Appendicitis after endoscopic band ligation for massive ileocecal hemorrhage.

A 68-year-old man was admitted with hematochezia. Emergency computed tomography showed multiple diverticula throughout the colon. Initial colonoscopy on day 2 showed no active bleeding, but massive hematochezia on day 3 led to the performance of an emergency endoscopy. Substantial bleeding in the ileocecal area obscured the visual field, making it challenging to view the area around the bleeding site. Two endoscopic band ligations (EBLs) were applied at the suspected bleeding sites. Hemostasis was achieved without active bleeding after EBL. However, the patient developed lower right abdominal pain and fever (39.4°C) on day 6. Urgent computed tomography revealed appendiceal inflammation, necessitating emergency open ileocecal resection for acute appendicitis. Pathological examination confirmed acute phlegmonous appendicitis, with EBLs noted at the appendiceal orifice and on the anal side. This case illustrates the efficacy of EBL in managing colonic diverticular bleeding. However, it also highlights the risk of appendicitis due to EBL in cases of ileocecal hemorrhage exacerbated by poor visibility due to substantial bleeding. Endoscopists need to consider this rare but important complication when performing EBL in similar situations.

What do you do with a normal appearing appendix? A national study of Pediatric Surgeons.

OBJECTIVES: Surgeons may encounter a grossly normal appearing appendix in a patient with clinically suspected appendicitis. The purpose of this study is to determine the practice of pediatric surgeons in Saudi Arabia when this is encountered, and determine the reasons behind their decision making. METHODS: An electronic survey was sent to all pediatric surgeons in Saudi Arabia. Data points collected included demographics, peri-operative imaging preference, and personal practice when managing an intra-operative grossly normal appendix in symptomatic children. RESULTS: A total of 105 responses were obtained yielding a response rate of 33.8% The majority of respondents, 88 (87.1%) would remove the appendix while 13 (12.9%) would leave it in situ. The most common reason for removing the appendix was the possibility of microscopic/Endo appendicitis 71 (34.8%) while the most common reason for leaving the appendix in situ was the possible usage of the appendix for reconstructive benefits in the future 11 (50%). The overwhelming majority 87 (86.1%) felt that there were no sufficient guidelines on removal of the normal appearing appendix at the time of surgery for suspected acute appendicitis. CONCLUSION: The majority of pediatric surgeons in Saudi Arabia would proceed with an appendectomy when an intra-operative grossly normal appendix is seen in patients suspected to have acute appendicitis. There is a clear lack of published pediatric guidelines and large studies to guide the correct course of action.

Differentiating appendiceal neoplasm from perforated appendiceal diverticulum in chronic appendicitis: a case report.

Low mucinous neoplasm of the appendix (LAMN) and appendiceal diverticulum are both uncommon pathologies that may pose a diagnostic challenge. Both may present as either appendicitis or asymptomatically and have a risk of perforation. LAMN, carries the additional risk of pseudomyxoma pertitonei and metastasis. Ensuring correct histopathology is crucial, as computed tomography (CT) abdomen/pelvis may only demonstrate a mildly dilated appendix, delaying diagnostic laparoscopy and appendicectomy. Here, we describe the case report of a 56-year-old woman who presented with chronic intermittent right iliac fossa pain initially determined to be chronic appendicitis. Following laparoscopic appendicectomy, histopathology demonstrated LAMN, however, on further re- assessment of histopathology, as well as the completion of a normal pan-CT and colonoscopy, a final diagnosis of ruptured appendiceal diverticulum was made. Our case demonstrates the utility of a multi-disciplinary approach in evaluating patients with possible appendiceal LAMN or appendiceal diverticulum.

Malrotated subhepatic caecum with subhepatic appendicitis: Diagnostic dilemma: A case report.

INTRODUCTION: Acute appendicitis is among common surgical emergency. Subhepatic appendicitis is rare and difficult to diagnose and manage. There are few case reports across the world. CASE PRESENTATION: We presented a case of 7 year's old child with no known medical illness presented with acute onset vague abdominal pain experienced for three days. he was symptomatically treated as Acute gastroenteritis and dyspepsia later diagnosed with acute appendicitis and underwent laparotomy. He has malrotated subhepatic cecum with Subhepatic gangrenous appendicitis Open appendectomy done and discharged improved. CLINICAL DISCUSSION: Subhepatic appendicitis is a condition where the appendix is abnormally located in the upper right abdomen. This atypical placement often leads to delayed diagnosis and complications due to its similar symptoms to other abdominal diseases. While ultrasound is a valuable tool for diagnosis, laparoscopic appendectomy is the preferred treatment method when available. However, in resource-limited settings without laparoscopic capabilities, open surgery is necessary. CONCLUSION: Subhepatic appendicitis is a rare occurrence and its infrequent location makes it difficult to diagnose. Awareness of various location of appendix, a high index of suspicion and radiological imaging is required for prompt diagnosis and management. Appendicitis in subhepatic appendix and high up cecum creates a lot of confusion in both diagnosis and surgical exploration which may lead in complication and delay in treatment.

