Acute abdominal pain presenting as a rare appendiceal duplication: a case report

We report the case of a 15-year-old African American girl who presented to our hospital with right lower quadrant pain and was subsequently found to have appendiceal duplication.There are two categorical systems that have described and stratified appendiceal duplication. Both classification systems have been outlined and referenced in this case report. A computed tomography scan has been included to provide a visual aid to help identify true vermiform appendiceal duplication. The presence of this anatomical abnormality is not a reason for surgical intervention; however, should this be found in the setting of acute appendicitis, aggressive resection of both appendices is mandatory.Appendiceal duplication is a rare anomaly that has been described less than 200 times in the literature. The incidence of duplicated appendices has been previously reported to be approximately 0.0004% [1]. This anatomical finding has been associated with intestinal, bone and genitourinary abnormalities as well [2-5]. While the presence of appendiceal duplication in the absence of inflammation is not always and/or immediately a surgical issue, once there is evidence of appendicitis, prompt and aggressive surgical intervention is necessary.A 15-year-old African American girl presented to our emergency room with abdominal pain. The pain had started 48 hours previously, with the onset in the supra-umbilical region and subsequent radiation to her right lower quadrant. The pain was exacerbated by movement of her right lower extremity. Our patient denied nausea, vomiting, chills or rigor. Upon physical examination, she had point tenderness in her right lower quadrant, without rebound tenderness, guarding or rigidity. Her white blood cell count was mildly elevated at 11,000 k/CMM (cubic millimeter) without leukemoid shift. A urine analysis did not reveal any abnormalities and a urine pregnancy test was negative.An ultrasound was performed, which did not visualize the appendix or any inflammatory ch