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PubMed1994

Retention mucocele of appendix due to endometriosis.

Retention mucocele of the appendix is caused by a variety of obstructive lesions such as postinflammation, fecalith, carcinoid tumor, and endometriosis. Appendiceal mucocele due to endometriosis is extremely rare; only one documented case of such condition has been recorded in the literature. We describe a young black woman who had abdominal pain, nausea, and vomiting. Abdominal exploration revealed a small retention mucocele caused by endometriotic obstruction at the distal segment of the appendix. No evidence of endometriosis in other organs was found. The patient was asymptomatic after appendectomy.

Adult↗
PubMed2004

Arteritis in the appendix: an unusual cause of right iliac fossa pain.

Many conditions can cause or mimic appendicitis, of which necrotising arteritis remains an unusual cause. Its significance stems from its association with the vasculitides in general. We describe here a 15-year-old-girl with an incidental finding of a focal arteritis in the vasculature of the appendix and with right iliac fossa pain. There was no evidence of suppurative inflammation of the appendix, and she made a good recovery following laparoscopic appendicectomy.

Abdominal Pain↗
PubMed2005

Bacterial-induced inflammation in germ-free rabbit appendix.

The intestinal ecosystem is defined by a series of interactions between the microbiota, the mucosal epithelium, and the gut-associated lymphoid tissue (GALT). Perturbations in the fine balance of the interactions between these components can result in gastrointestinal diseases such as inflammatory bowel disease (IBD). The pathophysiology of IBD is thought to develop as a result of dysregulated mucosal immune responses to normal luminal microflora. Several animal models for IBD have been developed and underscore the role of the immune system in development of disease. Most of the existing animal models studying IBD are based on the use of chemically induced IBD or of genetically modified and germ-free animals. It is, however, important to study inflammatory responses that can develop from interactions between bacteria, the mucosal epithelium, and GALT in animals that are not genetically modified or immunocompromised. In this report, we document the use of a germ-free ligated rabbit appendix model to induce inflammatory changes in response to specific bacteria. With the introduction of a Bacteroides vulgatus isolate from humans into the germ-free ligated appendix, we found chronic inflammatory changes, including glandular distortion, gland drop-out, decreased goblet cells, and crypt abscess formation. However, with the introduction of other experimental luminal contents, we observed no inflammation. These results show that specific microbial composition can induce inflammation. We suggest that this model may be useful to study the mechanism by which specific bacteria establish inflammatory responses in the gut.

Animals↗
PubMed2005

Use of the appendix as ureteral substitute in a patient with a single kidney affected by relapsing upper urinary tract carcinoma.

The treatment of upper urinary tract transitional cell carcinoma (UT-TCC) in single-kidney patients requires the radical removal of cancer, but also, when feasible, the preservation of the continuity of the urinary tract by various surgical techniques. In case of wide resections during ureteral surgery, a ureteral replacement could be advocated. In the literature, the cecal appendix has rarely been used as a ureteral substitute, moreover in benign pathological conditions, showing encouraging early results. The positive functional and oncological outcomes obtained after a lengthy follow-up in a single-kidney patient with UT-TCC treated by ureteral resection and appendix interposition confirm the viability of this surgical option.

Aged↗
PubMed1995

Dual carcinoid/epithelial neoplasia of the appendix.

We report a series of 13 lesions of the human vermiform appendix in which a carcinoid component was associated with a separate non-carcinoid epithelial component that included an adenoma-like lesion of the mucosal epithelium. We use the term dual carcinoid/epithelial neoplasia to describe this phenomenon. The carcinoid component was insular/trabecular in nine cases, tubular in one case and of goblet cell type in three. The epithelial component was a mucinous cystadenoma in four, a mucinous tumour of uncertain malignant potential in three, and a mucinous cystadenocarcinoma in six. No intermediate cell population was seen and in three cases the carcinoid and epithelial components were in different parts of the appendix, leading us to suggest that these lesions may be true 'collision' tumours in which two neoplasms have arisen in the same organ. The prognosis appears to be no worse than for either of the components alone, but conclusions regarding these lesions must be guarded on account of their rarity and the small numbers available for study.

Adenocarcinoma↗
PubMed1995

Intussusception of the appendix: a report of three cases with different clinical and pathologic features.

