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PubMed2000

[Sonographic representation of the normal and acute inflamed appendix--in patients wi right-sided abdominal pain].

The detectability, vascularization and size of the normal and inflamed appendix were investigated in the study. 148 patients under suspicion of appendicitis or with lower right abdominal pain were studied over a period of five months beginning in January 1998. An ultrasound-transducer was employed at a wave length of 3.5 MHz to 10 MHz. Vascularization was measured using 'Duplex' and 'Color Angio'. The results were compared with operative evidence, histology and patient history. The appendix was detected in about 30% of the cases (47/148). But of the presumably normal appendices only 12% (13/109) were detected. 27 appendices sonographically diagnosed as acutely inflamed were confirmed by operation and phlegmonic. The acute appendicitis was sonographically diagnosed with a sensitivity of 82% and a specificity of 95%. The diameter of the normal appendices was an average of 5.5 mm, that of the acute was 12.2 mm whereby 21 of 25 organs were at least 9 mm. The measurement of the organ size seems to be more helpful than the detection of vascularization. Both methods alone cannot detect the acute phlegmonic appendicitis. The normal appendix was less frequently detected than described in current literature. Patients with pain present difficulties in ultra-sound examination because both the cooperation and the time for the correct diagnosis are limited.

Abdominal Pain↗
PubMed1999

[Ultrasound appendix imaging in mucoviscidosis patients].

PURPOSE: The aim of this study was to determine the presentation of the appendix in patients with cystic fibrosis (CF) compared to a healthy control group and patients with acute appendicitis using high resolution graded compression sonography. METHOD: 59 CF patients (mean age 11 years), 54 healthy children (mean age 9 years) and 322 patients with histologically proven acute appendicitis were evaluated by sonography. A blind ending tubular structure in longitudinal sections and a target-like figure in cross sections without peristalsis was considered as appendix. The maximum distance between the outer echolucent layers was calculated as diameter. RESULTS: In 20%, 67% and 90% of the cases, the appendix was identified in the CF-group, healthy children, and patients with acute appendicitis. The mean diameters were 9.8, 3.9, and 10.9 mm respectively. These differences were statistically significant (p < 0.001 and p < 0.012). CONCLUSION: The appendiceal mucocele in cystic fibrosis is an uncommon but important differential diagnosis of the acute appendicitis.

Acute Disease↗
PubMed1982

Colonoscopic appearance of the remnant of the appendix after total inversion.

In a series of 395 total colonoscopies, an oblong smooth tumor was seen in the cecum of six patients corresponding to the remnant of the totally inverted appendix. All the patients had undergone a laparotomy during which the appendix was inverted. The histological examination demonstrated a uniform finding without any signs of polyp or malignancy. Our findings stress that the appendix fails to undergo necrosis after total inversion in some cases, in which the changes in the cecum can be readily identified by total colonoscopy.

Adult↗
PubMedDate not supplied

CT of the normal appendix.

We conducted a prospective evaluation of the normal vermiform appendix in 203 patients. Conventional CT techniques were utilized with an 8 mm slice thickness and 10 mm slice interval. The normal appendix was definitely identified in 51% of the patients studied. Computed tomographic appearance of the normal appendix is demonstrated, and potential pitfalls are described.

Adolescent↗
PubMed1982

A bullet in the appendix.

An unusual case of a foreign body lodged in the appendix after traumatic intestinal penetration is described. Although rarely found, foreign bodies in the appendix may produce acute appendicitis and other complications which necessitate surgery. An appendectomy is recommended: 1) for all symptomatic patients; 2) in patients with pointed objects retained because such patients are at potential risk for perforation; or 3) in any patient with a foreign body in the appendix who is undergoing intra-abdominal surgery for other reasons.

Adult↗
PubMed1995

Selective recruitment of lymphocyte subsets to the inflamed appendix.

Total lymphocyte counts and the distribution of lymphocyte subsets were determined in peripheral venous blood and appendiceal mononuclear cells from 60 patients who underwent appendicectomy for the clinical diagnosis of appendicitis. A significant peripheral lymphopenia was observed in the 46 patients with histologically confirmed acute appendicitis which was accompanied by an increase in the appendiceal lymphocyte concentration. There was an even greater depletion of CD45RO+ (memory) T lymphocytes in peripheral blood and an increase in the inflamed appendix. Reciprocal changes were observed in the CD45RA+ (naive) T lymphocyte subset. These changes were reflected in the local arterial and venous CD45RA and CD45RO T lymphocyte subsets. Proliferation studies showed an expanded functional repertoire of T lymphocytes in the inflamed appendix. Selective recruitment of memory T lymphocytes from the peripheral blood to the inflamed appendix was demonstrated.

