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PubMed1983

Isolation of Campylobacter jejuni from an appendix.

Campylobacter jejuni Skirrow biotype 1, Lior serotype 8 was isolated from the appendix of an 11-year-old boy who had a 6-h history of acute abdominal pain. Histological diagnosis on the appendix section was early acute appendicitis. Dilute carbol fuchsin stain and indirect fluorescent antibody test performed on the appendix section also revealed the presence of Campylobacter sp. The patient developed a significant bactericidal antibody titer of 1,024, providing substantial clinical evidence of the pathogenicity of the isolate. This case indicated that not only may abdominal pain caused by Campylobacter enteritis mimic appendicitis, but the organism may actually be recovered from the infected appendix.

Antibodies, Bacterial↗
PubMed1986

Distribution of immunoglobulin producing cells is different in normal human appendix and colon mucosa.

The densities of IgG-, IgA-, IgM- and IgD-producing immunocytes were determined by paired immunofluorescence staining and morphometric analysis in the lamina propria of normal appendix specimens. Normal colon specimens were used as reference material, mostly paired from individual subjects. The density (median of cells/mm2 lamina propria area) of IgA immunocytes tended to be slightly higher in the appendix than in the colon (1259 vs 962) and the same held true for IgM cells (71 vs 55). Conversely, the overall density of IgG immunocytes was much higher in the appendix than in the colon (95 vs 38). A striking feature was the fact that almost 50% of all immunocytes were of the IgG isotype adjacent to lymphoid follicles. It seemed justified to conclude, therefore, that the abundance of such follicles explains the overall enrichment of IgG-producing cells in normal appendix mucosa. These immunocytes most likely represent follicle derived B cells that have reached terminal maturation locally, whereas precursors generated from less mature memory clones probably emigrate and home ubiquitously to distant sites of the gut lamina propria where they develop into IgA-producing immunocytes.

Adolescent↗
PubMed1995

Foreign bodies of dental origin in the appendix.

Foreign bodies found in the appendix have been reported many times. To date 254 occurrences have been documented. However, only 4 previously reported episodes involve teeth, dental restoration or dental equipment. We present a patient with a 6 month history of intermittent right iliac fossa pain following the ingestion of a gold inlay restoration, which was found at operation to be in the distal appendix. Previous reports suggest that symptoms from foreign bodies in the appendix occur in 73% of cases, and in 93% when the object is sharp. Therefore, appendicectomy is recommended when a foreign body is detected in the appendix, and particularly if it has sharp edges.

Abdominal Pain↗
PubMed2003

Ovoid shape of the vermiform appendix: a criterion to exclude acute appendicitis--evaluation with US.

PURPOSE: To investigate whether the shape of the appendix in transverse section may be considered an ultrasonographic (US) criterion to exclude or confirm acute appendicitis. MATERIALS AND METHODS: The shapes of appendices of 100 control subjects, of 174 patients with clinical suspicion of acute appendicitis but without acute appendicitis, and of 108 patients with acute appendicitis were prospectively evaluated with US. Definite diagnoses in patients with clinical suspicion of acute appendicitis were established and confirmed either with surgery and histologic examination in 161 patients or with clinical follow-up in 121 patients. Statistical measures such as sensitivity, specificity, positive and negative predictive values, and accuracy were assessed for the appendiceal shape as a diagnostic US criterion for acute appendicitis. RESULTS: An at least partly round appendix indicated acute appendicitis with a sensitivity of 100%; specificity of 37%; positive and negative predictive values of 50% and 100%, respectively; and accuracy of 61%. In 67 of 174 patients with clinical suspicion of acute appendicitis but without acute appendicitis, the partly ovoid appendiceal shape aided in the exclusion of acute appendicitis, since it indicated a normal appendix with a probability of 86%. In 65 of 174 patients with clinical suspicion of acute appendicitis but without acute appendicitis, the ovoid shape over the entire appendiceal length excluded acute appendicitis with confidence. CONCLUSION: The shape of the appendix in transverse section is a useful US criterion, since an ovoid shape over the entire appendiceal length reliably rules out acute appendicitis.

Acute Disease↗
PubMed1997

Helical CT technique for the diagnosis of appendicitis: prospective evaluation of a focused appendix CT examination.

