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PubMed2006

Strangulated appendix epiploica in paraumbilical hernia: preoperative diagnosis and laparoscopic treatment.

Appendix epiploica can occasionally cause acute abdominal pain. The usual presentations are torsion or primary epiploic appendicitis. Strangulation inside a paraumbilical hernia with acute abdominal pain is seldom reported in the literature. The authors report a case of preoperative diagnosis and laparoscopic treatment of strangulated appendix epiploica in paraumbilical hernia that presented as acute abdominal pain.

Abdomen, Acute↗

PubMed1987

Argyrophil, non-argentaffin carcinoids of the appendix vermiformis. Immunohistochemical and ultrastructural studies.

Five argyrophil, non-argentaffin classical carcinoids of the appendix were found in 19 appendiceal classical carcinoids and were investigated histochemically, immunohistochemically and ultrastructurally. All tumors consisted entirely of argyrophil cells. Three of the five carcinoids were composed almost totally of peptide YY cells and were negative for serotonin. One of them consisted of peptide YY cells (60%), somatostatin cells (40%), and a few cells with glucagon-like immunoreactivity (GLI). The remaining one without peptides was homogeneously immunoreactive for serotonin alone. Ultrastructurally, each of the four peptide-positive carcinoids was composed of one kind of endocrine cell type with round secretory granules. Average diameter of granules were 150, 160, 190, and 210 nm, respectively. The non-argentaffin, serotonin-positive carcinoid showed predominant round secretory granules and a few irregular ones, both being 150 nm in largest diameter. It is suggested that the argyrophil, non-argentaffin carcinoids of the appendix are subdivided into two groups; carcinoids composed mainly of peptide (especially, peptide YY)-positive cells with round granules of D1 and/or L cell type and those of serotonin-positive cells with pleomorphic granules of ECn cell type.

Adolescent↗

PubMed1994

Primary adenocarcinoma of the vermiform appendix associated with transitional cell carcinoma of the bladder.

A case of primary adenocarcinoma of the vermiform appendix coexisting with transitional cell carcinoma (TCC) of the bladder is presented. The patient was a 74-year-old male who underwent radical cystectomy with continent urinary diversion using the Florida pouch. Two different cancers were found, TCC of the bladder and mucinous adenocarcinoma of the appendix. To our knowledge, this is the only such case reported in the medical literature.

Adenocarcinoma, Mucinous↗

PubMed2000

Primary mucinous adenocarcinoma of the appendix: a rare entity in the differential diagnosis of ovarian cancer.

We report a 58-year-old female patient with the suspected diagnosis of ovarian cancer. Upon surgical exploration, examination of the appendix revealed the histological diagnosis of primary mucinous adenocarcinoma. This is an unusual consideration in the differential diagnosis of the ovarian cancer. We discuss the diagnosis, classification and treatment of the cancer of the appendix in relation to ovarian cancer.

Adenocarcinoma, Mucinous↗

PubMed1982

Adenocarcinoma of the appendix in older patients.

Acute inflammation of the appendix secondary to luminal obstruction is the chief reason for appendectomy. The rare association of a malignant neoplastic process with the inflammatory process is usually an unexpected finding and is often not diagnosed until the histologic study has been completed. Two patients with adenocarcinoma of the appendix are presented. They exemplify the diverse situations of intraoperative recognition with immediate definitive treatment, or surgical management after appendectomy alone. A review of the literature confirms the rarity of appendiceal adenocarcinoma in older patients. In this report, the pathophysiology of appendiceal carcinoma and guidelines for therapy are outlined. Emphasis is placed on the possible occurrence of a malignant appendiceal lesion in the elderly patient with acute appendicitis.

Adenocarcinoma↗

PubMed1991

Adenocarcinoma of the vermiform appendix. A population study.

We report seven cases of adenocarcinoma of the vermiform appendix occurring in Iceland during 1974-1989. The patients ranged in age from 25-83 years, mean age 55.1 years. There were five males and two females. Five had mucinous adenocarcinoma, two had adenocarcinoma. Four patients presented with symptoms and signs of acute appendicitis and all had surgically resectable disease. Three of these patients were alive with no evidence of disease four months, two years and 15 years after presentation; one death of disease occurred seven years after ileocecal resection. In three cases, the clinical presentation was that of metastatic adenocarcinoma of unknown origin. Of these patients two were diagnosed at autopsy and one after appendectomy for perforated appendicitis. Survival in this group was six weeks, three months and twelve months, respectively. In none of our patients was the diagnosis made preoperatively and no tumors were found in appendices removed incidental to other intra-abdominal operations. The incidence of adenocarcinoma of the vermiform appendix in Iceland during 1974-1989 was approximately 0.2 cases/100.000/year.

Adenocarcinoma↗

PubMed2006

Surgical treatment of malignant carcinoid tumours of the appendix.

