Published Paper Details:

Agenesis of vermiform is a exceptionally rare congenital anomaly, most often identified incidentally during surgical exploration for suspected acute appendicitis. Its clinical significance lies in its ability to closely mimic acute appendicitis, frequently leading to diagnostic and intraoperative dilemmas. This case report discusses a 29 year old female who presented with acute onset abdominal pain and vomiting for last 24 hours, clinical examination revealed severe colicky pain localized to right iliac region suggestive of acute appendicitis. Ultrasound of the same day reported a mildly inflamed appendix with diameter 6.6 mm, enlarged surrounding lymph nodes and no abnormality related to adnexa, reinforcing the provisional diagnosis. Intraoperatively, the appendix was not found at the converge of taenia coli. Further exploration of right adnexa reveled a ruptured, twisted, hemorrhagic ovarian cyst on the right side, for which right oophorectomy was performed. Postoperative management included broad spectrum antibiotics, aseptic wound care and radiological follow ups, leading to significant clinical improvement. The absence of the appendix obliges the surgeon to actively search for alternative causes of right iliac fossa pain, particularly gynecological conditions in females of reproductive age. Unnecessary caecal dissection may increase operative time and risk of complications such as serosal injury or postoperative ileus. When appendicular agenesis is confirmed and the underlying pathology is appropriately addressed, the prognosis is excellent, with no long-term adverse outcomes related to the anomaly itself. Awareness of this rare entity, combined with a systematic intraoperative approach and judicious decision-making, is crucial to prevent avoidable morbidity and to ensure optimal surgical management in patients presenting with a clinical picture suggestive of acute appendicitis.