Acute Disease↗
PubMed1995

Association between mucosal hyperplasia of the appendix and adenocarcinoma of the colon.

Mucosal hyperplasia of the appendix is a seemingly benign change of poorly understood significance, at times found in patients with colorectal malignancy. To determine the incidence of this change and its association with colonic adenocarcinoma, we have examined the appendiceal mucosa in 122 ileocolectomy specimens gathered between 1987 and 1990, and in 273 consecutive appendectomies carried out during 1990 at The Methodist Hospital in Houston, Texas. We found that 23 out of 122 ileocolectomies (18.8%) showed mucosal hyperplasia of the appendix and, of these, 17 (77%) were associated with colorectal malignancy, predominantly of the right side. Moreover, 24 of 273 appendectomies (8.8%) exhibited the presence of mucosal hyperplasia and, of these, six (25%) also were associated with adenocarcinoma of the colon. On the basis of this significant rate of association, we feel that a concomitant colorectal carcinoma should be ruled out in patients who exhibit mucosal hyperplasia of the appendix.

Adenocarcinoma↗
PubMed1999

Mucin-related epitopes distinguish M cells and enterocytes in rabbit appendix and Peyer's patches.

The biochemical composition of the apical membranes of epithelial M cells overlying the gut-associated lymphoid tissues (GALT) is still largely unknown. We have prepared monoclonal antibodies (MAbs) directed against carbonate-washed plasma membranes from epithelial cells detached with EDTA from rabbit appendix, a tissue particularly rich in GALT. As determined by immunofluorescence microscopy, several MAbs specifically recognized either M cells or enterocyte-like cells of the domes from rabbit appendix, sacculus rotundus, and Peyer's patches. M cells were identified by their large ventral pocket containing lymphoid cells and by specific labeling with antivimentin. Among various characterized MAbs, MAb 104 recognized rabbit immunoglobulins and was used as an apical marker for M cells in the rabbit appendix, MAb 58 selectively stained an integral membrane glycoprotein of greater than 205 kDa located at the apex of M cells, and MAb 214 stained a smaller soluble glycoprotein associated with the apical surfaces from neighboring enterocytes. In addition, both MAbs 58 and 214 also labeled luminal mucus and secretory granules in goblet cells. The selective association of mucin-related molecules at the surfaces of either M cells or enterocyte-like cells of the follicle-associated epithelium suggests that specific carbohydrate antigens are differentially expressed by epithelial cells and could account for the differential binding properties of pathogens.

Animals↗
PubMed2006

Variant Creutzfeldt-Jakob disease: prion protein genotype analysis of positive appendix tissue samples from a retrospective prevalence study.

OBJECTIVE: To perform prion protein gene (PRNP) codon 129 analysis in DNA extracted from appendix tissue samples that had tested positive for disease associated prion protein. DESIGN: Reanalysis of positive cases identified in a retrospective anonymised unlinked prevalence study of variant Creutzfeldt-Jakob disease (vCJD) in the United Kingdom. STUDY SAMPLES: Three positive appendix tissue samples out of 12,674 samples of appendix and tonsil tested for disease associated prion protein. The patients from whom these samples were obtained were aged 20-29 years at the time of surgery, which took place in 1996-9. SETTING: Pathology departments in two tertiary centres in England and Scotland. RESULTS: Adequate DNA was available for analysis in two of the three specimens, both of which were homozygous for valine at codon 129 in the PRNP. CONCLUSIONS: This is the first indication that the valine homozygous subgroup at codon 129 in the PRNP is susceptible to vCJD infection. All tested clinical cases of vCJD have so far occurred in the methionine homozygous subgroup, and a single case of probable iatrogenic vCJD infection has been identified in one patient who was a methionine/valine heterozygote at this genetic locus. People infected with vCJD with a valine homozygous codon 129 PRNP genotype may have a prolonged incubation period, during which horizontal spread of the infection could occur either from blood donations or from contaminated surgical instruments used on these individuals during the asymptomatic phase of the illness.

Adolescent↗
PubMed1974

Bacterial flora of the appendix fossa in appendicitis and postoperative wound infection.