PURPOSE: To evaluate a focused, helical computed tomographic (CT) technique for imaging the appendix in patients suspected of having appendicitis. MATERIALS AND METHODS: One hundred patients prospectively underwent appendix CT examination, with use of oral and colon contrast media and contiguous, thin-collimation, helical CT imaging of the right lower quadrant. Results were correlated with the results of surgery and pathologic examination from 61 patients or from clinical follow-up in 39 patients. RESULTS: CT scans were positive for appendicitis in 59 patients: true-positive in 56 patients on the basis of surgery and pathologic examination, and false-positive in two patients on the basis of clinical follow-up; in the case of the other positive scan, the clinical outcome was indeterminate. CT scans were negative for appendicitis in 41 patients: true-negative in five patients on the basis of surgery and pathologic examination, and true-negative in 36 patients on the basis of clinical follow-up. CT had a sensitivity of 100%, a specificity of 95%, a positive predictive value of 97%, a negative predictive value of 100%, and an accuracy of 98%. The normal appendix was always identified. CT helped establish alternative diagnoses in 33 of the 41 patients (80%) in whom the results of CT were negative for appendicitis. CONCLUSION: Appendix CT examination can help diagnose or exclude appendicitis and establish an alternative diagnosis.

Acute Disease↗
PubMed2000

Needle perforation of the appendix.

BACKGROUND/AIMS: Needles are among the most frequently swallowed foreign bodies. In most cases they are excreted per vias naturales, but in some cases needles can lead to perforation of the stomach or duodenum in adults. METHODS: We report a case of acute appendicitis after perforation of the appendix by a swallowed needle. An appendectomy was performed without any knowledge of the reason for perforation. RESULTS: Inspection of the resected appendix demonstrated a needle of 1.5 cm length inside the lumen of the appendix, which had caused a perforation of the distal end of the appendix. CONCLUSION: As seen in this case a longer-lasting nondiagnosed perforation can lead to extensive local inflammation which could have been avoided by early surgical treatment which should also be considered if the patient has very few symptoms, as in this case.

Adult↗
PubMed2003

Implications of removing a normal appendix.

BACKGROUND: The diagnosis of acute appendicitis remains difficult and therefore 15-30% of the removed appendices appear to be normal. The aim of this study was to investigate morbidity, mortality and costs of removing a normal appendix in patients with suspected appendicitis. PATIENTS AND METHODS: Retrospective study of patients who underwent a negative appendectomy for suspected appendicitis in the period 1991-1999 with a median follow-up of 4.4 years. Patients who underwent an elective appendectomy or appendectomy for other reasons were excluded. RESULTS: In 285 patients (70% women, 30% men) a normal appendix was removed. In 192 (67%) patients a muscle-splitting incision was performed, in 6 (2%) a median laparotomy, and in 51 (18%) the normal appendix was removed by laparoscopy. In 36 patients (13%) a diagnostic laparoscopy was converted to a muscle-splitting incision. Complications occurred in 16 (6%) patients, in 5 (2%) a re-operation was needed. The mean hospital stay was 4.4 (SE 2.8) days, in case of complications 7.4 (SE 4.2) days. The mean extra hospital costs of a negative appendectomy were EUR 2712. CONCLUSION: The removal of a normal appendix has considerable complications and costs. In an attempt to prevent these costs, extra diagnostic tools should be considered. Expensive diagnostic tools such as diagnostic laparoscopy should be used selectively in order not to further increase costs.

Adolescent↗
PubMed1994

Blunt traumatic rupture of the high right ureter, repaired with appendix interposition.

We report the first case of upper lumbar ureteral replacement with the vermiform appendix, in a blunt traumatic ureter rupture with important urinoma. In selected cases, in which the appendix has a required caliber and length, the vermiform appendix is a very good autograft for ureteral substitution. The vermiform appendix must be preserved if possible in the abdominal surgery.

Accidents, Traffic↗
PubMed1991

Human appendix B cells naturally express receptors for and respond to interleukin 6 with selective IgA1 and IgA2 synthesis.

Past studies have shown that freshly isolated human B cells from peripheral blood and tonsils do not express IL-6 receptors (IL-6R); however, mitogen or antigen activation of these B cells induces IL-6R and responsiveness to IL-6. In this study, we have shown that a high proportion of B cells enzymatically dissociated from human appendix, a gut-associated lymphoreticular tissue (GALT), expresses the IL-6R, and that recombinant human IL-6 induces significant increases in the number of Ig-producing cells. The recombinant human IL-6-induced increase in Ig-producing cells is restricted to the IgA isotype. Further, IgA2 is the major subclass; however, significant numbers of IgA1 producing cells are also seen. In contrast, human tonsillar and peripheral blood B cells express low levels of IL-6R, and exogenous IL-6 does not increase numbers of Ig-producing cells. When PBMC or tonsillar cells are stimulated with PWM, the former display an equal distribution of IgA1 and IgA2 secreting cells, while tonsillar B cells are mainly of the IgA1 subclass. The distribution of surface Ig-positive (sIg+) B cells in the appendix B cell population is sIgA+ greater than sIgG+ greater than sIgM+, and the sIgA+ B cells express higher levels of IL-6R when compared with sIgG+ or sIgM+ B cells. These studies show that human appendix contains B cell subsets that constitutively express IL-6R, and that a high proportion of these cells are committed to the IgA isotype. Furthermore, higher numbers of IL-6 responsive IgA2 B cells are present in the human appendix as compared to tonsils or PBMC.

