Post-operative appendix stump: How to handle?

The article is written by Specialist Doctor II Phan Phi Tuan, Head of Surgery Department, Vinmec Phu Quoc International General Hospital. Dr. Phan Phi Tuan has strengths in diagnosis and treatment of gastrointestinal diseases and urinary diseases; Gynecological laparoscopic surgery such as ovarian cyst, ectopic pregnancy...

95.5% of cases of appendicectomy following laparoscopic appendectomy are related to the condition of the appendix and cecum at surgery, the complexity of the surgery, and the distal bowel obstruction. Approximately 0.26% of cases occur with the use of titanium forceps (provided that the base of the appendix is ​​not too large or necrotic).
Posterior suture and appendix stump inclusion are also considered to be the cause of appendicectomy complications, for the following reasons:
Damage to the cecum during suturing Needle penetrates the intestinal wall causing fistula Sewing into the blood vessel causes Local lesions Formation of adhesions after surgery causing intestinal obstruction and caecal fistula However, there are no statistics comparing the rate of appendiceal stump rupture after laparoscopic appendectomy with or without pouch suture, root inclusion appendix. But in most cases of appendiceal root excision, the technique of suturing the appendix stump was not performed.
One study showed that, when the appendix stump showed signs of necrosis, clipping the appendix stump was more likely to cause the appendix to burst than other methods. A case of appendiceal rupture due to a remnant of the appendix stump longer than 5 mm was also reported. It is thought that leaving the appendix stump longer than 5mm will lead to ischemia, inflammation, and abscess of the appendix root followed by rupture of the appendix apex. The usual cause is that the source of the appendix is ​​not correctly identified for some reason.

Usually, the condition of the appendix stump occurs most on day 3-4 after surgery but there are also cases on day 21 after surgery.

With the appearance of pus or fluid from the wound, despite repeated drainage and dressing changes, in the early stages of appendicitis, some cases can be confused with an infection of the surgical site.
Patients with appendicitis have a feeling of fatigue and slow recovery after surgery. In addition, the patient may have fever, vomiting, abdominal pain, peritonitis, and sepsis. For an accurate diagnosis, the patient can be given the color indicator methylene blue to drink, if the fluid from the drainage has colored indicator, it is a gastrointestinal leak. The doctor combined with a clinical examination and possibly a CT colonoscopy with contrast will show contrast from the cecum to leak out. In some cases, it is necessary to take a fistula.

If there is no distal obstruction and there is a fistula outside the abdominal wall, there is no severe peritonitis, the appendix stump can be treated medically as a gastrointestinal fistula. If medical treatment fails, the patient needs surgery.
The process of treating appendicitis stump includes:
Medical treatment: Usually in 4-6 weeks with adequate nutrition, low fiber. Vacuum aspiration Laparoscopy through fistulas with bio-glue pump Using monoclonal antibodies in Crohn's disease Surgery after 4-6 weeks or complications during medical treatment When surgery is indicated, depending on the condition of the lesion Injury, the doctor can choose one of the following methods:
Laparoscopic suturing the base of the appendix Open surgery suturing the base of the appendix Sewing the base of the appendix, bringing the ileum to the skin. Right colectomy right anastomosis Right colectomy right colostomy. In addition, in a small number of cases, depending on the school, the doctor can also apply the following:
Place drainage into the cecum, suture the appendix to the abdominal wall, drain the caecum to the skin. When the drain is dry, withdraw the drain. However, this method causes a prolonged gastrointestinal leak. Proceed as above and bring the ileum to the skin. For direct advice on the treatment of appendicitis and appendicitis after surgery, please dial 1900 232 389 (key 0 to call Vinmec) or register for an appointment at the hospital HERE. If you need a remote health consultation with Dr. Vinmec, you can book a consultation HERE. Download the exclusive application MyVinmec for faster scheduling, more convenient calendar tracking.