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At least 631 records · Page 35Linked to original sources
PubMed1993

Idiopathic granulomatous appendicitis, or Crohn's disease of the appendix revisited.

Idiopathic granulomatous appendicitis has been categorized as primary Crohn's disease of the appendix based on its pathologic features, although the clinical course of this condition simulates acute appendicitis. In this study we report the clinical and pathologic features of 10 cases of idiopathic granulomatous appendicitis and compare the histopathology to 14 appendices inflamed by Crohn's disease. The patients comprised six women and four men with an age range of 15 to 48 years (mean, 29 years). Six patients had acute onset of right lower quadrant abdominal pain while in three patients the presentation was subacute; one patient was asymptomatic. Focal neutrophilic infiltration of crypts with crypt abscesses, mucosal erosion and ulceration, fissures, transmural lymphoid aggregates, and mural fibrosis were comparable in idiopathic granulomatous appendicitis and Crohn's disease affecting the appendix. Fistulization occurred more commonly in Crohn's disease. Idiopathic granulomatous appendicitis contained 19.7 granulomas per tissue section (range, 2.75 to 71.0) compared with 0.3 granulomas per tissue section (range, 0 to 3.0) for appendices affected by Crohn's disease. No patient with granulomatous appendicitis treated by simple appendectomy had recurrence of disease at mean follow-up of 4.5 years. Our morphologic data support the clinical contention that idiopathic granulomatous appendicitis is nosologically distinct from Crohn's disease. Ironically, the presence of numerous granulomas is the histopathologic feature distinguishing idiopathic granulomatous appendicitis from Crohn's disease.

Adolescent↗
PubMed2005

Neuroendocrine tumours (carcinoids) of the appendix.

Neuroendocrine tumours (NETs) of the appendix (formerly 'carcinoids') are rare and are usually detected incidentally after appendectomy. Histopathologically they derive from a subepithelial cell population, which is different from NETs in other sites. They are preferentially located at the tip of the appendix. Tumours <1 cm hardly ever metastasize and are treated by appendectomy. Tumours >2 cm require right hemicolectomy because of a significant risk of metastatic spread. Treatment for lesions 1-2 cm is controversial and needs further characterization of the tumour (i.e. mesoappendiceal invasion, vascular invasion, mitotic activity, proliferation markers) and careful patient risk evaluation. Goblet-cell carcinoids have features resembling both carcinoid and adenocarcinoma and should be treated by hemicolectomy. Overall prognosis of small appendiceal NET is excellent in all ages.

Adult↗
PubMed1980

Perforation of the appendix in the neonatal period.

Perforation of the appendix in the neonatal period may be a complication of neonatal necrotizing enterocolitis and should be differentiated from perforating appendicitis in later life. A patient is presented together with a review of the literature to illustrate this concept. Perforation of the appendix occurred in a 12-day-old preterm baby. Th cause of this perforation is assumed to be localized full thickness necrosis of the appendiceal wall, a form of neonatal necrotizing enterocolitis. The similarity between the clinical histories of neonates with so called "appendicitis" and those with necrotizing enterocolitis is pointed out. It is argued that "idiopathic primary peritonitis" probably does not exist, but that the peritonitis may be secondary to similar small perforations of the bowel. The importance of a thorough search for such a perforation is stressed.

Appendicitis↗
PubMed1998

Laparoscopic appendectomy in children performed using single endoscopic GIA stapler for both mesoappendix and base of appendix.

BACKGROUND/PURPOSE: Similar to open appendectomy (OA), most of the methods described for laparoscopic appendectomy (LA) require two steps: (1) dissection and division of mesoappendix and (2) excision of appendix. Dissection of mesoappendix requires more skill and experience during LA. In single endoscopic GIA stapler laparoscopic appendectomy technique (SESLAT), both mesoappendix and base of appendix may be divided in one step with the application of a single endoscopic GIA stapler. METHODS: LA was attempted in 18 patients who had acute appendicitis and was successfully performed in 16 patients. RESULTS: In two patients, the operation was converted to OA. The authors did not need conversion to OA because of complication resulting from the use of the stapler. CONCLUSIONS: SESLAT is a quick, easy, and versatile method for LA in children that obviates dissection of mesoappendix and related complications. Thus, it enables LA to be performed by inexperienced beginners.

