Nonoperative management of appendiceal phlegmon or abscess in children less than 3 years of age.

Background: In children less than 3 years of age, there is little experience in the nonoperative management of appendiceal phlegmon or abscess (APA), especially in APA with an appendicolith. The purposes of this study were to evaluate the effects of an appendicolith and the success rate of nonoperative management for APA in these young children. Methods: Children younger than 3 years of age with APA who underwent attempted initial nonoperative treatment between January 2008 and December 2016 were reviewed. Based on the presence or absence of an appendicolith on admission ultrasonography examination or computed tomography scan, children were divided into two groups: appendicolith group and no appendicolith group. Results: There were 50 children who met the study criteria. Among 50 children, three children failed to respond to nonoperative treatment because of aggravated intestinal obstruction or recurrent appendicitis within 30 days of admission. The overall success rate for nonoperative management of APA was 94% (47/50) in children younger than 3 years old. The rate of diarrhea and CRP levels were higher in the appendicolith group than that of the no appendicolith group (P < 0.05). However, the success rate and the hospital length of stay for nonoperative treatment in the appendicolith group and the no appendicolith group were similar without statistical significance. Conclusion: APA with or without an appendicolith can have nonoperative management without immediate appendectomy in children less than 3 years old.

Rare complication of appendix: small bowel gangrene caused by the appendicular knot.

Intestinal knot formation was first described by Riverius in 16th century and later by Rokitansky in 1836. We report a very rare cause of small bowel gangrene caused by appendiceal knotting on to the ileum in a previously healthy mid aged lady. Patient underwent laparatomy and right hemicolectomy and primary anastomosis. The intra operative findings were the appendix was twisting (knotting) the small bowel about 40cm from the terminal ileum and causing gangrene to the segment of small bowel. Appendicitis is a common condition and management is usually straightforward. However we must be aware of rare complications which may arise that require a change from the standard treatment of acute appendicitis.

Tumoración gástrica submucosa ulcerada. ¿Puede ser algo benigno? / Ulcerated submucosal gastric tumor. Could it be a benign condition?

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Appendix Invagination Mimicking Ileocecal Intussusception in a Pediatric Patient: A Case Report.

BACKGROUND: Appendix invagination is a rare cause of right lower quadrant abdominal pain. Clinical findings are not specific and can mimic a wide range of diseases. CASE REPORT: An 8-year-old girl was admitted with abdominal pain lasting for 2 weeks. Clinical and radiologic findings suggested ileocecal intussusception initially. A failed hydrostatic reduction attempt and subsequent abdominal ultrasound and computed tomography studies showed that the underlying pathology was invagination of the vermiform appendix. The patient was managed conservatively and spontaneous reduction was observed during follow-up. She underwent appendectomy 9 months later due to chronic appendicitis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Appendix invagination should be kept in mind while evaluating patients with suspected ileocecal intussusception. In distinguishing between these two conditions, a blind-ending invaginating segment is an important clue in favor of appendix intussusception.

Intestinal stem cells and intestinal homeostasis in health and in inflammation: A review.

BACKGROUND: The human intestine is a complex group of organs, highly specialized in processing food and providing nutrients to the body. It is under constant threat from microbials and toxins and has therefore developed a number of protective mechanisms. One important mechanism is the constant shedding of epithelial cells into the lumen; another is the production and maintenance of a double-layered mucous boundary in which there is continuous sampling of the luminal microbiota and a persistent presence of antimicrobial enzymes. However, the gut needs commensal bacteria to effectively break down food into absorbable nutrients, which necessitates constant communication between the luminal bacteria and the intestinal immune cells in homeostasis. Disruption of homeostasis, for whatever reason, will give rise to (chronic) inflammation. DISCUSSION: Both medical and surgical management of this disruption is discussed.

¿Puede ser una apendicitis aguda la primera manifestación de endometriosis? / Can acute appendicitis be the first manifestation of endometrial disease?

