A tale of two appendices – an unexpected finding

Anomalies of the appendix are uncommon and are usually discovered incidentally during surgery for appendicitis. We present a rare case of appendiceal duplication, which can have serious consequences if overlooked during an operation. Following an initial admission for right iliac fossa pain which led to an uneventful laparoscopic appendicectomy, a 36 year old male was readmitted for increasing abdominal pain and distension. Subsequent surgical exploration revealed a second appendix, which was retrocaecal and gangrenous. Careful inspection of the caecal pole should always be performed during surgery to exclude appendiceal abnormalities such as appendiceal duplication. The Cave-Wallbridge classification exists to provide surgeons with a framework to classify appendiceal duplications.