis: Preoperative imaging findings in four cases. Abdom Imaging. 2013;38(6):1214–9., , , , .
Take home messages: Stump appendicitis or its secondary signs are detectable with ultrasound. It is important to be aware of the possibility of this condition in patients that have previously undergone appendectomy.