Objetivo. Demostrar la relación entre la afectación endometriósica del apéndice cecal y el desarrollo de una apendicitis aguda. Pacientes y métodos. Presentamos una serie institucional de 8 pacientes con endometriosis apendicular diagnosticadas tras apendicectomía entre junio de 2009 y marzo de 2014. Resultados. La media de edad fue 40,6 años, 6 en edad fértil. En 5 (62,5%) la afectación endometriósica apendicular resultó única y en 3 (37,5%) múltiple, fundamentalmente en el ovario. Siete (87,5%) iniciaron los síntomas como una apendicitis aguda. Los implantes endometriósicos afectaban la capa serosa en 6 pacientes, la capa muscular en una y la grasa periapendicular en otra. Conclusión. El diagnóstico de endometriosis apendicular en mujeres con apendicitis aguda solo se puede realizar tras el examen de las piezas de apendicectomía, aunque puede ser sospechado en el contexto clínico. La laparoscopia permite un diagnóstico adecuado con exploración completa de la pelvis, la apendicectomía y el tratamiento de otras lesiones (AU)

Aim. To determine the relationship between endometriotic involvement of the appendix and the development of acute appendicitis. Patients and methods. We report a series of 8 patients with appendiceal endometriosis diagnosed after appendicectomy from June 2009 to March 2014. Results. The mean age was 40.6 years. Six patients were of reproductive age. Endometriotic appendiceal involvement alone was found in 5 patients (62.5%) and multiorgan involvement, mainly affecting the ovary, in 3 patients (37.5%). Clinical presentation was acute appendicitis in 7 patients (87.5%). Endometriotic implants involved the serous layer in 6 patients, the muscle layer in one patient, and periappendiceal fat in another patient. Conclusion. Diagnosis of appendiceal endometriosis in women with acute appendicitis can only be performed after specimen study, although it may be suspected in the clinical context. Laparoscopy allows pelvic and abdominal cavity examination, appendectomy, and the treatment of other lesions (AU)

Variantes morfométricas del apéndice cecal en el vivo / Morphometric variants of the cecal appendix in a living person

Introducción: la antropometría y situación del apéndice cecal son parámetros inconstantes en el humano. Los conocimientos acumulados son escasos y muy limitados, provenientes, en su mayoría, de estudios en cadáveres. El objetivo de la investigación fue determinar las características biométricas y posiciones anatómicas del apéndice cecal en el vivo.Método: se realizó un estudio observacional, descriptivo, de carácter prospectivo, en un universo de 236 pacientes intervenidos quirúrgicamente, con diagnóstico de apendicitis aguda en el Hospital Clínico Quirúrgico Docente Celia Sánchez Manduley, en Manzanillo, Granma. Las vías de abordaje fueron las laparotomías paramedia derecha infraumbilical (58,47 por ciento), y de McBurney (41,53 por ciento). En el curso de la laparotomía se observó el ciego y su apéndice, realizándose la ectomía por técnica habitual, a medio centímetro de su punto de unión con el ciego, midiéndose de manera extracorpórea. Resultados: el ciego se localizó en la fosa ilíaca derecha en 184 pacientes (77,97 por ciento). El apéndice se implantó posterior a la válvula íleo-cecal en 213 casos (90,26 por ciento) con una longitud media de 9,31 cm más menos 3,37. La situación más frecuente fue la mesocelíaca (40,25 por ciento). El meso-apéndice fue triangular en 161 casos (68,22 por ciento) e insertado en el tercio medio en el 75,84 por ciento. La irrigación del apéndice fue más frecuente a través de 3 ramos arteriales (77,97 por ciento).Conclusiones: predominó la localización del ciego en la fosa iliaca derecha, la implantación posterior a la válvula íleo-cecal, la posición mesocelíaca, la longitud media fue de 9,31 cm. El meso-apéndice fue predominantemente de forma triangular, insertado en el tercio medio con 3 ramos arteriales.

Introduction: the anthropometry and location of the cecal appendix are inconstant parameters in the human being. The accumulated knowledge is scarce and very limited, mostly coming from studies in cadavers. The objective of the research was determining the biometrical characteristics and anatomical position of the cecal appendix in living persons. Method: we carried out a prospective, descriptive, observational study, in an universe of 236 surgically treated patients, with a diagnostic of acute appendicitis in the Teaching Surgical Clinical Hospital Celia Sanchez Manduley, in Manzanillo, Granma. The approaching ways were infra umbilical right paramedical laparotomies (58,47 percent) and McBurney's laparotomies (41,53 percent). In the course of the laparotomy we observed the cecum and the appendixes, carrying out the ectomy by usual technique, half centimeter before its linking point with the cecum, measuring it in an extracorporeal form.Results: the cecum was located in the right iliac fossa in 184 patients (77,97 percent). The appendix was implanted behind the ileo-cecal valve in 239 cases (90,26 percent) with a 9,31 cm plus minus 3,37 average longitude. The most frequent location was the meso-celiac one (40,25 percent). The meso-appendix was triangular in 161 cases (68,22 percent) and inserted in the medial third in 75,84 percent. The appendix irrigation was more frequent through 3 arterial branches (77,97 percent)...