Three cases of intussusception of the appendix (IA) with distinctive pathologic changes were reported. All patients were women with different clinical presentations. Grossly, a complete intussusception was found in one case (case 1), while the others (cases 2 and 3) showed a partial intussusception. In case 1, almost the total segment of the appendix bearing the villous adenoma with focal malignant transformation became completely telescoped into the cecum. In case 2, no underlying appendiceal lesion was disclosed. In case 3, appendiceal endometriosis was found as the point of traction. Awareness of such a rare complication associated with various appendiceal lesions provides a clue for making an accurate diagnosis and selecting appropriate surgical management.

Abdominal Pain↗
PubMed1998

Preliminary report of a modified continent appendix stoma in a sigmoid urinary reservoir pouch.

BACKGROUND: The application of an appendix stoma in a Mainz urinary reservoir pouch is an established procedure and assures good continence. We modified this method for use with a sigmoid pouch. METHODS: In each of 3 men with bladder carcinoma, an appendix with a blood supply was prepared and anastomosed to the detubularized sigmoid pouch with a 3-cm submucosal tunnel. RESULTS: In all 3 patients, this procedure was performed successfully, and the pouch was completely continent. Self-catheterization could be performed without difficulty by 2 patients, and with slight resistance in the remaining patient. The patients are satisfied with their quality of life. CONCLUSIONS: We conclude, based on our findings and these preliminary observations, that this procedure is a potentially good alternative for the placement of continent stoma in continent urinary reservoir surgery.

Aged↗
PubMed1982

Adenocarcinoma of the vermiform appendix.

Primary carcinoma of the appendix, though rare, occurs often enough to warrant its inclusion in diagnostic possibilities when the symptoms of acute appendicitis, without leukocytosis, are present in geriatric patients. A case of mucinous adenocarcinoma of the appendix in an 88-year-old white woman is presented. The substantial relief following right hemicolectomy has persisted for several months of follow-up.

Adenocarcinoma↗
PubMed1970

The neurological junction between the appendix and ascending colon.

The junction between gut wall having the intramural plexus distribution characteristic of large bowel and that of appendix does not occur at the anatomical junction of the caecum and the appendix but at a level proximal to this and just distal to the ileocaecal valve.

Appendix↗
PubMed1985

Gut associated lymphoid tissue: a morphological and immunocytochemical study of the human appendix.

Gut associated lymphoid tissue in 15 normal appendices has been characterised in tissue sections using both morphological criteria and immunocytochemical techniques. A panel of monoclonal and polyclonal antibodies was used including antibodies to B-cells, T-cells, macrophages, HLA DR and immunoglobulins. The lymphoid tissue in the appendix was shown to bear a strong resemblance to that in lymph nodes with the exception of the region where the appendix follicles associate with the dome epithelium, which has no lymph node equivalent. This zone of cells between the lymphoid follicles and the dome epithelium termed the 'mixed cell zone' has been shown to contain an abundance of HLA DR-bearing cells, some of which have irregular nuclear morphology and resemble follicle centre cells. These cells were seen to extend into the epithelium of the dome but not the crypts. Using a monoclonal anti-B-cell antibody a population of B-cells was detected in the equivalent areas of mixed cell zone and epithelium and quantitative studies showed that these intraepithelial B-cells comprised approximately 4-5% of the cells in the epithelium. The mixed cell zone was also seen to contain T-cells, S-100 protein-containing macrophages and occasional lysozyme-containing macrophages. Plasma cells were rarely seen in this area.

Antibodies, Monoclonal↗
PubMed1977

Streptococcus milleri in the appendix.

The appendix was investigated as a possible habitat of Streptococcus milleri. Both normal and inflamed appendices were examined and the isolation rates compared. S. milleri was present in a quarter of the normal appendices and more than half of those associated with apendicitis--a difference that was statistically highly significant. The isolation rates throughout were indepencent of age. There was a pronounced connection between the presence of S. milleri in the appendix and the purulent manifestations of appendicitis. S. milleri was isolated from other abdominal sites associated with appendicitis. The frequency of isolation was increased by culture in an enrichment broth containing nalidixic acid and sulphadimidine.

Appendicitis↗
PubMed1976

Diverticula of the vermiform appendix: a report of nine cases.