Appendix↗
PubMed2006

Revisiting MRI for appendix location during pregnancy.

OBJECTIVE: The purpose of this study is to determine the location of the appendix in pregnant patients by MRI and to investigate the possibility of gradual upward displacement of the appendix during pregnancy. CONCLUSION: The gradual upward displacement of the appendix during pregnancy was confirmed. MRI can be used for determination of the appendix localization in pregnant patients. Further studies with a larger number of patients will be helpful to answer this clinically relevant question.

Appendix↗
PubMed2002

Non-Hodgkin's lymphoma of the appendix: clinical and CT findings with pathologic correlation.

OBJECTIVE: The purpose of this report is to describe the clinical, CT, and pathologic features of non-Hodgkin's lymphoma of the vermiform appendix. CONCLUSION: Non-Hodgkin's lymphoma of the appendix typically manifests with acute symptoms in patients who have no prior history of lymphoma. Most patients with the disease present clinically with signs and symptoms suggestive of acute appendicitis. On CT, lymphomatous infiltration of the appendix produces markedly diffuse mural soft-tissue thickening (range of diameters, 2.5-4.0 cm; mean diameter, 3.2 cm). The vermiform morphology of the appendix is usually maintained, and aneurysmal dilatation of the lumen is sometimes seen. Stranding of the periappendiceal fat seen on CT may represent superimposed inflammation or even direct lymphomatous extension. Coexisting abdominal lymphadenopathy is not seen in all patients. Although appendiceal lymphoma is rare, the characteristic CT appearance could lead to a preoperative diagnosis.

Adult↗
PubMed1986

Diverticulosis of the vermiform appendix.

A case of appendicitis that was associated with a rare congenital diverticulum of the appendix is presented, along with the results of a retrospective study of diverticulosis of the appendix over a 10-year period. The incidence of the condition in this series (0.65%) is similar to other published series; however, two cases involved rare congenital diverticula--only 43 of such cases have been previously recorded in the medical literature world-wide. The average age of patients who present with acute appendicitis with acquired diverticula (37.8 years) is greater than that of patients without the condition. The perforation rate of an inflamed appendix when diverticula were present (27%) was higher than when no diverticula existed (6.6%). Because of the earlier and higher perforation rate, it is proposed that appendicectomy be performed if an appendix with diverticula is found during the course of a laparotomy for some other condition.

Adult↗
PubMed2005

Myeloid sarcoma of appendix mimicking acute appendicitis.

CONTEXT: Myeloid sarcoma is a neoplasm of immature myeloid cells involving an extramedullary anatomic site that is usually, although not always, associated with acute myeloid leukemia. Any extramedullary site can be involved by myeloid sarcoma, but involvement of the cecal appendix is uncommon, and symptoms mimicking acute appendicitis as a result of appendiceal involvement are rare. OBJECTIVE: To describe the clinicopathologic features of 2 patients with myeloid sarcoma involving the appendix who presented with right lower quadrant pain suggestive of acute appendicitis and prompting appendectomy. DESIGN: Clinical information for both patients was obtained from the medical record. Routine hematoxylin-eosin-stained slides, naphthol-ASD-chloroacetate stain, and immunohistochemical stains for myeloid, B-cell, and T-cell antigens were prepared. RESULTS: Peripheral blood and bone marrow were infiltrated by coexistent acute myeloid leukemia in case 1 but were negative for leukemia in case 2. In case 2, the patient had a history of acute myeloid leukemia that had been treated by an allogenic bone marrow transplant 7 months earlier. Histologic examination of the appendix revealed poorly differentiated myeloid sarcoma in both cases. Each neoplasm was positive for chloroacetate esterase, myeloperoxidase, lysozyme, and CD43 and was negative for CD3 and CD20. CONCLUSIONS: Myeloid sarcoma involving the appendix can rarely cause pain or other symptoms mimicking acute appendicitis. A high index of suspicion combined with the use of cytochemical and immunohistochemical studies are helpful in establishing the diagnosis.

Abdomen↗
PubMedDate not supplied

Carcinoid of the appendix during laparoscopic cholecystectomy: unexpected benefits.

