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PubMed1992

Mucocele of the appendix: imaging findings.

Mucocele of the appendix, a cystic mass resulting from a dilated appendiceal lumen caused by abnormal accumulation of mucus, is a rare entity that often is not considered when problems of the right lower quadrant are assessed. Preoperative recognition of mucocele of the appendix is important because of the possibility of rupture at surgery with development of pseudomyxoma peritonei and to predict malignant transformation. The appearances of mucoceles of the appendix on sonography, CT, and barium studies are illustrated.

Appendix↗
PubMed2000

Accuracy of noncompressive sonography of children with appendicitis according to the potential positions of the appendix.

OBJECTIVE: This study evaluates noncompressive sonography of appendicitis in children according to the potential positions of the appendix. SUBJECTS AND METHODS: We evaluated 425 consecutive boys and girls clinically suspected of having appendicitis. Noncompressive sonography used a 5.0-MHz curved-array transducer to assess deep layers. We systematically investigated the possible positions of the appendix by evaluating the right retrocecal region through the flank, the pelvis through the suprapubic region with the urinary bladder full, and the right lower quadrant. Whenever the appendix was not visualized, graded compression examination was performed with 5.0-MHz curved-array and 7.5-MHz linear transducers, and the remainder of the abdomen was thoroughly examined with 5.0- and 3.75-MHz curved-array transducers. Sonographic findings were correlated with pathology findings after surgery in 212 cases and with clinical follow-up in 213. RESULTS: Of the 425 patients with abdominal pain, 199 had surgically confirmed appendicitis; noncompressive examination accurately identified 135 (31.7%) of these 425 cases, and the combined noncompressive and compressive examinations diagnosed 196 cases. The combined noncompressive and compressive techniques had a sensitivity of 98.5% (95% confidence interval, 96.8-100), specificity of 98.2% (96.5-99.9), positive and negative predictive values of 98.0% (99.9) and 98.7% (97.2-100), respectively. CONCLUSION: The noncompressive technique is a valuable tool in sonographic investigation of appendicitis.

Abdominal Pain↗
PubMed1979

Right ureteral occlusion due to isolated Crohn's disease of the appendix.

A case of Crohn's disease limited to the vermiform appendix is described. The patient was initially thought to have an appendiceal abscess. The condition was complicated with right ureteral occlusion. Urinary stasis completely ceased after removal of the appendix. Our patient is apparently the first reported case of obstructive uropathy due to isolated Crohn's disease of the appendix.

Adult↗
PubMed1983

Ultrasonographic findings in diseases of the appendix.

Ultrasonographic findings in patients with diseases of the appendix, including acute appendicitis, suspected appendiceal abscess, and palpable right-lower-quadrant abdominal mass, are described. An appendiceal abscess may manifest as a cystic mass, a mixed solid and cystic mass, or a hypoechoic solid mass. An appendiceal calculus within an abscess can be recognized as a hyperechoic structure with acoustic shadowing. On ultrasonography, acute appendicitis in female patients may mimic tubo-ovarian disease. Ultrasonographic features of isolated Crohn's disease of the appendix and mucocele of the appendix are also described.

Abscess↗
PubMed2006

Giant mucocele of the appendix: clinical and imaging findings in 3 cases.

OBJECTIVE: Clinical and imaging (sonographic and computed tomographic [CT]) findings in 3 cases of giant mucocele of the appendix are described. METHODS: Clinical records of 3 cases of giant mucocele of the appendix were reviewed. All patients had a basal B-mode sonographic examination and a contrast-enhanced sonographic examination using a second-generation low-mechanical index contrast medium. In all cases, a dual-phase spiral CT examination was carried out. RESULTS: In 2 cases, the abdominal masses were discovered in asymptomatic patients; 1 patient had vague abdominal discomfort. A pathologic diagnosis of benign cystoadenoma was found at pathologic examination in all cases, and malignant pseudomyxoma peritonei was disclosed in 1 patient 1 year later. Common sonographic findings were as follows: (1) a huge abdominal mass with a maximum diameter ranging between 20 and 25 cm; (2) a thin hyperechoic border without either solid vegetations or signs of infiltration of surrounding tissues; (3) a complex internal echo structure with anechoic lacunae interspersed between curvilinear, wavy bands of echogenic material (the so-called sonographic onion skin sign); and (4) avascularity of the masses shown on contrast-enhanced sonography with a low-mechanical index medium. At CT, a well-circumscribed cysticlike mass of low attenuation was displayed in all cases. There was lack of enhancement during a dual-phase examination in 2 cases; in the other, a small peripheral area of faint enhancement was appreciated. Only in the latter case could CT reliably assess the origin of the mass. CONCLUSIONS: It is suggested that a combination of sonographic (namely the onion skin sign) and CT findings may aid in the correct preoperative diagnosis of giant mucocele of the appendix.

Aged↗
PubMedDate not supplied

[Carcinoid of the appendix. A case report].