Adolescent↗
PubMed1980

Adenocarcinoma of the appendix penetrating the bladder.

We report a case of a mucous papillary tumor in the bladder. Initial treatment was transurethral resection but open partial bladder resection became necessary. Operation revealed an appendix tumor penetrating the bladder. Histologically, it was primary adenocarcinoma of the appendix.

Adenocarcinoma, Papillary↗
PubMedDate not supplied

Mucinous cystadenoma of the appendix: diagnosis, surgical management, and follow-up.

PURPOSE: To review the diagnostic examination and clinical presentation of mucinous cystadenoma of the appendix. METHODS: Case report from experience at an Air Force tertiary care hospital in a 66-year-old woman with chronic right lower quadrant pain. RESULTS: After extensive preoperative evaluation and subsequent diagnostic laparoscopy, a right hemicolectomy was performed for a mucinous cystadenoma of the appendix. CONCLUSIONS: Appendiceal mucinous cystadenoma is a rare entity found in only 0.3% of appendiceal specimens. Preoperative evaluation with radiologic and endoscopic methods is helpful but not always diagnostic. Although a benign disease process, complications from rupture, invasion into adjacent organs, or recurrence warrant adherence to strict oncologic principles for resection.

Aged↗
PubMed1997

Cytogenetic analysis of several pseudomyxoma peritonei lesions originating from a mucinous cystadenoma of the appendix.

Epithelial proliferative lesions of the appendix are rare and have never been studied cytogenetically. We present the chromosomal banding analysis of four successfully short-term cultured samples from pseudomyxoma peritonei lesions originating from a cystadenoma of the appendix. All four sample contained clonal chromosome abnormalities. In three of them, the clone 46,XX,der(6)?del(6)(q16q21)?del(6)(q27) was found, whereas a clone with the karyotype 46,XX,t(2;17)(p21;p13),t(6;12)(p21;q13),t(12;15)(q24;q15) was detected in the fourth sample. Our findings support the view that pseudomyxoma peritonei originates by spreading from a primary mucinous neoplasm of an intraperitoneal organ rather than through mucinous metaplasia or multifocal primary neoplastic transformation of the peritoneum.

Adult↗
PubMedDate not supplied

Carcinoid tumors of the appendix in children: two case reports and review of the literature.

Carcinoid is the most common tumor of the appendix. Reported incidence in pediatric population is 1 per 100,000 per annum. Clinical presentation like acute appendicitis is frequent, but carcinoid tumor can be an incidental finding during surgical procedures other than appendectomy. Size and depth of invasion are important prognostic criteria and tumors larger than 2 cm metastasize more frequently than smaller ones. Simple appendectomy is considered appropriate treatment, while right colectomy is indicated in tumor bigger than 2 cm. The authors report 2 cases of carcinoid tumors of the appendix in children, smaller than 2 cm treated with appendectomy alone, and disease free at follow-up.

Appendiceal Neoplasms↗
PubMed1993

Endoscopic removal of an infarcted appendix epiploica.

Infarction of an appendix epiploica is a rare event that is seldom diagnosed preoperatively. Report herein is a case of a 76-year-old male complaining of abdominal pain. The etiology of this pain was unclear but the diagnosis of epiploitis was preoperatively suspected. The infarcted epiploic appendix was identified and resected laparoscopically.

Abdominal Pain↗
PubMed1976

Primary carcinoma of the appendix.

Primary adenocarcinoma of the appendix is rare and less than 200 cases are on record. The present material consisted of 20 cases collected from different hospitals. The cases are described in respect of sex and age-distribution, symptoms, treatment and prognosis. Of 7 patients with malignant mucocele, 6 subjected to appendectomy only, were still alive 5 years after the operation. Of 12 patients with colonic type of adenocarcinoma, 3 had been treated with appendectomy only. Of these, 2 were still alive 5 years after the operation. The remaining 9 patients had undergone right hemicolectomy. Only one of them was alive 5 years after the operation. A compilation of a further 39 cases garnered from the literature, however, showed that 60% had survived at least 5 years after right hemicolectomy, compared with 46% after appendectomy alone. Appendectomy alone is probably a sufficiently radical operation for malignant mucocele provided the tumor has not grown through the submucosa and that it is confined to the tip of the appendix. Right hemicolectomy is indicated for the colonic type of adenocarcinoma.

