Acute appendicitis after a prior appendicectomy: an unorthodox surgical paradox

Acute appendicitis after prior appendicectomy is highly difficult to diagnose, especially in face of definite history of appendicectomy and presence of appendicectomy scar in the right iliac fossa. We are highlighting a case report of a 40 year old woman who despite having had appendicectomy 2 years back presented with severe abdominal pain in the right iliac fossa in association with anorexia, nausea, vomiting and low-grade pyrexia of one day duration. On the basis of clinical evaluation and haematological and radiological investigations, diagnosis of perforated appendicitis was made. After thorough counselling of the patient and relatives, re-exploration of the patient was performed after excision of previous appendicectomy scar. The appendix was found to be perforated with an extraluminal faecolith and purulent exudate in the right iliac fossa. Appendicectomy and local peritoneal lavage resulted in uneventful recovery of the patient. Histopathology of the specimen revealed acutely inflamed appendicitis.