Hidden schistosomiasis unveiled by appendicular peritonitis: A case report.

INTRODUCTION AND IMPORTANCE: Schistosomal appendicitis is a rare disease, with reported prevalence rates ranging from 1.31 to 3.2 %. The presented case underscores the critical significance of considering appendicular schistosomiasis as a potential etiology in cases of acute appendicitis, emphasizing the necessity of comprehensive histopathological examination for accurate diagnosis and appropriate postoperative management. CASE PRESENTATION: A 29-year-old man from Guinea, with no significant medical history, presented with vomiting, persistent abdominal pain, and fatigue over five days. Physical examination revealed signs of peritoneal irritation and imaging showed features indicative of acute appendicitis. An appendectomy was conducted laparoscopically. Histological examination confirmed gangrenous appendicitis with the presence of schistosome eggs, diagnosing acute gangrenous appendicitis with schistosomiasis. The patient recovered well postoperatively and was discharged after treatment with praziquantel. CLINICAL DISCUSSION: The clinical presentation of schistosomal appendicitis resembles that of other acute appendicitis cases. When suspicion arises due to risk factors, confirming schistosomiasis may involve serology, polymerase chain reaction assays, and identifying eggs in urine or feces. Computed tomography findings cannot distinguish acute appendicitis caused by Schistosoma species from other causes. CONCLUSIONS: Histopathological appendix analysis is crucial for detecting conditions like schistosomiasis, warranting postoperative care. Praziquantel therapy post-surgery is vital for eradicating the disease and preventing complications.

Open Versus Laparoscopic Appendectomy: A Comparison of Outcome in a Teaching Hospital, Northeast Nigeria.

Background: Appendectomy could be open or laparoscopic. Laparoscopic appendectomy (LA) is gradually gaining ground in Nigeria, but its outcome is not entirely known. Objective: This study compared the outcomes of LA with those of open appendectomy (OA) in terms of the surgical site infection rate, post-operative pain, time to return of bowel sounds, length of hospital stay, return to normal activities and direct cost of treatment. Patients and Methods: This was a prospective randomised study. All patients above 18 years who were diagnosed with acute appendicitis in Federal Teaching Hospital, Gombe, were recruited after adequate counselling and consent obtained over the 18 months of the study. Results: Forty (40) patients were recruited with 20 on each arm. The average age was 25 years (±) 6 years and M:F was 1:1.9. The rates of surgical site infection and post-operative pain between both methods were not statistically different, while the time to return of bowel sound, the length of hospital stay and the return to normal activity were significantly reduced in LA compared to OA. However, OA was cheaper in terms of direct cost compared to LA. Conclusion: This study showed that LA may be the preferred method when a quicker recovery from treatment is anticipated, provided the patient can afford the direct cost of the procedure.

Single-cell sequencing of the vermiform appendix during development identifies transcriptional relationships with appendicitis in preschool children.

BACKGROUND: The development of the human vermiform appendix at the cellular level, as well as its function, is not well understood. Appendicitis in preschool children, although uncommon, is associated with a high perforation rate and increased morbidity. METHODS: We performed single-cell RNA sequencing (scRNA-seq) on the human appendix during fetal and pediatric stages as well as preschool-age inflammatory appendices. Transcriptional features of each cell compartment were discussed in the developing appendix. Cellular interactions and differentiation trajectories were also investigated. We compared scRNA-seq profiles from preschool appendicitis to those of matched healthy controls to reveal disease-associated changes. Bulk transcriptomic data, immunohistochemistry, and real-time quantitative PCR were used to validate the findings. RESULTS: Our analysis identified 76 cell types in total and described the cellular atlas of the developing appendix. We discovered the potential role of the BMP signaling pathway in appendiceal epithelium development and identified HOXC8 and PITX2 as the specific regulons of appendix goblet cells. Higher pericyte coverage, endothelial angiogenesis, and goblet mucus scores together with lower epithelial and endothelial tight junction scores were found in the preschool appendix, which possibly contribute to the clinical features of preschool appendicitis. Preschool appendicitis scRNA-seq profiles revealed that the interleukin-17 signaling pathway may participate in the inflammation process. CONCLUSIONS: Our study provides new insights into the development of the appendix and deepens the understanding of appendicitis in preschool children.