Carcinoid tumors of the midgut arise from the distal duodenum, jejunum, ileum, appendix, ascending and right transverse colon. The appendix and terminal ileum are the most common location. The majority of carcinoid tumors originate from neuroendocrine cells along the gastrointestinal tract, but they are also found in the lung, ovary, and biliary tracts. We report the first case of elective laparoscopic cholecystectomy in which we found a suspicious lesion at the tip of the appendix and proceeded to perform a laparoscopic appendectomy. The lesion revealed a carcinoid tumor of the appendix.

Appendectomy↗
PubMed1999

[Intraepithelial enteroendocrine cells in cecum and appendix from ovoalbumin sensitized rabbits].

Intraepithelial enteroendocrine cells (IEC) produce peptides which influence motility, secretion and absorption of nutrients. Recently the role of these cells in the immune mucosal system is under study. The aim of the present study was to evaluate the modifications in number of IEC in cecum and appendix from Ovalbumin (OVA) sensitized rabbits. Twenty adult New Zealand rabbits were separated in two groups: Group 1 (G1 = 10) not sensitized normal control. Group 2 (G2 = 10) were sensitized twice intraperitoneally with 70 mg OVA and 30 mg ALUM/ml (aluminium hydroxide). Anti OVA specific IgE was evaluated by means of PCA test (passive cutaneous anaphylaxis). Samples form cecum and appendix were fixed in buffered formaldehyde 10%, paraffin embedded and stained with anti-Chromogranin A for neuroendocrine cells. 400 high power fields were counted in each animal, referred as IEC/100 enterocytes. In cecum surface epithelium and crypt were considered. Surface epithelium, deep crypts and superficial crypts were evaluated in appendix. Results showed in cecum in G1:1,6 IEC/100 enterocytes in surface epithelium and 3/100 in crypts; G2 6 IEC/100 in surface epithelium and 12/100 in crypts. The difference between G1 and G2 was statistically significant (p < 0.05). In appendix surface epithelium from G1 showed 5.2/100 while G2 5.4/100. Superficial crypts 8.5 (G1) and 11.3 (G2) (p < 0.05) and deep crypts 4.9 (G1) and 8.5 (G2) (p < 0.01). The results showed that OVA-sensitized animals presented increment in the number of IEC in surface epithelium and crypts which may indicate a relationship between these cells and rabbit mucosal immune system.

Animals↗
PubMed1997

[Use of appendix to restore a ureter: report of 2 cases].

In two cases the appendix was utilised as a substitute for part of the left ureter. Case one used the appendix as a conduit from the upper left ureter to the right one to treat the megaureter, and the other one used the appendix as a connection to join the two transected openings of the left ureter to treat the obstruction caused by the chronic ureteritis of the left ureter. Long-term observation after the operation showed satisfactory functions of kidneys. We suggested that the appendix is an autologus tissue whose active peristalsis, little mucous absorption along with its easy performance make this method highly valuable and practical.

Adolescent↗
PubMed2000

Agenesis of the vermiform appendix.

Agenesis of the vermiform appendix is very rare. The incidence is estimated to be one in 100,000 laparotomies for suspected appendicitis. Several criteria have to be met before the investigator can conclude that the appendix is congenitally absent. This case is reported to bring this entity to the attention of surgeons who may encounter a similar situation during celioscopy. A 29-year-old patient was admitted through the emergency room with the chief complaint of abdominal pain. Acute appendicitis was suspected, and he was accordingly prepared for celioscopy. This report presents a patient with vermiform appendix agenesis diagnosed at celioscopy with concomitant mesenteric lymphadenitis. Agenesis of the vermiform appendix is very rare, and the diagnosis should not be made unless the ileocecal and retrocecal area are thoroughly explored.

Abdomen, Acute↗
PubMed2001

[Mucocele of the appendix. Retrospective study of 10 cases].

PURPOSE: The purpose of our work was to assess the value of abdominal sonography (US) and computed tomography (CT) in the preoperative diagnosis of appendiceal mucocele. MATERIAL: and methods. We retrospectively reviewed 10 cases of mucocele of the appendix, 7 cases without pseudomyxoma peritonei, and 3 cases with pseudomyxoma peritonei. All cases were investigated radiologically by plain film and US, barium enema was performed in 3 cases and CT in 5 cases. RESULTS: Mucoceles of the appendix are rare and their clinical presentation is not specific. US confirms the appendicular involvement, but often poses the differential diagnosis with acute inflammation, abscess or localized appendicular peritonitis. CT appears as a mandatory examination since it allows accurate preoperative diagnosis period. In this series, the diagnosis was made preoperatively in the 5 cases where CT had been performed. CONCLUSION: US is useful to confirm the abnormal pattern of the appendix but does not allow accurate diagnosis of mucocele. CT is more specific and accurate for diagnosis of mucocele of the appendix.

Abdominal Pain↗