Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 2/2018

01-02-2018 | Original Scientific Report

Appendiceal Duplication: A Comprehensive Review of Published Cases and Clinical Recommendations

Authors: H. Nageswaran, U. Khan, F. Hill, A. Maw

Published in: World Journal of Surgery | Issue 2/2018

Login to get access

Abstract

Background

Duplex appendix is very rare (incidence 0.004%) but has clinical relevance given the frequency of appendicectomies performed. Failure to recognise duplication can result in failure of treatment and medico-legal consequences. A review of published cases was undertaken to identify factors that may help in managing this rare condition.

Methods

All English and non-English publications were identified in PubMed, Embase and Cochrane databases. Patient demographics, intraoperative findings, anatomical details and histopathology were analysed.

Results

A total of 141 cases were identified [male/female ratio 1.4:1, median age 20 years (range foetus to 69 years)]. Duplication of the appendix ranges from branching of the appendix trunk to a fully matured appendix located elsewhere along the colon. Most can be categorised by the Cave–Wallbridge classification. There were 22 Type A, 8 Type B1, 46 Type B2 and 10 Type C cases (Cave–Wallbridge). There were six cases of horseshoe and two cases of triple appendix. Six reports gave anatomical descriptions that could not be classified by Cave–Wallbridge categories and in 11 cases there were no anatomical descriptions.