Effect of COVID-19 Pandemic on Admission Pattern to Pediatric Surgery Division at King Fahad University Hospital and Subsequent Quality of Presentation in Cases: A Comparative Study and Single-Center Experience.

The coronavirus disease 2019 (COVID-19) pandemic has affected healthcare systems worldwide, with mandatory quarantine and isolation measures being implemented to curb the spread of the virus. These measures have potentially led to delayed or complicated presentations of non-COVID-19 cases, including pediatric surgical cases. This study aims to evaluate pediatric surgical admission patterns, analyze the incidence of surgical diagnoses, and assess the severity of presentation during the COVID-19 period compared to the pre-COVID-19 period. This retrospective observational study was conducted at a university hospital in the eastern region of Saudi Arabia to assess the effect of the pandemic on pediatric surgery admissions patterns and severity of presentation during the COVID-19 period (March 2, 2020, to March 1, 2022) and pre-COVID-19 period (March 1, 2018, to March 1, 2020). Of the 903 pediatric surgical admissions, 366 (40.5%) presented during the COVID-19 period. The admission rate per month decreased by 6.9 during COVID-19 compared to pre-COVID-19 (mean [SD]: 21.5 [9.3] vs. 14.6 [8.2], p = 0.01). The most common admission diagnoses were appendicitis (17.5%) and inguinal hernia (15.8%). There was a 15% increase in the percentage of emergency admissions (54.4% vs. 47.3%, p = 0.037) during COVID-19 compared to pre-COVID-19. Of note, the percentage of patients admitted with acute appendicitis increased by 35.9% (20.8% vs. 15.3%, p = 0.03). Furthermore, the emergency admissions for patients with inguinal hernia doubled (26.6% vs. 12.7%, p = 0.035). No significant difference in ICU admissions, hospital length of stay, and routine discharge were observed. In conclusion, the COVID-19 pandemic correlated with a significant decrease in overall admissions and an increase in emergency admissions, including those for appendicitis and inguinal hernia. The increase in complicated conditions was not significant. There was no significant difference in ICU admissions and hospital length of stay. Future studies involving multiple centers are necessary to validate these findings.

An FUO patient diagnosed as appendicitis: a case report.

BACKGROUND: The diagnosis and management of fever of unknown origin pose significant challenges in the field of infectious diseases, as it is influenced by various factors. Infectious diseases have long been recognized as the primary etiology of fever of unknown origin. However, not all infectious diseases can definitively identify the causative pathogen and infection sites. CASE PRESENTATION: we present a case report of an individual with fever, nausea, and anorexia but did not report any abdominal pain. Physical examination revealed no signs of abdominal tenderness. Repeated imaging studies including enhanced CT and color US of the appendix, only one color US suggested the possibility of appendicitis. Despite effective anti-infective treatment, the patient continued to experience low-grade fever, leading to the decision for laparoscopic exploration and subsequent appendectomy. Pathological findings confirmed the presence of appendicitis. After the surgical procedure, the patient's temperature and infectious markers returned to within normal range, ultimately leading to a diagnosis of appendicitis. CONCLUSIONS: The atypical symptoms and signs, along with the negative imaging results, contribute to the under diagnosis of appendicitis and the progression of fever of unknown origin, thereby exacerbating the physical, mental, and economic burden on patients. Consequently, there are valuable insights to be gained regarding the management of both appendicitis and fever of unknown origin.

Application of transumbilical single-incision laparoscopy in the treatment of complicated appendicitis in overweight/obese adolescents.

OBJECTIVE: To investigate the clinical efficacy of transumbilical single-incision laparoscopic surgery in the treatment of complicated appendicitis in overweight/obese adolescents. METHODS: A retrospective analysis was conducted on the clinical data of 226 adolescent patients with complicated appendicitis who were admitted to our hospital from January 2014 to June 2022. Among them, 102 cases underwent transumbilical single-incision laparoscopic appendectomy as the observation group, and another 124 cases underwent conventional three-port laparoscopic appendectomy as the control group. The surgical time, intraoperative blood loss, duration of incisional pain, postoperative flatus time, length of hospital stay, surgical site infection (SSI), satisfaction with cosmetic result, and occurrence of postoperative complications were compared between the two groups. RESULTS: Both groups completed the surgery smoothly, and there were no statistically significant differences in gender, age, BMI, duration of illness, white blood cell count, and preoperative CRP value between the two groups (P > 0.05). There were no statistically significant differences in surgical time and intraoperative blood loss between the two groups (P > 0.05). However, the observation group had shorter hospital stays, shorter duration of incisional pain, shorter postoperative time to flatus, and lower overall postoperative complication rates compared to the control group, with statistically significant differences (P < 0.05). The observation group had higher satisfaction with cosmetic result compared to the control group, with statistically significant differences (P < 0.05). Both groups were followed up for one year postoperatively, and there were no occurrences of residual appendicitis or severe adhesive intestinal obstruction. CONCLUSION: When proficiently mastered, the application of transumbilical single-incision laparoscopy in the treatment of complicated appendicitis in overweight/obese adolescents offers advantages such as minimal trauma, rapid recovery, fewer complications, and improved aesthetic outcomes.