Adenocarcinoma↗
PubMed1980

Bacterial studies of peritoneal cavity and postoperative surgical wound drainage following perforated appendix in children.

This study reports bacterial specimens obtained from 112 children presenting with a ruptured appendix. Additional samples were studied from 11 of these patients who developed a postoperative surgical draining wound. Bacterial growth occurred in 100 peritoneal fluid specimens. Anaerobic bacteria alone were present in 14 specimens, aerobes alone in 12, and mixed aerobic an anerobic flora in 74 specimens. There were 144 aerobic isolates (1.4 per specimen). The predominant isolates were: E. coli (57 specimens); alpha-hemolytic steptococcus (16 specimens); gamma-hemolytic streptococcus (15 specimens); Group D streptococcus (12 specimens); and P. aeruginosa (9 specimens). There were 301 anaerobic isolates (three per specimen). The predominant isolates were: 157 Bacteroides spp. (including 92 B. fragilis group and 26 B. melaninogenicus group); 62 gram-positive anaerobic cocci (including 30 Peptococcus sp.; 29 Peptostreptococcus sp.); 27 Fusobactenium sp.; and 16 Clostridium sp. B. fragilis and Peptococcus sp. occurred in 23 patients. Beta lactamase production was detectable in 98 isolates recovered from 74 patients. These included all isolates of B. fragilis and six of the 23 Bacteroides sp. Forty-nine organisms (16 aerobic and 33 anaerobic) were recovered from the draining wounds. The predominant organisms were: B. fragilis (8 specimens); E. coli (6 specimens); Peptostreptococcus sp. (5 specimens); and three specimens each of P. aeruginosa and Peptococcus sp. Most of these isolates were also recovered from the peritoneal cavity of the patients. These findings demonstrate the polymicrobial aerobic and anaerobic nature of peritoneal cavity and postoperative wound flora in children with perforated appendix, and demonstrate the presence of beta lactamase-producing organisms in three-fourths of the patients.

Appendectomy↗
PubMed1983

Clinical significance of mucosal inflammation of the vermiform appendix.

In 942 emergency appendectomies, the clinical data of 77 patients with inflammatory changes confined to the mucosa of the vermiform appendix were compared with data from 622 patients with diffuse acute appendicitis and 243 patients without evidence of inflammation in the appendix. In all cases, routine histologic sections of the specimens were reviewed. Of the 77 patients with mucosal appendiceal inflammation, 50 were female and 50% were under 17 years of age. In several clinical aspects, such as incidence of nausea, vomiting, migration of pain, and localized muscular rigidity, there existed significant differences between patients with mucosal inflammation and patients with diffuse appendicitis. Conversely, no statistically significant differences were found between patients with mucosal inflammation and patients without evident appendiceal inflammation. These results in addition to the frequent finding of histologically indistinguishable changes in appendices removed incidentally suggest that the condition is not responsible for the actual complaint.

Adolescent↗
PubMed2005

Carcinoid tumor of the appendix in childhood: the experience of two Italian institutions.

