[Malignant disease of the appendix].
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Deciduosis of the appendix is a rare cause of acute appendicitis in pregnancy. Ectopic decidual cells localized in the submesothelial stroma may represent a physiologic reaction of the pluripotent stromal cells to progestational hormonal stimulation. Less frequently, deciduosis is based on a preexisting extragenital endometriosis, visible in a localization other than strictly submesothelial, in residuals of cyclic proliferation and bleeding, and in endometrial glandular formations embedded in the decidual cells.
Gastrointestinal bleeding can be caused by a variety of pathologies. Primary aortoappendicular fistula is rare and, in our case, arose in addition to a chronic contained rupture sac of an abdominal aortic aneurysm. Clinical diagnosis is difficult. Aortic aneurysmorrhaphy along with extensive debridement and emphasis on antibiotic therapy is curative.
A 48-year-old patient who had had an aortofemoral reconstruction with a Dacron graft nine years earlier presented with intestinal bleeding. At laparotomy the cause was found to be a fistula between a proximal false aneurysm and the vermiform appendix. The patient recovered after removal of the graft and extraanatomic revascularization associated with appendectomy. Four other similar case reports have been found in the literature.
Acute appendicitis is primarily not a radiologically established diagnosis. In atypical abdominal symptoms plain radiographs and additive real-time ultrasonography may often show typical findings especially in complications of acute appendicitis (perforation, abscess formation and ileus). In these cases the differential diagnosis is narrowed and further therapeutic steps may be modified considerably.
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