Meckel's Diverticulum With Perforation.

Meckel's diverticulum (MD) is a common congenital defect of the small intestinal tract resulting from incomplete obliteration of the vitellointestinal duct. It presents with unexplained gastrointestinal bleeding, bowel obstruction, and inflammation. In rare instances, the presentation is with perforation similar to acute appendicitis with perforation. The symptoms, clinical exam, and radiological findings of our patient, a 38-year-old male, were consistent with perforated acute appendicitis; he was found to have a perforated Meckel's diverticulum intraoperatively.

Typical Presentation to Rare Diagnosis: A Case Report of Appendicitis Revealing Cecal Adenocarcinoma.

Appendicitis is predominantly observed in teens and young adults. While typical causes include fecalith-induced luminal obstructions, in older adults less common etiologies such as tumors should be considered. This report highlights a rare case of appendicitis secondary to cecal adenocarcinoma in a high-risk patient with a history of obesity and type 2 diabetes mellitus. This case underscores the necessity of considering malignancy as a differential diagnosis in older adults presenting with appendicitis-like symptoms.

An Uncommon Consequence of Perforated Acute Appendicitis in Elderly Patients: Fournier's Gangrene.

Acute appendicitis that is not diagnosed and treated promptly typically results in serious complications that raise the risk of necrotizing fasciitis, particularly in elderly patients. We present a case of a 77-year-old male, who presented to the emergency department with a clinical manifestation of Fournier's gangrene caused by acute perforated appendicitis. The patient had no symptoms or signs of an acute abdomen, and within three days he developed significant unilateral scrotal swelling and skin changes. Our case demonstrates the need to treat Fournier's gangrene as a consequence of an intra-abdominal infectious disease, particularly in elderly comorbid patients with atypical symptoms of acute appendicitis, and highlights the importance of early surgical intervention.

Concurrent Appendicitis and Meckel's Diverticulitis Presenting With Small Bowel Obstruction in an Adult: A Case Report.

We present a case of multiple abdominal pathologies occurring simultaneously, which emphasizes the importance of keeping a broad differential and evaluating each diagnosis. A 33-year-old female presented with abdominal pain, nausea, and vomiting. Her workup included computerized tomography which demonstrated acute appendicitis with concern for a closed-loop bowel obstruction. She was offered diagnostic laparoscopy with anticipation of laparoscopic appendectomy and further evaluation for the source of the bowel obstruction. At the time of surgery, a Meckel's diverticulum with acute diverticulitis was identified, in addition to an inflamed appendix. A small band near the base of the Meckel's diverticulum was found and divided. The appendix was treated with a laparoscopic appendectomy and the Meckel's diverticulum was resected. She did well in recovery and continued to do well at her follow-up appointment. This case emphasized the importance of a thorough evaluation of a patient's differential diagnosis, as it is possible for multiple pathologies to occur simultaneously.

Acute appendicitis induced by bone fragment ingestion: A pediatrics case report.

Acute appendicitis is an ordinary surgical emergency, typically attributed to luminal obstruction by fecaliths or lymphoid hyperplasia. However, ingested foreign bodies as an etiology are rare but increasingly recognized, particularly in pediatric patients. We present the case of a 9-year-old male patient who presented to the emergency department with symptoms consistent with acute appendicitis. Further investigation revealed the presence of a bone fragment within the appendix, leading to acute inflammation. Foreign body ingestion should be considered in pediatric patients with acute appendicitis. This case report underscores the importance of comprehensive clinical evaluation and appropriate diagnostic imaging modalities in guiding optimal treatment strategies.

Appendicitis links to the afterward subsequent psoriatic disease occurrence in Taiwan national health insurance research database: A population-based cohort study: Appendicitis links to psoriatic diseases.