OBJECTIVES: Although rare, carcinoid tumor of the appendix is the most common neoplasm of the gastrointestinal tract in children and adolescents. It is usually an incidental finding after a laparotomy for appendectomy, with a frequency of 2 to 5 cases per 1000 appendectomies. The experience with 14 cases of carcinoid reported in the appendix is described. METHODS AND RESULTS: In six patients the tumor measured 1 cm or less; only in one patient did it measure 2 cm. In three patients the tumor measured between 1 and 2 cm and in four the size was not known. In five cases the lesion had invaded the mesoappendix and periappendiceal fat. All tumors were discovered by chance, and three patients underwent further surgery as a result of suspected involvement of the margins. All the patients were alive with no evidence of disease at 24 to 214 months from diagnosis. CONCLUSIONS: Traditionally, local invasiveness and size have been considered prognostic factors. In our experience, both patients with local invasiveness and the patient with a tumor larger than 2 cm had good outcomes. Ileocolectomy performed in the patient with a 2-cm tumor and in another two patients with smaller tumors did not demonstrate residual disease. Although the need for right hemicolectomy still remains controversial for tumors measuring more than 2 cm, the approach may be nonaggressive in case of tumors invading the serosa and the periappendiceal fat. Nonaggressive treatment has been suggested by some authors in cases of tumors larger than 2 cm; however, larger series need to be evaluated.

Adolescent↗
PubMed1999

Salvage continent vesicostomy after enterocystoplasty in the absence of the appendix.

PURPOSE: We describe a surgical procedure for a select group of children who had previously undergone augmentation enterocystoplasty, following which intermittent catheterization became more and more difficult or impractical. A new access to the reservoir became necessary, and alternative conduits included the appendix, ureter and tubularized ileum or stomach. Each conduit had its advantages and disadvantages but all required transperitoneal dissection. We report a simple extraperitoneal surgical technique that involves use of the Mitrofanoff and Nissen principles. MATERIALS AND METHODS: A 2x6 cm. flap of the anterior wall, which is usually intestine, of the augmented bladder is raised. The base of the flap is just below the bladder dome. The flap is then tubularized over a 14F catheter and the cystostomy is closed. The bladder is plicated around the base of the tube, similar to the Nissen gastroesophageal fundoplication. The plication extends and covers the proximal 3 cm. of the tube. Intraoperative bladder distention is performed to confirm the competence of the continence mechanism. The distal part of the tube is then anastomosed to the inverted umbilical skin or to a tubularized abdominal wall skin flap. RESULTS: The aforementioned technique was used in 5 children 3 months to 6 years old. Earlier augmentation ileocystoplasty and bladder neck reconstruction had been performed in 4 children. The appendix was unavailable for a Mitrofanoff vesicostomy in all cases. This procedure was also performed on a 13-year-old boy with severe myogenic detrusor failure, due to posterior urethral valves, and a bladder capacity of 700 ml. There was no significant surgical morbidity and all children are dry between clean intermittent catheterizations 1 to 5 years postoperatively (mean 3.3). CONCLUSIONS: Use of the Mitrofanoff and Nissen principles proved to be simple and reliable, and avoided secondary intraperitoneal exploration and use of bowel in these select cases.

Child↗
PubMed1975

Primary adenocarcinoma of the appendix.

A case of primary adenocarcinoma of the appendix in which the patient had the usual symptoms of acute appendicitis is presented. A review of the literature showed the potential for early extension and nodal metastasis in this lesion and led to the recommendation of right hemicolectomy as the treatment of choice. The operation should be done either primarily or secondarily after an appendectomy and should lead to a five-year survival of approximately 45%. Every effort should be made to make the diagnosis and provide definitive treatment at the primary operation by examining the appendix grossly and obtaining frozen section microscopic study of any suspicious tumor or ulceration.

Adenocarcinoma↗
PubMed1980

Leiomyoma of the appendix.

Primary leiomyoma and leiomyosarcoma of the appendix are extremely rare, and most often the diagnosis is histopathologic. We have reported the largest leiomyoma of the appendix known to date.

Adult↗
PubMed2003

Appendix retrieval after laparoscopic appendectomy: a safe and inexpensive technique.

We describe a useful technique for retrieving the dissected appendix in a bag after laparoscopic resection. This permits laparoscopic appendectomy to be completed with a single 10-mm and two 5-mm (or 3-mm) ports and using only a 10-mm telescope. It obviates the need to change the standard 10-mm telescope to 5-mm scope or the extension of a smaller port incision to extract the specimen. The appendix was removed successfully and without complications using this technique in 89 consecutive laparoscopic appendectomies. The technique is safe, inexpensive, and uses readily available equipment.

Adolescent↗