Conclusions

An anteriorly placed appendix, away from the convergence of the taenia, or a normal appendix in the presence of convincing clinical or radiological signs of appendicitis should instigate a careful examination of the caecal pole and possible exploration of the retrocaecal space for appendiceal duplication. If the patient had previous surgery for congenital abnormalities, Type B1 or Type C duplication should be considered.
Literature
1.
2.
Ahmed I et al (2007) The position of the vermiform appendix at laparoscopy. Surg Radiol Anat 29(2):165–168PubMedCrossRef
3.
Collins DC (1955) A study of 50,000 specimens of the human vermiform appendix. Surg Gynecol Obstet 101(4):437–445PubMed
4.
Picoli G (1892) Quoted by Gupta and Kak, 1964. Progresso Medico (Napoli) 6:32
5.
6.
7.
8.
Mesko TW, Lugo R, Breitholtz T (1989) Horseshoe anomaly of the appendix: a previously undescribed entity. Surgery 106(3):563–566PubMed
9.
10.
Pal AK, Dube RS (1984) Appendix duplex. J Indian Med Assoc 82(11):414PubMed
11.
12.
Al-Bdour MN, Rashaideh MA, Alkasasbeh MA, Shawaqfeh JS (2008) Appendiceal duplication: a rare condition with serious clinical and medicolegal implications. Pak J Surg 24(1):74–75
13.
14.
15.
Peddu P, Sidhu PS (2004) Appearance of a type B duplex appendix on barium enema. Br J Radiol 77(915):248–249PubMedCrossRef
16.
Aggouri Y et al (2015) Duplication appendiculaire révélé à l’occasion d’un syndrome appendiculaire récidivant. Pan Afr Med J 20(1):1-3
17.
Scarff JE Jr, Harrold MW, Wylie JH Jr (1982) Duplication of the vermiform appendix: new variant of a rare anomaly. South Med J 75(7):860–862PubMedCrossRef
18.
Bluett MK et al (1987) Duplication of the appendix mimicking adenocarcinoma of the colon. Arch Surg 122(7):817–820PubMedCrossRef
19.
McNeill SA, Rance CH, Stewart RJ (1996) Fecolith impaction in a duplex vermiform appendix: an unusual presentation of colonic duplication. J Pediatr Surg 31(10):1435–1437PubMedCrossRef
20.
Kim EP, McClenathan JH (2001) Unusual duplication of appendix and cecum: extension of the Cave-Wallbridge classification. J Pediatr Surg 36(9):E18PubMedCrossRef
21.
Mukhopadhyay M et al (2010) Renal teratoma with duplication of cecum and appendix. J Pediatr Surg 45(1):255–258PubMedCrossRef
22.
23.
Lopez-Deogracias M et al (2008) Duplicated appendix in the presence of an adenocarcinoma. Cir Esp 83(6):333PubMedCrossRef
24.
Willard RL (1969) Duplication of the appendix: report of a case. J Am Osteopath Assoc 68(8):785–787PubMed
25.
Di Prima F, Braccio F, Carfagna C (1988) Duplication of the vermiform appendix. Radiol Med 75(6):680–681PubMed
26.
Kurihara H, Mochizuki H (1994) Duplication of vermiform appendix. Nihon Rinsho 6:687–689
27.
Konstantinov PI, Titarenko Ia A (1997) Duplication of the appendix in a child. Vestn Khir Im I I Grek 156(1):109PubMed
28.
29.
Rivera C (1999) Duplicacion Apendicular. Rev Chil Cir 51:529–530
30.
Eroglu E, Erdogan E, Gundogdu G et al (2002) Duplication of appendix vermiformis: a case in a child. Tech Coloproctol 6(1):55–57PubMedCrossRef
31.
Dibrova Iu A et al (2006) Observation of a double appendix. Klin Khir 2:62–63
32.
Marshall AP, Issar NM, Blakely ML (2013) Appendiceal duplication in children presenting as an appendiceal tumor and as recurrent intussusception. J Pediatr Surg 48(4):e9–e12PubMedCrossRef
33.
Bolatkale M, UG, Can C, Kanat BH, Topacoglu H (2014) Double appendix. Int Med J 21(3):343–344
34.
Rosenberger RC (1903) An appendix vermiformis with a double lumen. Proc Pathol Soc (Phila) 24:202–206
35.
36.
De Lagausie P et al (1989) Hypotrophic and duplicated appendix. A case in a child. Chir Pediatr 30(4):216–217PubMed
37.
38.
Griffiths EA et al (2003) Acute inflammation of a congenital cecal diverticulum mimicking appendicitis. Med Sci Monit 9(12):CS107-9PubMed
39.
Maizels G (1966) Duplication of the vermiform appendix. S Afr Med J 40(46):1123–1125PubMed
40.
Modi H, KM, Sloane J, Richman P, Meyrick-Thomas J (2008) A case of a duplicated vermiform appendix associated with a Meckel’s Diverticulum. Gastroenterol Today 18(4):114-115
41.
42.