The incidence, clinical features and pathology of nine cases of diverticula of the appendix in Malaysians are reported. The findings are discussed and compared with those previously reported. The pathogenesis of the lesion in eight cases is unknown. The rare association of lumenal obstruction by a carcinoid tumour and diverticulum formation in the appendix is seen in one case.

Adult↗
PubMed1987

Tuberculosis of the appendix--a report of 17 cases and a suggested aetiopathological classification.

Tuberculosis of the appendix is rare. It is usually secondary to tuberculosis elsewhere in the abdomen. Tuberculosis of the appendix is not associated with any specific clinical features and diagnosis is revealed only after histopathological examination. Appendicectomy should be performed in all patients with abdominal tuberculosis subjected to laparotomy and all surgically removed appendices should be subjected to histopathological examination.

Appendectomy↗
PubMed1992

Femoral hernia appendix causing small intestinal obstruction.

An 88 year old woman presented with a painful, irreducible right femoral hernia and small intestinal obstruction. At laparotomy, some distal small intestine was found to have twisted around an uninflamed appendix which was acting as a 'band', with its tip fixed in the femoral hernia sac. Although the association between the appendix and femoral hernia is well recognized, the production of small intestinal obstruction by this particular mechanism has not been previously reported.

Aged↗
PubMed2002

Normal appendix: is there any significant difference in the maximal mural thickness at US between pediatric and adult populations?

PURPOSE: To evaluate the normal maximal mural thickness (MMT) of the appendix in asymptomatic subjects and determine whether any significant difference in MMT exists between pediatric and adult populations. MATERIALS AND METHODS: The MMT of 187 appendices in asymptomatic subjects was measured at sustained-compression ultrasonography (US). The measured MMTs were categorized into three groups according to patient age (39 young children [including infants] aged 1-6 years, 79 older children and adolescents aged 7-15 years, 69 adolescents and adults aged 16-82 years), and the relationships between categoric variables were analyzed by using analysis of variance and the parametric Scheffé test. RESULTS: The mean MMTs in the young children, older children and adolescent, and adolescent and adult groups were 1.9 mm +/- 0.4 (SD), 2.0 mm +/- 0.5, and 2.1 mm +/- 0.5, respectively. The corresponding ranges of normal MMT were 1.1-2.8, 1.0-2.8, and 1.2-3.0 mm, respectively. No significant difference in normal appendix MMT was observed between the young children group and the older children and adolescent group (P =.2) or between the older children and adolescent group and the adolescent and adult group (P =.639). The difference in MMT between the young children group and the adolescent and adult group was marginally significant (P =.042). CONCLUSION: Although adoption of age-related MMT criteria does not seem warranted because it would necessitate measurement precision below 0.5 mm, which is not possible to achieve consistently in daily practice, data indicate that in children aged 6 years or younger, an appendiceal mural thickness of less than 3 mm should be regarded as normal.

Adolescent↗
PubMed2003

A case of leukemia of the appendix presenting as acute appendicitis.

A 71-year-old man was admitted to our hospital because of right lower abdominal pain. He was suspected of having acute appendicitis and soon after admission, appendectomy was performed. Macroscopically, the appendix was greatly swollen and reddened, but had no abscess. Microscopically, polymorphonuclear leukocytes were not found, but diffuse infiltration of atypical cells was observed. Examination of a bone marrow aspirate revealed 74% blasts that were peroxidase stain positive. We diagnosed acute myelogenous leukemia (FAB classification, M2). He received induction chemotherapy, but died 49 days after admission. Leukemic cell infiltration of the appendix is rare and acute appendicitis as the initial manifestation of leukemia is even rarer.

Aged↗
PubMed2005

Mucocele of the vermiform appendix with sonographic appearance of an adnexal mass.

Mucocele of the vermiform appendix is caused by mucus retention in its lumen, due to obstruction or hyperproduction. Appendiceal malignancy can be the underlying cause, making accurate preoperative diagnosis imperative. In women, it can sometimes present as an adnexal mass. A rare case of an appendiceal mucocele is presented, mimicking a cystic tumor of the right adnexum, both clinically and ultrasonographically. In addition, serum levels of CA-125 were increased. This is the first case of a mucocele of the appendix simulating an adnexal mass on ultrasound with increased levels of CA-125 to be reported. This clinical entity should be considered in patients presenting on ultrasound with a right-sided adnexal mass as a rare potential diagnosis.

Adnexal Diseases↗