Variantes morfométricas del apéndice cecal en el vivo / Morphometric variants of the cecal appendix in a living person

Introducción: la antropometría y situación del apéndice cecal son parámetros inconstantes en el humano. Los conocimientos acumulados son escasos y muy limitados, provenientes, en su mayoría, de estudios en cadáveres. El objetivo de la investigación fue determinar las características biométricas y posiciones anatómicas del apéndice cecal en el vivo.Método: se realizó un estudio observacional, descriptivo, de carácter prospectivo, en un universo de 236 pacientes intervenidos quirúrgicamente, con diagnóstico de apendicitis aguda en el Hospital Clínico Quirúrgico Docente Celia Sánchez Manduley, en Manzanillo, Granma. Las vías de abordaje fueron las laparotomías paramedia derecha infraumbilical (58,47 por ciento), y de McBurney (41,53 por ciento). En el curso de la laparotomía se observó el ciego y su apéndice, realizándose la ectomía por técnica habitual, a medio centímetro de su punto de unión con el ciego, midiéndose de manera extracorpórea. Resultados: el ciego se localizó en la fosa ilíaca derecha en 184 pacientes (77,97 por ciento). El apéndice se implantó posterior a la válvula íleo-cecal en 213 casos (90,26 por ciento) con una longitud media de 9,31 cm más menos 3,37. La situación más frecuente fue la mesocelíaca (40,25 por ciento). El meso-apéndice fue triangular en 161 casos (68,22 por ciento) e insertado en el tercio medio en el 75,84 por ciento. La irrigación del apéndice fue más frecuente a través de 3 ramos arteriales (77,97 por ciento).Conclusiones: predominó la localización del ciego en la fosa iliaca derecha, la implantación posterior a la válvula íleo-cecal, la posición mesocelíaca, la longitud media fue de 9,31 cm. El meso-apéndice fue predominantemente de forma triangular, insertado en el tercio medio con 3 ramos arteriales(AU)

Introduction: the anthropometry and location of the cecal appendix are inconstant parameters in the human being. The accumulated knowledge is scarce and very limited, mostly coming from studies in cadavers. The objective of the research was determining the biometrical characteristics and anatomical position of the cecal appendix in living persons. Method: we carried out a prospective, descriptive, observational study, in an universe of 236 surgically treated patients, with a diagnostic of acute appendicitis in the Teaching Surgical Clinical Hospital Celia Sanchez Manduley, in Manzanillo, Granma. The approaching ways were infra umbilical right paramedical laparotomies (58,47 percent) and McBurney's laparotomies (41,53 percent). In the course of the laparotomy we observed the cecum and the appendixes, carrying out the ectomy by usual technique, half centimeter before its linking point with the cecum, measuring it in an extracorporeal form.Results: the cecum was located in the right iliac fossa in 184 patients (77,97 percent). The appendix was implanted behind the ileo-cecal valve in 239 cases (90,26 percent) with a 9,31 cm plus minus 3,37 average longitude. The most frequent location was the meso-celiac one (40,25 percent). The meso-appendix was triangular in 161 cases (68,22 percent) and inserted in the medial third in 75,84 percent. The appendix irrigation was more frequent through 3 arterial branches (77,97 percent)(AU)

Appendiceal inflammation affects the length of stay following appendicectomy amongst children: a myth or reality?

The effect of the severity of appendiceal inflammation on post-operative stay in children following appendicectomy has shown conflicting results. This study was conducted to determine the association between the severity of appendiceal inflammation and post-operative stay amongst children undergoing open appendicectomy. A retrospective cohort study was conducted at a District General Hospital for two years. A total of 204 patients were included in the study with an age range between 3 and 16 years. Females were 54.9% while the rest were male. Mean age was 12.5 ± 3 years. The association of the severity of appendiceal inflammation and post-operative stay was assessed by multivariable Cox Proportional hazards model. Mean post-operative stay was 2.32 days (95% CI 2.14-2.51). Macroscopically perforated appendix, histological inflammation and post-operative complications were significantly associated with post-operative stay on univariable analysis (P < 0.05). Whereas, the multivariable analysis showed that the post-operative stay was significantly prolonged only in case of either perforated appendix or post-operative complications while it remained unaffected by the histological inflammation.

