Appendiceal diverticulitis and acute appendicitis: differences and similarities.

INTRODUCTION: Acute appendiceal diverticulitis is an unusual cause of acute abdomen, considered clinically indistinguishable from acute appendicitis. MATERIAL AND METHODS: In a historic cohort study with 27 cases of appendiceal diverticulitis and 54 cases of acute appendicitis, we compared clinical characteristics, diagnostic tests and pathology findings of the two processes. RESULTS: Mean age at presentation was lower in acute appendicitis (37.24 +/- 19.98 vs. 54.81 +/- 17.55 years, p < 0.001), with significant differences between men (33.33 +/- 15.89 vs. 57 +/- 18.02 years, p < 0.001) but not between women (41.76 +/- 24.87 vs. 50.44 +/- 16.69 years, p = 0.34). In the diverticulitis group, 48.15 % had leukocytosis vs. 81.48 % in the appendicitis group (p = 0.02); there was no difference in leukocyte count (13770.37 +/- 4382.55 vs. 14279.63 +/- 4268.59, p = 0.61). Patients with appendiceal diverticulitis had a higher incidence of appendiceal mucocele (p = 0.01) and a lower proportion of appendiceal gangrene (p = 0.03). There were no differences in appendiceal perforation or ulceration. Symptom duration before emergency department attendance (71.61 +/- 85.25 hours vs. 36.84 +/- 33.59 hours; Z = -3.1 p = 0.002), duration of surgery (85 +/- 40 minutes vs. 60 +/- 21 minutes, Z = -3.2, p = 0.001) and the presence of appendicular plastron was higher in patients with diverticulitis vs. appendicitis (8 vs. 5 patients [p = 0.01, Odds ratio 2.2]). CONCLUSIONS: Appendiceal diverticulitis presents a series of clinical, epidemiological and pathological differences with respect to acute appendicitis. The former shows a more indolent course with delayed diagnosis.

Diverticulitis apendicular y apendicitis aguda: diferencias y semejanzas / Appendiceal diverticulitis and acute appendicitis: differences and similarities

Introducción: la diverticulitis aguda apendicular es una causa poco frecuente de abdomen agudo, considerada clínicamente indistinguible de la apendicitis aguda. Material y métodos: estudio de cohortes retrospectivo de 27 casos de diverticulitis apendicular y 54 casos de apendicitis aguda. Se analizaron las características clínicas, pruebas diagnósticas y hallazgos anatomopatológicos de ambos procesos. Resultados: la edad de presentación fue más temprana en las apendicitis aguda (37,24 ± 19,98 años vs. 54,81 ± 17,55 años; p < 0,001), con diferencia significativa entre los varones (33,33 ± 15,89 años vs. 57 ± 18,02 años; p < 0,001), pero no entre las mujeres (41,76 ± 24,87 años vs. 50,44 ± 16,69 años; p = 0,34). Un 48,15 % de diverticulitis presentaron leucocitosis por un 81,48 % de las apendicitis (p = 0,02), no hubo diferencias en el recuento leucocitario (13770,37 ± 4382,55 vs. 14279,63 ± 4268,59; p = 0,61). Los pacientes con diverticulitis apendicular tuvieron mayor proporción de mucocele apendicular (p = 0,01) y menor proporción de gangrena apendicular (p = 0,03). No hubo diferencias en la perforación ni en la ulceración apendicular. La duración de los síntomas antes de la asistencia de los pacientes al servicio de urgencias (71,61 ± 85,25 horas vs. 36,84 ± 33,59 horas; Z = -3,1 p = 0,002), la duración de la intervención (85 ± 40 minutos vs. 60 ± 21 minutos; Z = -3,2, p = 0,001) y la presencia de plastrón apendicular fue mayor en los pacientes con diverticulitis apendicular (8 vs. 5 pacientes [p = 0,01; Odds ratio 2.2]). Conclusiones: la diverticulitis apendicular presenta una serie de diferencias clínicas, epidemiológicas y anatomopatológicas en relación con la apendicitis aguda. Estas diferencias muestran un curso más indolente en la DAA con un retraso diagnóstico (AU)

Introduction: Acute appendiceal diverticulitis is an unusual cause of acute abdomen, considered clinically indistinguishable from acute appendicitis. Material and methods: In a historic cohort study with 27 cases of appendiceal diverticulitis and 54 cases of acute appendicitis, we compared clinical characteristics, diagnostic tests and pathology findings of the two processes. Results: Mean age at presentation was lower in acute appendicitis (37.24 ± 19.98 vs. 54.81 ± 17.55 years, p < 0.001), with significant differences between men (33.33 ± 15.89 vs. 57 ± 18.02 years, p < 0.001) but not between women (41.76 ± 24.87 vs. 50.44 ± 16.69 years, p = 0.34). In the diverticulitis group, 48.15 % had leukocytosis vs. 81.48 % in the appendicitis group (p = 0.02); there was no difference in leukocyte count (13770.37 ± 4382.55 vs. 14279.63 ± 4268.59, p = 0.61). Patients with appendiceal diverticulitis had a higher incidence of appendiceal mucocele (p = 0.01) and a lower proportion of appendiceal gangrene (p = 0.03). There were no differences in appendiceal perforation or ulceration. Symptom duration before emergency department attendance (71.61 ± 85.25 hours vs. 36.84 ± 33.59 hours; Z = -3.1 p = 0.002), duration of surgery (85 ± 40 minutes vs. 60 ± 21 minutes, Z = -3.2, p = 0.001) and the presence of appendicular plastron was higher in patients with diverticulitis vs. appendicitis (8 vs. 5 patients [p = 0.01, Odds ratio 2.2]). Conclusions: Appendiceal diverticulitis presents a series of clinical, epidemiological and pathological differences with respect to acute appendicitis. The former shows a more indolent course with delayed diagnosis (AU)

Linitis-like squamous esophageal cancer diagnosed by endoscopic ultrasonography-guided fine-needle aspiration cytology: report of two cases.

Endoscopic ultrasonography-guided fine-needle aspiration cytology (EUS-FNA) may provide full-thickness biopsies, adequate for cytology and histology. In the present case report, we describe the first cases of a rare well-differentiated squamous esophageal carcinoma (verrucous esophageal cancer), finally diagnosed by EUS-FNA using a large FNA needle after several upper endoscopies with biopsies negative for malignancy. In this report, we highlight the usefulness of this procedure and EUS features in the diagnosis of suspicious esophageal lesions with negative endoscopic biopsies for malignancy.