A case of a young male operated on for acute appendicitis due to a carcinoid of the base is reported. Since the tumor was infiltrating the resection margin of the appendix, the patient was later treated with a right hemicolectomy. Carcinoid tumor is unusual, but can be encountered several times during the career of a surgeon (1/200-300 appendicectomy). The tumor is more frequent in women (2-4:1), located at the tip of the appendix (62-78%) and has a diameter less than 1 cm in 70-95% of cases. It is more frequently diagnosed incidentally after an operation for acute appendicitis and occasionally during other procedures (colectomy, cholecystectomy, salpingectomy). Liver metastases are rare (< 2%), related to the dimension of the primitive tumor (21-100% when > 2 cm) and can cause a "carcinoid syndrome": flush, diarrhea bronchoconstriction, cardiac valve disease. Diagnosis is made by the pathologist and staging by conventional radiologic procedures (TAC, US), dosage of neuroendocrine mediators such as 24 hours urinary 5-HIAA. Nowadays 111In-octreotide scintigraphy (SRS) has an 86% sensitivity to detect the carcinoid and is useful for staging and for planning a surgical intervention. Simple appendectomy is adequate treatment for appendiceal carcinoids less than 1 cm in diameter. Adequate treatment for tumors greater than 2 cm is right hemicolectomy. A point of controversy is what to do for tumors in the 1 to 2 cm range. It seems that appendectomy alone is sufficient except in those cases when mesoappendiceal invasion is identified. When surgical margins after appendectomy are not free of tumor, additional surgery seems warranted. Carcinoid tumor of the appendix has a good prognosis with a 5-year-survival rate, of 85.9-100%. When liver metastases are encountered octreotide can relieve symptoms and sometimes the progression of the disease.

Abdomen↗
PubMed2001

[Endometriosis of the appendix vermiformis].

11 cases of the endometriosis of the appendix vermiformis were analyzed among women in age between 19-57 years. We observed that endometriosis of appendix were accompanied by advanced stages of the ovarian or peritoneum endometriosis in 9 cases. Diagnosis of endometriosis of the appendix is almost impossible before operation because it often could be covered by other genital organs diseases such like: uterine fibromas, ectopic pregnancy, PID. The clinical symptoms of appendicitis observed before an operation seldom find confirmation in results of additional laboratory tests.

Adult↗
PubMed2002

[Ureteroplasty using the appendix: apropos of a case].

OBJECTIVE: To report a case of ureteroplasty using the vermiform appendix. METHODS: Herein we describe a patient who underwent partial resection of the ureter due to a neoplasm. The ureteral defect was repaired using the vermiform appendix. The surgical technique and the results achieved are presented and the literature is briefly reviewed. RESULTS/CONCLUSIONS: The few cases reported in the literature and the case described herein show the utility of the vermiform appendix for ureteral substitution in specific cases where this procedure is indicated.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2002

Villous adenoma of the appendix. Diagnostic and therapeutic approach.

UNLABELLED: Appendix villous adenoma is a rare pathological entity that shows a particular form of clinical presentation that is different from villous adenomas in other places along the gastrointestinal tract. PATIENTS AND METHODS: We reviewed cases of appendix villous adenoma diagnosed in our hospital during the last five years; we studied age, distribution, sex, clinical presentation, diagnostic methods used, treatment and follow-up of patients. RESULTS: We diagnosed 6 cases of villous adenoma of the appendix, acute appendicitis being the most common form of clinical presentation. Treatment was appendectomy in two cases, right hemicolectomy in two patients, subtotal colectomy in one case, and Hartmann's technique with appendectomy in one more case. CONCLUSIONS: We consider appendectomy the treatment of choice when no malignant degeneration is present in the adenoma and invasion of surgical resection borders is absent.

Adenoma, Villous↗
PubMed1992

Arterial vascularization of the vermiform appendix in human fetus.

In 50 human fetuses of the crown-rump length ranging from 88 mm to 185 mm (12 to 20 weeks), the variability of the arterial vascularization of the vermiform appendix was investigated using the injection method. 3 vascularization types were distinguished on the basis of the size and number of the supplying arteries. The obtained results were compared with those reported by other authors who studied vermiform appendix vascularization in adults. In most cases the vermiform appendix is supplied by single ramus arising from ileocolic artery.

Appendix↗
PubMedDate not supplied

Agenesis of the appendix vermiformis.

Agenesis of the appendix vermiformis represents a rare condition that accounts in approximately 1 in 100.000 laparotomies performed for suspected acute appendicitis. L.B., female, born at term after a normal pregnancy. Shortly after birth she presented respiratory distress; chest x-ray showed a left diaphragmatic hernia (CDH). At operation was noted the absence of the appendix and of the mesenteriolum as well together with the presence of a mesenterium commune. Other associated anomalies were detected: dextroposition of the heart, hypoplasia cnemis, hexadactylism of right foot, congenital hip displacement and bilateral congenital cataract. Etiopathogenesis of the agenesis of the appendix can be easily understood from an embryological point of view, following the cecal pole development. Diagnosis of this malformation is possible only after an accurate laparotomic or laparoscopic exploration around the ileocecal and retrocecal zone.