Histomorphological study of lymphoid follicle of vermiform appendix.

The study was done to find out the number of lymphoid follicle of vermiform appendix in Bangladeshi people and to increase the knowledge regarding variational anatomy in our population. Total 40 fresh appendixes were collected for histological study of different age and sex during postmortem examination in the autopsy laboratory of Forensic department of Mymensingh Medical College. This cross sectional descriptive study was done by convenient sampling technique. For convenience of differentiating the number of lymphoid follicle of vermiform appendix in relation to age and sex, findings were classified in four groups, up to 20 years, 21 to 35 years, 36 to 55 years and 56 to 70 years. In the present study the number of lymphoid follicle were highest in group A, mean were (5.40+/-1.30) and lowest in group D where mean were (1.05+/-0.35). In male mean were 3.16 and in female mean were 2.86. Diameter of the lymphoid follicle in group A was highest (40.14+/-2.66) and lowest in group D (0.24+/-1.35). Number of germinal centre are highest in group B (2.20 +/- 0.45) and lowest in group D (0.00 +/- 0.00).

Colitis ulcerosa con afectación segmentaria del recto y del ostium apendicular. A propósito de un caso / Ulcerative colitis with segmentary affectation of the rectum and appendiceal opening. A case report

La colitis ulcerosa es una enfermedad inflamatoria crónica que en un 95% de los casos se circunscribe al recto-sigma, lugar donde empieza y progresa en sentido ascendente. La lesión histológica es siempre continua, de forma que no hay zonas sanas dentro del área afectada, siendo esta una de las principales características que la diferencian de la enfermedad de Crohn. La afectación de forma segmentaria y en tramos diferentes del tubo digestivo, aunque descrita en la literatura médica, se considera excepcional. Presentamos el caso clínico de un paciente diagnosticado en nuestro hospital de colitis ulcerosa, que en curso de la colonoscopia se objetivó afectación inflamatoria de los primeros 5 cm del recto, con normalidad del resto de colon, alcanzándose el ciego y apreciándose en el ostium apendicular lesiones de aspecto inflamatorio.Se tomaron biopsias de la mucosa rectal y del ostium apendicular. El estudio anatomopatológico confirmó el diagnóstico en ambas muestras

Ulcerative colitis is a chronic inflammatory disease that is limited to the rectum-sigma, place where it starts and progresses in ascending sense, in 95% of the cases. The histological lesion is always continuous so that there are no healthy areas inside the affected area. This is one of the main characteristics that differentiates it from Crohn's disease. The segmentary form and that found in different sections of the colon, although described in the medical literature, is considered to be exceptional. We present the clinical case of a patient diagnosed in our hospital of ulcerative colitis. During the colonoscopy, inflammatory affectation of the first 5 cm of the rectum, with normality of the rest of the colon, was found. We reached to the cecum where we observed lesions with an inflammatory aspect in the appendiceal opening. Biopsies of the rectal mucous and of the ostium appendiceal were obtained. The pathology study confirmed the diagnosis in both samples

Role of the appendix in the pathogenesis of ulcerative colitis.

Although human appendix has been considered as a vestigial remnant, recent observations have focused attention on the role of the appendix in the pathogenesis of ulcerative colitis (UC). Many case-control studies suggest that previous appendectomy is rare in UC patients. This inverse relation is limited to patients who undergo appendectomy before the age of 20 years. Moreover, several investigators reported the improvement of UC after appendectomy, especially in young patients. In the appendix of UC patients, the CD4/CD8 ratio is significantly increased, and the proportion of CD4+CD69+ (early activation antigen) T cells, but not of CD4+HLA-DR+ (mature activation antigen) T cells, is also significantly increased. These findings suggest that the appendix may be a priming site in the development of UC. Further studies including analysis of CD4+ and CD8+ T cells are necessary to clarify the role of the appendix in the pathogenesis of UC.

Position and susceptibility to inflammation of vermiform appendix in Accra, Ghana.

