A Case of Retained Viable Appendiceal Segment after Perforated Appendicitis

Conservative management of perforated appendicitis is widely accepted; however, residual appendiceal tissue may persist and lead to delayed complications. We report a rare case of a retained viable appendiceal segment identified during interval appendectomy (IA).

An 82-year-old patient was treated conservatively for perforated appendicitis without abscess formation but with marked periappendiceal inflammatory changes. Two months after the initial treatment, an IA was planned. Follow-up CT demonstrated enlargement of the appendix compared with the initial imaging. Intraoperatively, the appendix was found to be transected at the mid-portion. The distal segment was separated from the proximal stump and encapsulated by the omentum and small intestine with dense adhesions. This distal segment remained viable because it retained blood supply through the mesoappendix and showed inflammatory enlargement. Histopathological examination demonstrated preserved appendiceal wall structure with inflammatory cell infiltration, without evidence of necrosis or malignancy. The postoperative course was uneventful, and the patient was discharged on POD 3.

A retained viable appendiceal segment may persist and enlarge after perforated appendicitis treated conservatively, potentially leading to delayed complications such as secondary perforation or abscess formation; therefore, surgeons should be aware of this possibility and consider IA in selected patients. Careful attention should be paid to ensure complete removal of the appendix, including any detached distal segments.