Yanar H et al (2004) The case of acute appendicitis and appendiceal duplication. Acta Chir Belg 104(6):736–738PubMedCrossRef
43.
Guerron AD, Patil DT, Seifarth FG (2013) Bifid appendix with appendicoumbilical fistula. J Pediatr Surg Case Rep 1(8):223–225CrossRef
44.
Gul M, Aliosmanoglu I, Timucin H, Vurupalmaz O, Arkanoglu Z, Taskesen F (2013) Appendix duplication: a rare presentation. Eur J Gen Med 10(1):51
45.
46.
Mir M, Bali BS, Manzoor MSM (2012) Duplex vermiform appendix: a case report of a rare anomaly. Internet J Surg 28(2)
47.
Sharma P, Mahajan A, Verma P, Arora A (2012) Bifid appendix: its embryologic explanation and clinical implications. Int J Anat Var 5:38–40
48.
González GHP, Vega AFM, Delgado CTC, Talamantes LAC, Sánchez CNA (2015) First case of verminform appendix duplication type A volvulus: a very rare cause of acute abdomen. J Pediatr Surg Case Rep 3(9):374–376CrossRef
49.
50.
Boleken ME, Yildiz E, Mete KAYA, Deniz M (2010) Appendix Duplication in association with persistent cloaca and type 2 pouch colon. Int J Anat Var 3:12–14
51.
Gupta RC, Kak VK (1964) Double appendix. J Indian Med Assoc 42:538–539PubMed
52.
Narula IM, Pendse AK, Dandia SD (1974) Appendix duplex. Int Surg 59(3):173–174PubMed
53.
54.
55.
Bali R et al (2011) Appendiceal duplication with simultaneous acute appendicitis and appendicular perforation causing small bowel obstruction. J Surg Case Rep 2011(2):3PubMedPubMedCentralCrossRef
56.
Barreto TF, Cruz-Alonso J (2011) Duplicación apendicular. Revista Cubana de Cirugía. 50(3):348–352
57.
Biermann R, Borský D, Gogora M (1993) Double appendicitis—a rare pathologic entity. Chirurg 64(12):1059–1061PubMed
58.
Chamisa I, Nikolov S, Bam TQ (2007) Duplex appendicitis. S Afr Med J 97(9):843PubMed
59.
Geurts BA, van Rijn AB, Koelma IA (2006) Acute appendicitis in a boy with an earlier appendectomy and a second appendix. Ned Tijdschr Geneeskd 150(52):2876–2879PubMed
60.
Gilchrist BF et al (1999) Duplication of the vermiform appendix in gastroschisis. J Am Coll Surg 189(4):426PubMedCrossRef
61.
Harman J, Schroeder D (1986) Double appendix. N Z Med J 99(804):469PubMed
62.
Hennekinne S et al (2001) Double appendicitis: a rare clinical form in appendix duplication. Presse Med 30(1):23–24PubMed
63.
64.
65.
Lin BC et al (1996) Duplication of the vermiform appendix. Eur J Surg 162(7):589–591PubMed
66.
Mitchell IC, Nicholls JC (1990) Duplication of the vermiform appendix. Report of a case: review of the classification and medicolegal aspects. Med Sci Law 30(2):124–126PubMedCrossRef
67.
Pearson RW (1983) The duplicate appendix: report of a case. J Am Osteopath Assoc 82(6):410–411PubMed
68.
Petit T et al (2001) Laparoscopic excision of an unusual appendiceal duplication. Ann Chir 126(10):1023–1025PubMedCrossRef
69.
Rizalar R et al (1996) Duplication of appendix with segmental dilatation of the colon, myeloschisis and anal atresia. Eur J Pediatr Surg 6(2):112–113PubMedCrossRef
70.
Elizabeth B, Schmidt S (2002) Type B2 appendiceal duplication with appendicitis: a case report. Internet J Surg 3(2)
71.
Sani R et al (2010) First case of double appendicitis complicating duplication of a vermiform appendix in an adult patient. Colorectal Dis 12(11):1162–1163PubMedCrossRef
72.
Theodoropoulos GE et al (2010) Ruptured cystadenoma of a duplicated appendix. Am Surg 76(3):341–343PubMed
73.
Travis JR, Weppner JL, Paugh JC 2nd (2008) Duplex vermiform appendix: case report of a ruptured second appendix. J Pediatr Surg 43(9):1726–1728PubMedCrossRef
74.
75.
76.
Grez M, Prado R, Vera AF (2011) Duplicacion del apendice vermiforme. Revista Chilena de Cirugia 63(3):313–316CrossRef
77.
Makni A et al (2013) Duplication of vermiform appendix. Tunis Med 91(3):220–221PubMed
78.
Miranda-Fraga P, Cruz-Rubín C, García-Álvarez J, García-Corona DA, Gutiérrez-Baños J (2012) Duplicacion apendicular. Revista Mexicana de Cirugia del aparato 1(1):62–66
79.
Mushtaque M, Mehraj A, Khanday SA, Dar RA (2012) Double appendicitis. Int J Clin Med 3:60–61CrossRef
80.
Sahin ST, Erhan Y, Aydede H (2013) Double acute appendicitis in appendical duplication. Ulus Travma Acil Cerrahi Derg 19(1):83–85CrossRef
