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A patient with a perforated appendix in a right inguinal hernial sac is reported. Some of the history of this condition is reviewed and a case is made that an appendix appearing in an inguinal hernial sac should carry the eponymous term "Amyand's hernia".
The submucosally embedded in situ appendix guarantees an ideal continence mechanism in patients with ileocecal urinary reservoirs. To date this modification of the Mainz pouch technique was performed successfully in 10 patients between September 1990 and October 1992. Pouch capacity ranged from 350 ml to 900 ml (mean: 565 ml), frequency of intermittent self-catheterization ranged from 3 to 7 times per day (mean: 4.4-5.4 times) and complete urinary continence without difficulty of self-catheterization was obtained in eight patients. Two patients with stomal stenosis needed to indwell a catheter. The follow up periods ranged from 3 to 24 months (mean: 14.7 months). The main advantages of appendix stoma technique are shorter operation time, a short ileal segment, no risk of nipple gliding or prolapse, no need for staples, thereby decreasing significantly the risk of stone formation, and facilitating easy catheterization. This method seemed to be valuable for continent urinary reservoir assuring patients of high quality of life.
The successful treatment of a patient with an invaginated appendix compounded by a bulbous, villoadenomatous polyp at the tip of the appendix, which became the leading part of a colic intussusception, is reported.
A new technique for appendicectomy is described. Following detailed laparoscopic inspection of the abdomen, the appendix is pulled out with a laparoscopic forceps through a small incision in the right lower abdomen; it is then skeletized. Following ligation with catgut and nylon, the appendix is severed using the thermocautery. The stump is subjected to careful after-coagulation or treated with iodine, and repositioned. Only the skin is sutured.
The presentation and management of a patient with liver metastasis from a 0.6 cm carcinoid tumor of the appendix is presented. This is the first documented case of distant metastasis from a carcinoid of the appendix less than 1 cm in size. Histopathologic, immunohistochemical, and electron microscopic studies support the appendiceal carcinoid as being the primary neoplasm. Invasion of the mesoappendix was the only finding to suggest potentially aggressive behavior. We reviewed the literature and found 414 previously reported cases that provided complete information regarding tumor size, mesoappendiceal invasion, and presence of metastasis. For the entire group the frequency of metastasis was related to tumor size greater than 2 cm (p less than 0.0001) and invasion of the mesoappendix (p less than 0.0001). After dividing the group based on size, mesoappendiceal invasion was related to metastasis in those tumors less than 2 cm in size (p less than 0.0001) but not in tumors larger than 2 cm (p = 0.1538).
The authors published experience with the treatment of four patients with primary adenocarcinoma of the appendix and an analysis of 20 patients with primary adenocarcinoma of the appendix treated in the North Moravia region during a ten-year period (1980-1989). The incidence of the disease is rare. Usually it is manifested by symptoms imitating acute appendicitis. In exceptional instances there are other symptoms such as melaena, invagination, infiltration of neighbouring organs etc. Only rarely the disease is diagnosed during appendectomy. Most frequently an adenocarcinoma of the colonic type is involved with a tendency of rapid local spread. In that case right-sided hemicolectomy is the method of choice. In exceptional instances simple appendectomy is sufficient (mucinous type of adenocarcinoma, Dukes A). In advanced stages of the disease a palliative surgical operation may frequently suffice. Radiotherapy and chemotherapy should be always considered with regard to the stage of the disease and the general state of the patient. The prognosis is similar as in adenocarcinoma of the colon.
The authors present two cases of pseudo tumoral type Mucus Secreting Tumours (MST) of the appendix. In this type (32% of the cases), the clinical presentation, barium enema, ultrasonography and most importantly CT scan generally confirm the preoperative diagnosis. We found three advantages this preoperative diagnosis. 1) Primarily it allow selection of a large surgical approach that permits full exploration of the abdominal cavity especially the ovaries (2-18% associated lesions); 2) also it allows a histopathological examination (frozen section) of the appendix to be performed during the operation; 3) and finally the surgical treatment will depend on the operative findings and the result of the histopathological examination: in the benign forms simple appendicectomy will be sufficient but the malignant forms (12% of the cases) should be treated by right hemicolectomy.
The authors report six cases of mucus-secreting tumor of the vermicular appendix, in four women and two men (mean age 59 years). All were benign. Pain in the right lower quadrant was the initial sign in 4 cases, while the mucus-secreting tumor was an incidental finding in the other two cases. A mass was palpated in the right lower quadrant in one case. A barium enema was performed in four cases and showed an extrinsic compression of the caecal base in one case, and of the right colon in another case. Four appendectomies, one associated with removal of the adjacent caecal tissues and two right colectomies were performed. Analysis of these six cases and a review of the literature allow us to recall the histologic classification of these tumors, which determines the prognosis and to emphasize the sonographic and CT scan findings which might lead to earlier preoperative diagnosis in the future. Management depends upon the circumstances under which the tumor is discovered, the local anatomy, and the type of tumor. Appendectomy is the treatment most often performed. Faced with a tumor of the appendix, without histologic proof or when the local anatomic conditions increase the risk of opening an abscess, right colectomy is recommended.
We report one new case inflammatory pseudotumor of the appendix. The inflammatory pseudotumor of the appendix is one of these benign tumors of the ileocecal junction that mimic neoplasia and can be treated by appendicectomy.
