Stump appendicitis: a relatively under-reported reality.

Stump appendicitis (SA) is a rare and under-reported complication of open as well as laparoscopic appendicectomy. Diagnosis of SA is often delayed and requires a high index of suspicion in those presenting with signs and symptoms of appendicitis and a history of appendicectomy.We presented a case of SA in a 20-year-old man with a history of open appendicectomy. He was managed conservatively using intravenous antibiotics. The risk of SA is influenced by surgical technique; however, it is unclear whether the incidence is higher with laparoscopic or open procedures. There is little evidence guiding the management of SA with the majority of reported cases treated operatively. This diagnosis should be suspected on the basis of history and examination and CT scanning is a useful tool in most adult cases aiding diagnosis. Management may be guided by the progression of the patient's symptoms either towards operative intervention or a conservative approach.

Spontaneous gastric perforation in an 11-year-old boy with anorexia nervosa: rare presentation with right iliac fossa pain.

Spontaneous gastric perforation is rare in children. It is usually associated with prematurity, foreign bodies and trauma. Anorexia nervosa (AN) can be an underlying condition although no cases are reported in the literature. We are reporting a rare case of 1-year-old boy with AN who presented with right iliac fossa (RIF) pain mimicking acute appendicitis. Intraoperative findings proved a gastric perforation. Pathophysiology of this condition in AN is poorly understood. Gastric smooth muscle atrophy and ischaemia can be the possible underlying mechanisms. The case discussed here highlights the fact that any abdominal pain in patients with underlying eating disorders (EDs) should raise suspicion of perforation as diagnosis can be far more complicated.