Three times a charm… a case of repeat appendicitis status post two prior appendectomies

Appendicitis is defined as the bacterial proliferation and inflammation of the vermiform appendix, typically caused by a fecalith . There have been a few cases reported in the literature of recurrent appendicitis status post an appendectomy, however there has been no reported case of a recurrence status post two prior appendectomies. We would like to present the first case of recurrent appendicitis status post two prior appendectomies.

A 32year old otherwise healthy male presented to the ER on 8/27 with right lower quadrant pain and no other symptoms. His initial triage vital signs were within normal limits. Of note patient had an appendectomy on 8/15/17 and a repeat appendectomy on 8/22/17 for recurrent appendicitis. Other than the RLQ abdominal pain, the patient's review of systems and physical examination were unremarkable. Patient's WBC was 7.5 and lactate was 1.4. A CT of the abdomen/pelvis showed a 1.3cm inflamed appendix. Patient was admitted to the Surgery service on IVF and IV antibiotics. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Appendicitis should continue to be on an emergency physician's differential for a patient with RLQ pain even when the patient has had a prior appendectomy. Appropriate management in the ER can lead to improved treatment, timely surgical consultations and decreased complications.