The authors present two cases of pseudo tumoral type Mucus Secreting Tumours (MST) of the appendix. In this type (32% of the cases), the clinical presentation, barium enema, ultrasonography and most importantly CT scan generally confirm the preoperative diagnosis. We found three advantages this preoperative diagnosis. 1) Primarily it allows selection of a large surgical approach that permits full exploration of the abdominal cavity especially the ovaries (2-18% associated lesions); 2) also it allows a histopathological examination (frozen section) of the appendix to be performed during the operation; 3) and finally the surgical treatment will depend on the operative findings and the result of the histopathological examination: in the benign forms simple appendicectomy will be sufficient but the malignant forms (12% of the cases) should be treated by right hemicolectomy.
After experiencing intermittent episodes of abdominal pain for two years, a 28-year-old woman developed partial small bowel obstruction. Barium enema and colonoscopy revealed the source of obstruction to be an apparent cecal carcinoma. At exploratory laparotomy a primary adenocarcinoma of the appendix with bilateral Krukenberg ovarian metastases was found. This is a rare occurrence and, to our knowledge, the first well-documented case in the English literature. These case also demonstrates difficulties in the preoperative diagnosis of adenocarcinoma of the appendix.
Five cases of goblet cell carcinoid tumor of the appendix showed characteristic histologic features that justified classification of these lesions as mucinous variants of carcinoid tumor. The tumor has low-grade malignancy, and metastases are uncommon. Resemblance to mucinous adenocarcinoma of the appendix is striking, and the features that help to differentiate the two lesions are delineated.
A clinicopathologic and immunohistochemical study of six cases of deciduosis of the appendix is presented. The patients were pregnant women aged 18-40 years. In four cases, the patients presented with signs and symptoms of acute appendicitis during their 26th to 31st week of pregnancy; in the other two, the lesions were discovered incidentally in appendectomy specimens obtained during cesarean section and tubal ligation at term. Histologically, the lesions were characterized by the presence of multiple, irregularly distributed submesothelial deposits of decidualized cells in the serosa of the appendix, without any associated evidence of endometriosis. By immunohistochemistry, the decidualized cells strongly labelled with vimentin antibodies, consistent with their stromal origin. In two cases, coexpression of vimentin and desmin intermediate filaments was observed, suggestive of myoid differentiation. The possible relationship of the lesions with the development of symptoms of peritoneal irritation in these patients is discussed along with a review of the literature on the abdominal complications of ectopic decidua.
A malignant lymphoma (ML) of the gastrointestinal tract occurs most frequently in the stomach, and ML of the appendix is very rare, with only 16 cases reported in the Japanese literature. Reported is a case of a primary ML the appendix in a 48 year old male, in whom an ileocecal resection was carried out. This case was pathohistologically diagnosed as a diffuse large lymphoma of the B cell type, according to the LSG classification. Therapeutic problems were encountered because of the difficulty in making an early diagnosis.
Sixteen instances of adenocarcinoma of the appendix treated at Roswell Park Memorial Institute between 1964 and 1986 were reviewed. Thirteen of 15 were mucinous and ten were well differentiated. Synchronous metastases were present in 11 patients, with carcinomatosis being the most common pattern of metastases (nine patients). Seven of eight women had ovarian metastases. Nine of the 11 patients with metastatic disease presented with complaints referrable to the metastatic site. The five year survival rate was 50 per cent in the eight patients who underwent right hemicolectomy and 25 per cent in the four patients who underwent appendectomy. The data from this review support right hemicolectomy as the treatment of choice for adenocarcinoma of the appendix. The prolonged survival time of patients with metastatic disease and the symptomatic nature of that disease support the application of palliative oophorectomy in patients with ovarian metastases.
A primary adenocarcinoma of the appendix is a rare lesion, and this paper reports a case of a primary adenocarcinoma of the appendix, but with the inclusion of 5 fistulae. According to the classification by Uihlein & McDonald, this histology is of the colonic type. The first known case accompanied with a fistula was reported by Haldane (1862) in the English-language literature and by Shiraishi et al. (1954) in Japan. Since then, 21 cases have been found in the Japanese literature. The patient underwent an operation and his prognosis has been considered good. A review of some the relevant literature is discussed with regard to the pathology, diagnosis, and treatment.
Two cases of adenocarcinoma of the vermiform appendix are described. The literature on these rare cancers which are almost always diagnosed at routine histology and whose prognosis is related to Duke grading and staging, is reviewed. The stable cure observed in one patient after 13 years after straightforward caecal resection for cancer of the appendix extending beyond the base of the implant (which today would be handled with hemicolectomy) and then treated for multiple polyps, two of them in a stage of malignant degeneration, suggests a difference of biological behaviour compared to tumours of the other colon districts. In the second case, stress is laid on the unusual extension of the tumour-related inflammation to the skin of the gluteal region.
Thirty-two patients with primary adenocarcinoma of the appendix were studied in this collective review. Diagnosis was never suspected preoperatively. Immediate operation was performed in 21 patients with a diagnosis of acute appendicitis. At operation, tumor of the appendix was only identified in 50 percent of the 32 patients. One patient with an obstructing tumor and peritoneal involvement died postoperatively. Estimated survival rate was 46% at five years. Probability of survival was unrelated to the histologic tumor type but significantly correlated with the extent of tumor spread. Right hemicolectomy led to a significant increase in survival compared with appendectomy alone and to a significant decrease in risk of recurrence. In Dukes' B2 and C patients, differences in the survival curves were in favor of right hemicolectomy. In patients with pseudomyxoma peritonei, long-term survival was obtained by repeated laparotomy with resection of mucinous material. Our results indicate that, in good risk patients, right hemicolectomy performed as first or second operation, provides better results than appendectomy alone.