3 DISCUSSION
With regard to the extreme scarcity of appendiceal anomalies,
duplication of the appendix is the most common anomaly that has been
reported. A review of published reported cases identified 141 duplicate
appendices.1 According to the Modified Cave-Wallbridge
classification of the anatomical variation of duplication, B2 is the
most common type.2 The literature reported less than
15 cases of appendicitis in double appendices. For these considerable
matchings and similarity to our case, we think that the literature
background strongly support our findings.
The preoperative diagnosis of appendix duplicity is
challenging.3 It is almost always identified
intraoperatively. In this case, we did not perform image studies, as
signs and symptoms were typical of acute appendicitis. Duplicity of the
appendices may be missed if the second appendix is concealed in the
retrocaecal position.2,4 Generally, surgical field
exposure is inadequate during open appendectomy, and routine caecal
mobilization and retrocaecal exploration are not performed routinely
during the procedure. Laparoscopy can increase the detection rate due to
a better visualization of the abdominal cavity.5
In our case, we fortunately detected and removed both appendices.
Intraoperative missing of the second appendix has serious medico-legal
consequences and increases the risk of complications if the missed
appendix got inflamed in the future. The literature reported a case of
ruptured appendix in the retrocaecal space presented after a previous
laparoscopic appendectomy.4 The diagnosis of appendix
duplicity should be considered in any patient with a history of
appendectomy who present with similar symptoms and signs of acute
appendicitis.