OBJECTIVES: To determine the normal (non-inflamed) position of the vermiform appendix in Ghana and carry out a pilot study to test the hypothesis "The retrocaecal appendix is less prone to inflammation". DESIGN: Retrospective autopsy study. SETTING: The pathology department and the department of surgery theatres of the Korle Bu Teaching hospital in Accra, Ghana SUBJECTS: Consecutive autopsies and inflamed appendices at appendicectomy. Deaths occurring from untreated appendicitis were excluded from the autopsy study. Conversely non-inflamed appendices and appendices from interval appendicectomy were excluded from the appendicitis study. RESULTS: There were 1358 autopsies and 323 inflamed appendices. In the autopsy study the retrocaecal position was the most common (914 [67.3%]). Other positions were pelvic (294 [21.6%]), preileal (66 [4.9%]), postileal (51 [3.8%]) and paracaecal (33 [2.4%]). These positions were similar in males and females. The positions of 323 inflamed appendices were: retrocaecal (183 [56.7%]), pelvic (66 [20.4%]), preileal (20 [6.2%]), postileal (15 [4.6%]) and paracaecal (39 [12.1%]). Comparing the nonretrocaecal to the retrocaecal position by chi square, the non-retrocaecal position was more prone to inflammation (p<0.001). CONCLUSION: The position of the normal appendix in Ghana differs from Western literature. The retrocaecal position appears less prone to inflammation in Ghanaians.

Mucocele de apêndice: aspectos clínicos, cirúrgicos e radiológicos / Mucocele of the appendix: clinical, surgical and radiologicas aspects

Os autores relatam um raro caso de mucocele de apêndice em mulher de 55 anos de idade, detectado durante exame ultra-sonográfico solicitado por suspeita de nefrolitíase. A realizaçäo subseqüente de tomografia computadorizada confirmou o diagnóstico. Revisam os aspectos clínicos, cirúgicos e radiológicos e as associações mórbidas concernentes à mucocele de apêndice

Torsión de apéndice epiploico: reporte de 2 casos: características ecográficas y tomográficas / Torsion of the epiploic appendix: report of 2 cases: echographia and tomography characteristics

El infarto de una apéndice epiploica produce un proceso inflamatorio que se localiza en la región del colon afectada así como a la porción correspondiente del omento mayor. La apendagitis epiploica tiene hallazgo sonográficos y de TAC característicos los cuales contribuyen al diagnostico rápido y por lo tanto ayudan con el manejo del paciente. Se presentan aquí dos casos.

Appendiceal colic: A rare complication of colonoscopy.

We report a case of appendiceal colic presenting as chronic right lower quadrant abdominal pain, without leukocytosis or other inflammatory signs, following an uneventful colonoscopic exam without biopsy or polypectomy. The resected appendix appeared grossly abnormal and was engorged with fecal material. The patient was immediately relieved of pain and remains so four years postoperatively. We conclude that insufflation of the cecum caused inspissation of fecal material into the lumen of the appendix. The ensuing incomplete or partial obstruction of the appendiceal lumen resulted in development of appendiceal colic without any signs or symptoms of inflammation.

Carcinoma primario de apéndice diagnosticado como cáncer de ovario avanzado / Primary carcinoma of the appendix diagnosed as advanced ovarian cancer

Se presenta un caso de cistoadenocarcinoma mucinoso del apéndice, diagnosticado preoperatoriamente como un cáncer de ovario avanzado. Se discute su presentación clínica, variedades histopatológicas y su tratamiento (AU)

Intestinal obstruction after appendectomy.

BACKGROUND: The frequency of intestinal obstruction varies in the literature (0.2-10.7%) and requires evaluation in a proper design. METHODS: From 1978 to 1985, 1951 patients underwent appendectomy; 58 patients were excluded because of appendectomy per occasionem, 156 because of previous laparotomy, and 190 because of simultaneous major surgery. Three foreigners were lost to follow-up. The cohort was linked to the Danish National Inpatient Register for identification of cases, defined by intestinal obstruction requiring surgical intervention. RESULTS: The follow-up period was long (median, 3563 days; range, 2-5113). Twenty-one patients developed intestinal obstruction. The cumulated incidence was 0.33% after 30 days, 0.79% after 1 year, and 1.51% after 14 years. Female sex as compared with male sex (RR = 3.91; 95% confidence limits (CL), 1.25-12.0) and removal of a removal of a normal appendix as compared with an inflamed appendix (RR = 4.0; 95% CL, 1.28-12.5) carried a significantly higher risk of intestinal obstruction. CONCLUSION: Intestinal obstruction after open appendectomy is rare.