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The authors review two patients' case histories. The perforation of the coecum in consequence of acute colonic pseudo-obstruction has been noticed first in Hungary. They summarize the characteristics and therapy of this syndrome.
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Two cases of perforations in diverticulitis of the caecum are presented. The disease was manifested with the following complications: inflammation and perforation. Diverticula of the caecum are asymptomatic, accidentally found during surgery undertaken for other reasons. Out two patients were admitted to the hospital as emergency-patients, with the suspicion of acute appendicitis. Symptoms were unusual. Both patients were operated on. Histopathologic findings confirmed the diagnosis of acute perforated diverticulitis of the caecum in both cases.
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Under study were the results of treatment in 10 056 patients with acute appendicitis, including 418 patients having its complicated forms. It is concluded that the extent of surgical intervention in complicated forms should be determined by the character of the complication, manifested in pathological changes of the peritoneal coat and patient's status. Appendectomy may be performed in most patients with appendicular infiltration. It is the authors' opinion that indications to peritoneal dialysis in peritonitis of appendicular origin should be largely restricted. The tactics employed by the authors enabled them to reduce the mortality in complicated forms of appendicitis up to 4.4%.
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Patients with right lower quadrant (RLQ) pain referred for imaging studies with a clinical diagnosis of appendicitis may have other pathologic conditions mimicking appendicitis. Appropriate diagnostic imaging may establish other specific diagnoses and thereby play a significant role in determining proper medical or surgical treatment. In this pictorial essay, we present a spectrum of imaging findings in patients whose clinical features were suggestive of appendicitis, but the diagnoses of a broad spectrum of other diseases were established with the imaging studies. The differential diagnoses of diseases mimicking appendicitis are reviewed.
A 38-year-old woman with stage T4N0M0 adenocarcinoma of the cecum presented with what seemed to be an appendiceal abscess. She had a 10-month history of intermittent abdominal pain in the right lower quadrant. Initial laparotomy revealed an abscess in that quadrant. The abscess was drained. A mass in the cecum, associated with dense fibrous tissue and abscess formation, was found on subsequent surgical exploration. Pathological examination revealed a well-differentiated mucinous adenocarcinoma of the cecum with transmural invasion. The lesion had replaced most of the vermiform appendix and was associated with a periappendiceal abscess. Colonic carcinoma masquerading as acute appendicitis or an appendiceal abscess is a well-recognized entity in the elderly but may be overlooked in younger patients because malignant disease is not suspected.
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The CT scans in 25 patients without ileocecal pathology and 52 patients with ileocecal abnormalities were retrospectively reviewed. The ileocecal region was identified in 18/25 (72%) of patients without pathology. Thirty of 52 patients with ileocecal pathology had inflammatory disease: Crohn's (13), appendicitis (9), abscess (6), and typhlitis (2). CT was complementary to barium studies, demonstrating wall thickening, pericolonic inflammatory change, masses, fascial thickening, and fistulae. Twenty patients had malignancy: primary carcinoma (9), metastases (7), and lymphoma (4). In all patients with carcinoma a mass was identified. Pericolonic stranding represented tumor extension in 5/6 patients. Metastases were identified as extrinsic ileocecal masses in all 7 patients. Liver, mesenteric and omental metastases were present in 8/20 patients. In patients with lymphoma there was wall thickening and two had additional pericecal lymphadenopathy. In 2 patients with hypoalbuminemia, findings included: wall thickening, mesenteric, and subcutaneous edema.
OBJECTIVE: To review the breed, age, gender, clinical and laboratory findings, treatment and outcome of horses with caecal disease presented to a referral centre. DESIGN: Retrospective study of 96 cases. PROCEDURE: The breed, age, and gender of the study population were compared with the corresponding hospital population for the same period. The means (+/- SD) for clinical and laboratory findings were recorded for each caecal disorder. Treatment was categorised as medical or surgical, and outcome was recorded. RESULTS: Caecal diseases included impaction (40% of total cases), rupture associated with concurrent unrelated disease (13%), rupture with parturition (9%), rupture with no associated disease (5%), infarction (11%), torsion (9%), abscess or adhesion (7%), tumour (3%), and miscellaneous conditions (3%). The breed or gender of affected horses did not differ from the hospital population, although horses > 15 years were more frequently represented (P < 0.05). This age group was specifically more predisposed to caecal impaction (P < 0.05), as were Arabian, Morgan, and Appaloosa breeds (P < 0.05). In horses with caecal impaction transrectal examination was the most useful diagnostic procedure; 90% of affected horses treated medically were discharged while horses treated by typhlotomy alone, or typhlotomy and blind end ileocolostomy, had survival rates to discharge of 71% and 86%, respectively. Horses with caecal rupture associated with concurrent un-related disease showed no signs of impending rupture; all were receiving phenylbutazone, all were euthanased, and 50% had caecal ulceration at necropsy. Of horses with caecal rupture with parturition 56% had prior dystocia; in two-thirds the site of rupture was the ileocaecal junction and all were euthanased. Horses with caecal rupture with no associated disease died or were euthanased; rupture was idiopathic. Horses with caecal infarction usually had signs of abdominal pain and abdominal fluid changes consistent with peritonitis; transrectal examination was nonspecific, and typhlectomy was successful in seven of eight horses. Horses with caecal torsion had signs of severe, acute abdominal pain and typhlectomy was successful in three of five horses. Diagnosis of caecal adhesion or abscess was assisted by transrectal palpation in two of seven horses and surgical treatment was successful in two of five horses. A caecal tumour was diagnosed in three horses aged 20 years or older that presented with chronic weight loss. Other caecal diseases were uncommon. CONCLUSION: Caecal disease is uncommon in equids but some specific features of the history and physical findings can alert the veterinarian to the possibility of caecal involvement in horses with gastrointestinal dysfunction. Medical or surgical therapy can be effective in horses where caecal rupture has not occurred.