A very rare association: acute apendagitis and appendicular agenesis, case report

1.1   Background: Apendagitis is an entity with an incidence about 8.8: 1,000,000 habitants. It represents difficult diagnosis pathology, completed many times only after surgical exploration. The association of Apendagitis with vermiform appendix agenesis has never been reported before in literature. 1.2   Case: A 4 years-old female present at emergency room with abdominal pain of 2 days of evolution. At physical exam with tachycardia, tachypnea, temperature of 38o C, dehydrated, abdominal pain localized in right iliac fossa, Mc Burney sign, other appendicular signs absents, without bowel sounds. Laboratories report leucocytes 14800 with neutrophils 78%. Without US or CT scan image in the hospital during night, acute appendicitis diagnosis was carried out and an appendectomy programmed. During surgery and after Cattel maneuver the vermiform appendix was not found and a Meckel diverticulum discarded. Mc Burney incision was extended and a necrotic epiploic appendix found in the ascendant colon, it was removed. Diagnosis of Apendagitis and appendicular agenesis was registered and after two days of analgesia treatment, patient was discharged without complications. 1.3   Conclusion: Apendagitis diagnosis is a rare entity that would be consider in cases of acute abdominal pain because would be misdiagnosed as another pathologies like diverticulitis, appendicitis or Meckel diverticulum. The preoperative diagnosis can only be achieved accurately by CT-scan and discarding other abdominal pain causes, avoiding unnecessary surgeries and allowing medical management for this entity.