An Unusual Tale of Two Appendices in a Case of Acute Appendicitis: One Gangrenous, One Inflamed

Appendicectomy is one of the most common surgeries performed worldwide. The incidence of acute appendicitis is higher among adolescents and young adults. Though various positions of the appendix, such as retrocecal, pelvic, subcecal, pre- or post-ileal, and their clinical implications have been well established, appendiceal anomalies like duplication or triplication of the appendix are yet to receive attention due to their very low incidence. We report an incidental finding of a duplicated appendix in a 19-year-old girl who presented with features of acute appendicitis. What makes this case report an interesting learning point for young surgeons is the identification of a perforated appendix with gangrene at the tip, along with an inflamed duplicated appendix. This report alerts us to the need for a thorough intraoperative inspection, to look for possible anatomical abnormalities, and to take the right management decisions to avoid unnecessary re-explorations. While operating a patient with features of acute appendicitis, a failure to identify a duplicated appendix is comparable to abandoning an inflamed appendix in-situ. Such instances not only increase the morbidity due to complications like the formation of pelvic abscesses, wound dehiscence, and surgical site infection, but also cause mortality.