OBJECTIVE: To investigate the psoriatic disease risk among patients with previous appendicitis. METHODS: This study was a nationwide population-based case-control study about the association between the psoriatic disease risk among patients with a history of appendicitis in Taiwan. The study population consisted of newly diagnosed psoriatic disease with at least two outpatient visits, and the control group included those patients without psoriatic disease at the same index date. Patients with a previous diagnosis of appendicitis or who underwent appendectomy surgery prior to their psoriatic disease diagnosis were recorded. The odds ratio of psoriatic disease diagnosis in the two groups with and without a history of appendicitis were analyzed and compared. RESULTS: A total of 48 894 individuals diagnosed with psoriatic disease were matched with 292 656 controls by age and gender. Notably, the proportion of patients with a history of appendicitis or primary appendectomy was significantly elevated among those with psoriatic disease compared with the control cohort (both p < .05). On average, the occurrence of appendicitis preceded the index date by 3.3 ± 2.3 years. Multivariate analysis revealed a heightened incidence rate of psoriatic disease in patients previously diagnosed with appendicitis, periodontal disease, Charlson comorbidity index score (CCIS) ≧1, and ill-defined intestinal infections. This association persisted after adjusting for confounding factors, such as periodontal disease, CCIS, Salmonella, and ill-defined intestinal infections. The odds ratios for psoriatic disease in individuals with a history of appendicitis, periodontal disease, CCIS ≧1, and ill-defined intestinal infections were 1.16, 1.008, 1.69, and 1.23, respectively, with corresponding 95% confidence intervals of 1.03-1.31, 1.05-1.11, 1.65-1.74, and 1.20-1.26. These findings underscore the independent association between appendicitis and subsequent development of psoriatic disease, even after adjusting for relevant comorbidities and potential confounders. CONCLUSION: Our research illustrates that appendicitis is associated with an increased likelihood of developing a psoriatic disease, despite several limitations. These limitations encompass variables such as dietary and smoking habits, alongside other potential confounding factors that were not fully considered. Moreover, inherent biases in utilizing national health insurance data, such as the absence of laboratory information, as well as the constraints inherent in a retrospective study design, should be acknowledged.

Assessment of diagnostic value of ultrasound and multi-slice spiral computed tomography in acute appendicitis: a retrospective study.

PURPOSE: Ultrasound and multi-slice spiral computed tomography (CT) are frequently used to assist the diagnosis of acute appendicitis (AA), and the examination results may vary among different demographics. This study aimed to compare the diagnostic accuracy of ultrasound and CT for AA. METHODS: We performed a retrospective analysis of patients diagnosed with AA who underwent emergency surgery at our hospital from March 2021 to August 2023, with postoperative pathological results as the gold standard. Differences in the diagnostic accuracy of ultrasound and CT for different types of AA, age groups, and body mass index (BMI) values were then analyzed. RESULTS: The overall sample comprised 279 confirmed cases of AA, with 64 cases of simple appendicitis, 127 cases of suppurative appendicitis, and 88 cases of gangrenous appendicitis. For these three pathological classifications, the diagnostic accuracy of ultrasound was 68.75% (44/64), 73.22% (93/127), and 81.81% (72/88), respectively, while the diagnostic accuracy of CT was 71.87% (46/64), 82.67% (105/127), and 90.90% (80/88), respectively. There was no statistically significant difference in the overall diagnostic accuracy between the two methods (P > 0.05). Subgroup analysis showed no difference in diagnostic accuracy between the two methods for patients with normal BMI (P > 0.05). However, for overweight, obese, and elderly patients, CT provided significantly better diagnostic accuracy than ultrasound (P < 0.05). CONCLUSION: While ultrasound and CT have similar diagnostic accuracy for different pathological types of AA, CT is more accurate for overweight, obese, and elderly patients.

Primary omental torsion with clinical masquerading as acute appendicitis and radiological key for diagnosis.

Omental torsion is a medical condition characterized by the twisting of the omentum along its longitudinal axis, which leads to compromised blood flow. This condition is rarely diagnosed before surgery and can present symptoms similar to other causes of acute surgical abdomen. This report details a case of primary omental torsion initially suspected to be acute appendicitis. The patient was admitted to the hospital with symptoms of lower right quadrant abdominal pain and mild fever. Computed tomography imaging revealed a twisted mass of fatty tissue with surrounding fat stranding changes, but no signs of appendicitis were found, indicating omental torsion. The patient underwent surgery to remove the twisted and necrotic omentum, leading to an improvement in symptoms. This case highlights the challenges in diagnosis and the crucial role of computed tomography imaging in managing this rare condition.