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.