Bacteria were isolated from 153 (47.5%) swabs of the appendix fossa in 322 patients undergoing appendicectomy. The commonest organism was Bacteroides species found in 78% of specimens. Other Gram-negative bacilli such as Klebsiella, or Enterobacter, and Esch. coli were present in 29 and 27% respectively. Gram-positive cocci were less frequently isolated.A positive culture was obtained more commonly in perforated appendicitis (79%) than where chronic fibrosis, lymphoid hyperplasia, or acute appendicitis was present or when the appendix was normal. Bacteroides was isolated twice as often in perforated appendicitis. The incidence of wound infection was 19% and varied according to the state of the appendix, being 63% in perforated appendicitis and 9.5% where lymphoid hyperplasia was present. Bacteroides was isolated from over 90% of the wound infections. In the patients with perforated appendicitis where effective chemotherapy was given the incidence of wound infection was 15% whereas in untreated or inappropriately treated patients it was over 50%. The isolation of bacteroides requires special precautions to be taken both in the collection of the specimen and laboratory culture. It is important that the chemotherapy of postappendicectomy infections include an antibiotic active against bacteroides.

Acute Disease↗
PubMed1976

The normal and abnormal development of the appendix. A radiographic assessment.

Radiographic examinations of the colon in the adult demonstrate a wide variety of contours of the interior cecal segment and appendix. These findings are a result of the normal developmental process of the appendix which can be arbitrarily separated into four stages. Examples of appendiceal development arrested at different stages, as well as variations of the normal adult appendix, are explained and illustrated. Forms of primitive development and lack of development (agenesis) are discussed.

Appendix↗
PubMedDate not supplied

Primary neoplasms of the appendix: radiologic spectrum of disease with pathologic correlation.

Although uncommon, primary appendiceal neoplasms often result in clinical symptoms that may lead to abdominal imaging. Acute appendicitis from luminal obstruction is the most common manifestation for most tumor types. Other manifestations include intussusception, a palpable mass, gastrointestinal bleeding, increasing abdominal girth (from pseudomyxoma peritonei), and secondary genitourinary complications. Asymptomatic appendiceal neoplasms may be discovered incidentally. Mucoceles from either benign or malignant mucinous neoplasms represent the majority of appendiceal tumors detected at imaging but are the least likely to manifest as appendicitis. Pseudomyxoma peritonei is a common manifestation of mucinous adenocarcinoma. Colonic-type (nonmucinous) adenocarcinoma of the appendix is much less common than mucinous tumors and typically manifests as a focal mass without mucocele formation. Carcinoid tumor is the most common appendiceal neoplasm but is less often detected radiologically because it is typically small and relatively asymptomatic. Goblet cell carcinoid tumor and non-Hodgkin lymphoma of the appendix are rare and usually infiltrate the entire appendix. Cross-sectional imaging, particularly computed tomography (CT), is effective in the evaluation of these neoplasms. CT appears to be the modality of choice whenever an appendiceal mass is suspected. CT will help rule out or confirm an appendiceal tumor and may suggest a more specific diagnosis.

Appendiceal Neoplasms↗
PubMedDate not supplied

Sensitization increases esterase-positive macrophage number in appendix from an animal model of food allergy.

BACKGROUND: Macrophages are mononuclear cells with phagocytic and antigen presenting properties. The role of macrophages in IgE-dependent allergic reactions and oral tolerance remains unclear. In previous works we demonstrated that ovalbumin (OVA)-sensitized rabbits present histopathological modifications of the mucosa in different regions of the digestive tract. The present study analyzes macrophage distribution and quantitative modifications in the cecal appendix of OVA-sensitized animals. METHODS: Adult new Zealand rabbits were divided into two groups: G1 (non-sensitized normal controls) and G2 (rabbits sensitized to OVA twice by subcutaneous route, with aluminum hydroxide as adjuvant). The alpha-naphthyl esterase technique was used for macrophage detection. RESULTS: Specific anti-OVA IgE was detected in sensitized animals by the PCA (passive cutaneous anaphylaxis) method. In 5 regions of the cecal appendix we observed a significant increase in the number of macrophages in sensitized animals (G2) versus the control group (G1). The observed sensitization-mediated increase in cells is probably related to enhanced recruitment of monocytes from peripheral blood towards the appendix. This process could be induced by chemical mediators, and demonstrates macrophage participation in local immune response during sensitization phenomena.

Animals↗
PubMed2001

Ten years' experience with the submucosally embedded in situ appendix in continent cutaneous diversion.

