A 33-year-old man presented with a three-day history of right lower quadrant abdominal pain, nausea, vomiting, fever, and localized peritonitis despite having undergone an open appendectomy three years earlier, with histopathological confirmation of acute appendicitis. Laboratory tests showed leukocytosis and elevated inflammatory markers, while computed tomography demonstrated free intraperitoneal fluid without a definitive source. Due to persistent signs of peritonitis, exploratory laparotomy was performed. Intraoperatively, dense adhesions surrounded the cecum, and mobilization of the right colon revealed a previously unrecognized retrocecal, subserosal second appendix arising from the omental tenia coli, consistent with type B2 appendiceal duplication. The duplicated appendix was perforated and was successfully removed by retrograde appendectomy. Comparative gross and histopathological examination confirmed two anatomically independent appendices, both demonstrating acute transmural appendicitis, establishing the diagnosis of sequential appendicitis secondary to appendiceal duplication. The patient had an uneventful postoperative recovery.  

Juan Sebastian Asteguieta Castillo is a 24-year-old physician from Guatemala and a graduate of Universidad Francisco Marroquín. He has a strong interest in general surgery, academic medicine, and clinical research. Throughout his early medical career, he has focused on producing high-quality scientific work, authoring five peer-reviewed publications and actively developing additional case reports for publication in international medical journals. His academic goal is to continue expanding his research portfolio while pursuing surgical training and participating in international scientific collaborations. He is committed to combining clinical excellence with impactful research and views every patient encounter as an opportunity to learn, teach, and advance the field of surgery through scientific inquiry.