Atypical Duplex Appendix: A Case Report

Abstract

Duplex appendix is a rare anomaly of the appendix with an incidence of 0.0004% to 0.009%. It varies in both presentation and position. Due to its rare occurrence and variable position, we present a case of duplex appendix with an atypical position in a 34-year-old male. The patient was diagnosed with acute appendicitis and underwent open appendectomy. During surgery, two appendices were observed, both arising anteriorly from cecum with one arising from taenia coli and the second arising adjacent to, medial, and parallel to the first, near ileocecal junction. Both were excised and sent for histological examination, which revealed neutrophilic infiltration in the mucosa, submucosa and muscularis propria of both appendices. Follow-up after one week was unremarkable. There are various classifications of duplex appendix but Modified Cave-Wallbridge classification is the most widely accepted. However, the position of both appendices in our case does not conform to this classification. Therefore, there may be a need to broaden this classification to incorporate the atypical cases. Additionally, in situations where a normal appendix is visualized or a previous appendectomy has been performed, and the clinical signs strongly suggest appendicitis, surgeons should consider the probability of this anomaly and look for it during surgery. Also due to its association with other anomalies, further investigations should be conducted to rule them out.