title: An unsuspected clinical condition: Appendicitis of appendicular residual, three cases report.
abstract: BACKGROUND
  Stump appendicitis is a rare complication of appendectomy unusually included in the differential diagnosis. This is found in appendectomized patients with similar symptoms to those of a previous appendicitis.
  
  
  METHODS
  We present three cases, two women and a man of 67, 30 and 24 years old, respectively. They underwent surgery at our centre and their appendectomies presented technical difficulties: problems when identifying the appendicular base or the complete appendicular structure. In the first case, diagnosis and therapy were performed with laparoscopy. The second case was diagnosed by an abdominal ultrasound (US) which revealed a tubular structure with thickened walls. An abscess was observed in the computed tomography (CT) scan for the third case and a laparotomy revealed the retained appendix.
  
  
  CONCLUSIONS
  Although there are several factors that can contribute to this rare pathology, the main cause of stump appendicitis is the persistence of a large appendicular remnant. CT and US are very useful diagnosis tools. Treatment consists to a completion appendectomy of the stump which can be carried out by an open or a laparoscopic approach.
  
  
  CONCLUSIONS
  In this rare pathology a prior history of appendicectomy can delay the diagnosis and increase its associated morbidity and even mortality. In patients with abdominal pain in the right lower quadrant and previous appendectomy, it is important to include this pathology in the differential diagnosis, in order to not delay the treatment and thus avoid complications.
authors.affiliation: General and Digestive Surgery Service, Hospital Universitario Central de Asturias, Calle de Celestino Villamil s/n, 33006 Oviedo, Asturias, Spain. Electronic address: dacusto_generation@hotmail.com.
authors.forename: Germán
authors.initials: G
authors.lastname: Mínguez
authors.forename: Rubén
authors.initials: R
authors.lastname: Gonzalo
authors.forename: Andrea
authors.initials: A
authors.lastname: Tamargo
authors.forename: Estrella
authors.initials: E
authors.lastname: Turienzo
authors.forename: Alicia
authors.initials: A
authors.lastname: Mesa
authors.forename: Lino
authors.initials: L
authors.lastname: Vazquez