81.
Vockelmann C, Spira A, Mecklenbeck FP (2012) Sometimes the worm is inside: simultaneous double appendicitis. RöFo 184(6):580–581PubMed
82.
83.
Dave V, Loh H, Thakur A, Suri RK (2013) Duplex appendix: a morphological, embryological and applied aspect. Int J Curr Res Rev 5(26):27–30
84.
Hentschel M (1969) Double appendix. Case report and review of the literature. Chirurg 40(12):565–567PubMed
85.
Menten ML, Denny H (1945) Duplication of the vermiform appendix, the large intestine and the urinary bladder. Arch Pathol 40:345–350
86.
Saleeby RG, Zollinger RM, Ellison EH (1954) Acute appendicitis in an adult with two separate vermiform appendices. Surgery 36(2):306–311PubMed
87.
88.
Coker DD, Hartong JM, Conklin HB (1975) Duplication of the vermiform appendix: case report. Mil Med 140(5):331–332PubMed
89.
Bannykh SI et al (2001) Partial caudal duplication in a newborn associated with meningomyelocele and complex heart anomaly. Teratology 63(2):94–99PubMedCrossRef
90.
91.
Drino E et al (1991) Rare anomalies in the development of the appendix. Acta Chir Iugosl 38(1):103–111PubMed
92.
Ninos A, Douridas G, Papakonstantinou E, Vidali M, Liapi G, Maletsikopoulos S, Antonakas P, Palivos L, Papandrikos J, Farazi C, Pierrakakis S (2010) A horseshoe double appendix positioned on a non-Hodgkin lymphoma. Hell J Surg 82(1):73–76
93.
Calota F et al (2010) Horseshoe appendix: a extremely rare anomaly. Chirurgia (Bucur) 105(2):271–274
94.
Oruc C et al (2013) An extremely rare appendiceal anomaly: horseshoe appendicitis. Ulus Travma Acil Cerrahi Derg 19(4):385–386PubMedCrossRef
95.
Uriev L et al (2006) Triple-barreled type of appendiceal triplication. Ann Diagn Pathol 10(3):160–161PubMedCrossRef
96.
Akhtar J, Ejaz T, Guiney EJ (1994) Appendix vermiformis duplex—a lesson for the unwary. Pediatr Surg Int 9(5):429–430CrossRef
97.
98.
Tiryaki C, Yazicioglu MB, Haksal MC, Ciftci A, Yıldız SY (2014) Primer epiploic appendagitis mimicking appendix duplication. Natl J Med Res 4(1):95–96
99.
Giffin HM, McManamy EP, Waugh JM (1942) Surgical significance of epiploic appendages. Arch Surg 45:351CrossRef
100.
Greenberg R, et al. (1997) Diverticular disease of the appendix. Harefuah 132(3):180-2, 239
101.
102.
Francis DM (1984) Appendicitis following appendicectomy. J R Coll Surg Edinb 29(1):61–62PubMed
103.
Goldschmidt W (1930) Vergetauschter doppelter wormfortsatz. Zentrablatt fur Chirurgie 57:3123
104.
Kelly HA, Hurdon E (1905) Vermiform appendix and its diseases. WB Saunders, Philadelphia
105.
Gladstone RJ, Wakeley CPG (1924) The relative frequency of the various positions of the vermiform appendix: as ascertained by analysis of 3000 cases: With an account of its development. Br J Surg 11:503–520CrossRef
106.
Metadata
Title
Appendiceal Duplication: A Comprehensive Review of Published Cases and Clinical Recommendations
Authors
H. Nageswaran
U. Khan
F. Hill
A. Maw
Publication date
01-02-2018
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 2/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-017-4178-1

Other articles of this Issue 2/2018

World Journal of Surgery 2/2018 Go to the issue

Original Scientific Report with Video

Lymph Node Evaluation in Robot-Assisted Versus Video-Assisted Thoracoscopic Esophagectomy for Esophageal Squamous Cell Carcinoma: A Propensity-Matched Analysis

Original Scientific Report

DNA Mismatch Repair Deficiency Promotes Genomic Instability in a Subset of Papillary Thyroid Cancers

Letter to the Editor

A Novel Scoring System for Diagnosing Acute Mesenteric Ischemia in the Emergency Ward: Methodological Issues

Reply, Letter to the Editor

Preoperative Anemia and the Outcome After Coronary Artery Bypass Grafting: Reply

Original Scientific Report

A Nationwide Population-Based Study on the Survival of Patients with Pancreatic Neuroendocrine Tumors in The Netherlands

Original Scientific Report

A Multi-institutional Comparison of Adrenal Venous Sampling in Patients with Primary Aldosteronism: Caution Advised if Successful Bilateral Adrenal Vein Sampling is Not Achieved