OBJECTIVE: To reevaluate the submucosally embedded in situ appendix as continence mechanism in a large single institutional series of ileocecal urinary reservoirs. MATERIAL AND METHODS: Between November 1990 and June 1999 an ileocecal reservoir with appendico-umbilical stoma was created in 118 patients (84 men, 34 women) aged 3.9-82.7 (mean 56.8) years as a primary urinary diversion or after failure of previous reconstruction. The most common indication for urinary diversion was bladder replacement after anterior exenteration for pelvic malignancies (n = 98), followed by functional or morphological bladder loss due to various benign conditions. The patients were followed prospectively according to a standard protocol. RESULTS: There were no perioperative deaths. In 3 patients necrosis of the appendix resulted in total incontinence with subsequent replacement by an intussuscepted ileal nipple. Impaired catheterization due to stomal stenosis was observed in 19 patients with recurrence in 6 and a total of 25 minor revisions. With a mean follow-up of 60 months all patients are continent day and night. CONCLUSION: Over 10 years, the submucosally embedded in situ appendix has survived as a continence mechanism in the original technique reliably providing continence in ileocecal reservoirs.

Adolescent↗
PubMed1977

Development of the rabbit appendix. I. Electron-microscopic observations.

The progressive lymphoepithelial development of the rabbit appendix was examined by light and electron microscopy. At 5 days postnatally, the appendix wall primitively resembles the mature organ but lacks both the discrete lymphoid organization and most cell types. The dome appears to be the first recipient of lymphoid cells. By 18 days the lymphoid nodule has become compartmentalized and lymphoid. The epithelium, although not fully developed, is in contact with the lymphocytes of the dome. The 5-week-old appendix has all the lymphoepithelial components of the adult but lacks the size of the mature organ. At all ages reported, plasma cells and dendritic cells are absent. Bacteria, thought to be essential to appendical lymphoid development, are not apparent at 5 or 18 days. The features common to central or peripheral lymphoid tissues are discussed.

Animals↗
PubMed2004

[Isolated Crohn's disease of the appendix as a source of enterorrhagia].

BACKGROUND: Crohn's disease confined to the appendix is relatively rare as a sole primary manifestation of the disease. Young people are more affected. The medical history and the physical examination are similar to the findings in acute appendicitis, but the manifestations are protracted. On physical examination there are signs of peritoneal irritation and an abdominal mass is palpable in the right iliac fossa. AIMS: To report a case of Crohn's disease confined to the appendix and presenting with enterorrhagia. The source of the bleeding was localized by colonoscopy. PATIENT: A 16-year old caucasian male without past history of gastrointestinal symptoms, presented with two episodes of enterorrhagia within a period of one year. In the second episode colonoscopy identified the appendicular ostium as the source of bleeding. RESULTS: At operation the cecum and terminal ileum were normal in thickness and texture, and an inflammatory appendix adherent to the omentum was removed. Microscopically there were non-caseating granulomas, intense infiltration of the wall with plasma cells, lymphocytes and macrophages. The patient has not suffered recurrence, and a colonoscopy realized 2 years after the operation did not show signs of Crohn's disease. CONCLUSION: This case, like others in the literature, appendectomy is curative, but a 5-year follow-up is mandatory. When a young patient presents with enterorrhagia, this diagnosis has to be considered.

Adolescent↗
PubMed2004

Intussusception of the appendix that reduced spontaneously during follow-up in a patient on hemodialysis therapy.

A 63-year-old man on long-term hemodialysis therapy was hospitalized due to right lower abdominal pain. CT scan demonstrated a multiple concentric structure in the ileocecal region. Colonoscopy showed a polyp-like tumor arising from the expected location of the appendix, with a dimple at the top. Barium enema study revealed a submucosal tumor-like filling defect in the cecum with non-filling of the appendix. A diagnosis of intussusception of the appendix (IA) was made. During the follow-up, IA reduced spontaneously. The present case report is the first description of IA in a patient on hemodialysis therapy. Furthermore, spontaneous reduction of IA is indeed rare.

Appendix↗
PubMed1980

Significance of retained barium in the appendix.

Barium is occasionally retained in the appendix after radiographic examinations of the gastrointestinal tract, and its significance has been debated for many years. This report details three cases in which barium was present in the appendix at the time of acute appendicitis. Review of these three cases and 13 cases previously reported suggests that retained appendiceal barium may be significant when it exists in either of two patterns. In patients with appropriate symptoms, a barium appendicolith has the same significance as a calcified appendicolith, strongly suggesting a diagnosis of appendicitis. Barium outlining a dilated appendical lumen also suggests appendicitis in the appropriate clinical setting. The significance of retained barium in the appendix in asymptomatic patients remains uncertain.

Appendicitis↗