Appendix↗
PubMed2004

Endometriosis of the appendix presenting as acute appendicitis.

While endometriosis is fairly common, endometriosis of the appendix is a very rare occurrence. Correct pre-operative diagnosis is uncommon and definitive diagnosis is established by histology of the appendix. We present a case of endometriosis of the appendix that manifested as acute appendicitis in a 40-year-old woman.

Adult↗
PubMed2004

[Carcinoid tumors of the appendix. A report of 46 cases].

Carcinoïd tumors of the appendix are rare. The appendix constitutes the most frequent localization of these tumors. We studied of a retrospective way all cases that had an appendectomy in the service of general surgery of Sfax on a period of 7 years going from 1995 to 2001. During this period, 9584 patients had an appendectomy in our service. Among which, 46 cases (0.48%) of carcinoid tumor of the appendix have been diagnosed. In more than 95% of cases, patients were admitted due to acute appendicitis; but none of them had the signs of the carcinoid syndrome. The treatment was a simple appendectomy in 44 cases (95%). The right hemicolectomy was necessary in two cases, because of an invasion of the appendicular base in a case and a tumor greater than 2 cm in the other case. There is no reported case of lymph node or systemic metastasis. The authors discuss data in the literature and analyse the features of the clinical picture, diagnosis, and try to define a convenient attitude of treatment of these tumors.

Adolescent↗
PubMed1991

Motor response to electric spatial stimulation of isolated intact and inflamed human appendix.

The smooth muscle responses to electric stimulation of intact, slightly or severely inflamed, isolated human appendix strips were studied. No changes were noted in the motility of the not inflamed and slightly inflamed appendices, (simple appendicitis), the preparations responded to nervous stimulation with contractions of the same size. The smooth muscle contractions were blocked by atropine, and enhanced by physostigmine, which proves the cholinergic nature of the innervation. The severe inflammation (acute phlegmonous appendicitis) reduced also the contraction and relaxation of the appendix strips. With the advancement of the inflammatory process, the decreased motility of the appendix can play an in vivo role in the rapid progress of the process.

Appendicitis↗
PubMedDate not supplied

Laparoscopic appendectomy for mucocele of the appendix: Report of 8 cases.

Mucocele of the appendix is an aseptic dilatation secondary to obstruction. Surgical excision is the treatment of choice in benign mucocele. The incidence of mucocele of the appendix in our center is 0.15%, of a total of 6000 appendectomies over 8 years. We operated on 9 cases; laparoscopic appendectomy was done in 8 of them. One patient had pseudomyxoma peritonei, so open surgery was done. Other organs were also examined as there is a possibility of concurrent tumors. As there is risk of malignancy of the appendix leading to port-site metastasis we used a non-permeable bag to remove the resected specimen.

Appendectomy↗
PubMed1991

[Goblet cell carcinoid of the vermiform appendix].

The goblet-cell-carcinoid of the appendix vermiformis lies somewhat between the carcinoid and the adenocarcinoma of the appendix concerning the biological behaviour and the histological characteristics. Referring an own well documented case (76 are well known in the available literature) the importance of the very conscientiously managed histological examination of each appendix specimen is emphasized with regard to the 5-year-survival of 73%.

Appendectomy↗
PubMed1990

[A carcinoma of the cecum arising from the orifice of the appendix: a case report].

Reported is the case of a 50-year-old man who was admitted to hospital because of an abdominal pain. A barium enema revealed the shade of a distended, unfilled appendix that had reversed itself on the cecum and the ascending colon, the latter showing compression from the exterior. Further, a colonoscopic examination uncovered a flat, nodular tumor of the cecum that had elevated at the orifice of the vermiform appendix, and 67Ga scintigraphy indicated the uptake at the lower right abdomen. A resected specimen of the tumor showed proliferation in the cecal mucosa at the orifice of the appendix, causing an appendiceal abscess, and the histopathological findings revealed an adenocarcinoma of the cecal mucosa but no malignant transformation of the appendiceal mucosa.

Adenocarcinoma↗
PubMed1990

Crohn's disease of the appendix.

Crohn's disease limited to the appendix is uncommon. The disease may mimic acute appendicitis with fever, leukocytosis, right lower quadrant pain, and occasionally a palpable mass. When Crohn's disease affects the appendix, it typically has a longer clinical period in which the patient has symptoms than do most cases of acute appendicitis. The most common preoperative diagnoses are acute appendicitis and appendiceal abscess. A review of the literature is presented along with our experience in three additional cases of Crohn's disease limited to the appendix. We suggest that Crohn's disease be included in the preoperative differential diagnosis and that extensive intraoperative examination of the gastrointestinal tract be made in any case of suspected appendicitis that has had a protracted preoperative course.

Adolescent↗