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Abstract

Abstract Background Acute appendicitis is among the most common surgical emergencies, but rare anatomical variants can complicate its diagnosis and management. The horseshoe appendix, classified as a Type D anomaly within the extended Cave-Wallbridge classification, is an exceptionally rare congenital variant characterized by a single lumen with two distinct cecal insertions and is almost always identified intraoperatively. Case presentation: We report the case of a 60-year-old woman with type 2 diabetes mellitus who presented with a three-day history of abdominal pain that began in the epigastrium and migrated to the right iliac fossa, accompanied by nausea and reduced appetite. Clinical examination and abdominal ultrasonography were consistent with acute appendicitis. Laparoscopic exploration revealed approximately 200 mL of purulent fluid and an inflammatory plastron involving the appendix, cecum, terminal ileum, and abdominal wall. Further dissection identified a horseshoe appendix with two separate, perforated cecal bases, consistent with a Type D appendiceal duplication. Both bases were ligated with polymer clips, and a complete appendectomy was performed without complications; the patient recovered uneventfully and was discharged in stable condition. Conclusions This case underscores the diagnostic and surgical challenges posed by rare appendiceal anomalies and highlights the importance of careful, systematic intraoperative exploration to achieve complete resection and avoid retained appendiceal tissue, particularly in complicated presentations.