Bifid vermiform appendix: a case report.
BACKGROUND
Appendiceal anomalies are extremely rare: they have a reported incidence of between 0.004% and 0.009% of appendectomy specimens. The authors report a case of a patient who was found to have 2 appendices at emergency laparotomy, review the classification system used, and discuss the potential clinical pitfalls of similar cases.


METHODS
A 23-year-old man was admitted as an emergency with abdominal pain and vomiting. The operative finding was of a bifid appendix. One appendix was grossly gangrenous and lacked a mesoappendix, whereas the other had a mesoappendix and appeared macroscopically normal. The appendices shared a common base that arose from the cecum in the typical anatomical position. No other intra-abdominal malformations were present at inspection during laparotomy. Histology confirmed features of gangrenous appendicitis. His postoperative recovery was uneventful, and he was discharged after 4 days.


CONCLUSIONS
Although rare, it is important for several reasons that surgeons are aware of the potential anatomical anomalies and malpositions of the vermiform appendix: first, a missed second appendix may result in serious clinical and medico-legal consequences; second, a double appendix can be confused with other intra-abdominal conditions; and finally, they can be associated with other congenital abnormalities.
Griffiths
Ewen A
EA
Department of General Surgery, Queen Elizabeth Hospital, Gateshead, United Kingdom. eagriffiths@btinternet.com
Jagadeesan
Jayaraman
J
Fasih
Tarannum
T
Mercer-Jones
Mark
M
D000328:Adult; D001064:Appendicitis / Q000473:pathology* / Q000601:surgery; D001065:Appendix / Q000002:abnormalities* / Q000473:pathology; D000013:Congenital Abnormalities / Q000145:classification; D005734:Gangrene; D006801:Humans; D008297:Male