Since their first description in 1882, malignant neoplasms of the appendix still remain rare. Malignant carcinoid tumours are the most common accounting for 85% of all appendiceal neoplasms. Preoperative diagnosis is invariably difficult, and precise treatment protocols for these neoplasms remain unclear. We reviewed our experience and searched published evidence to produce management guidelines. A retrospective review of all malignant carcinoid tumours diagnosed in our hospital between April 1994 and December 2003 was performed. Patient demographics, operative details, histological types and clinical outcomes were retrieved from case notes supplemented by a questionnaire to the patient's General Practitioner. A literature search was then performed. Nine patients were identified with classical carcinoid tumours (CCT); (M = 3 and F = 6, mean age: 43, range 14-81) and two patients with goblet-cell morphology (F = 2, age 46 and 76). Mean follow-up was 63 months (range 1-125 months). Nine patients were alive at the end of follow-up. Appendicectomy was performed for acute appendicitis. Other appendiceal pathologies were identified following hemicolectomy and oophorectomy. CCT are the most common tumours and have the better prognosis. From our experience and subsequent review of the literature, we recommend right hemicolectomy as the treatment of choice for malignant carcinoid tumours. However, small CCTs less than 2 cm in diameter at the tip of the appendix, with a low proliferative index, without angiolymphatic or mesoappendiceal extension can be treated by appendicectomy. Following oncological assessment, further adjuvant therapy should be considered for patients with advanced disease.

Adolescent↗

PubMed1997

Mucinous cystadenoma of the appendix with raised serum carcinoembryonic antigen concentration: clinical and pathological features.

A case of mucinous cystadenoma mimicking ovarian cancer is reported. Serum carcinoembryonic antigen (CEA) concentration was raised, and computed tomography of the abdomen and pelvis demonstrated a long oval shaped cystic mass measuring 9 cm in length on the right anterior side of the uterus. Because of possible right ovarian cancer, laparotomy was performed and the mass was found to be a mucinous cystadenoma of the appendix. This case indicates that mucinous cystadenoma of the appendix may show an unusual presentation including its location as well as the high serum CEA, mimicking ovarian cancer. Therefore, gynaecologists as well as gastroenterologists should consider its possibility as a differential diagnosis of the right adnexal mass in a patient without previous appendectomy.

Aged↗

PubMed1996

Incidental mucinous cystadenocarcinoma of the appendix.

The incidental finding of a rare appendiceal tumour in a previously healthy male patient is described. He presented as an emergency with a self-inflicted abdominal stab injury. At laparotomy, there was no visceral damage but the appendix was hugely distended and appendectomy was performed. Subsequent histological examination of the appendix revealed a low-grade mucinous cystadenocarcinoma. A right hemicolectomy was performed two months later which demonstrated no residual tumour.

Abdominal Injuries↗

PubMed1976

The appendix of the ventricle of the larynx.

A review of 100 consecutive laryngograms showed visualization of the appendix of the laryngeal ventricle in 40% of cases. This high incidence of visulization is related to thorough anesthesia, repeated performance of phonation and the reverse "E" maneuver as well as awareness of the anatomical structure. The appendix of the laryngeal ventricle courses superiorly between the laryngeal vestibule and the thyroid cartilage which differentiates this normal structure from ulcerations and fistulous tracts of laryngeal tumors.

Anesthesia, Local↗

PubMed2001

Intussusception of the appendix secondary to mucinous cystadenoma.

Intussusception of the appendix vermiformis in adults is an unusual entity. We present a 52-year-old male patient with intussusception of the appendix due to a mucinous cystadenoma, and discuss the clinical features, preoperative diagnosis, classification and therapy of this condition together with a review of the literature.

Appendiceal Neoplasms↗

PubMed1983

Appendix epididymidis and aberrant ductules of the bull: light-microscopic and ultrastructural study.

The appendix epididymidis and aberrant ductules possessed similar morphological characteristics. The epithelium was 31 +/- 3 microns in height and consisted primarily of ciliated and nonciliated cells, although a few lymphocytes were also present. The ultrastructure of major cell types showed most cell organelles in their cytoplasm. However, these organelles were poorly developed, suggesting that neither cell type performed either a secretory or an absorptive function. Although the vestigial organs and ductuli efferentes were similar in epithelial height and epithelial cell types, there were important morphological differences that were reliably used to differentiate between the two. First, the luminal diameter was significantly smaller in the vestigial organs (60 +/- 12 vs. 146 +/- 44 microns in the ductuli efferentes). Second, the nonciliated cells of the vestigial organs, unlike those of the ductuli efferentes, lacked both dense granules and vacuoles in the cytoplasm. Finally, the tubular cross-sections of the vestigial organs were closely packed and were located at the tip of the caput epididymidis in the case of the appendix epididymidis, and between the lobules of the ductuli efferentes in the case of the aberrant ductules.

Animals↗

PubMed2005

Appendix mass: do we know how to treat it?

INTRODUCTION: The traditional management of appendiceal mass has been an initial conservative approach followed by interval appendicectomy. More recently, the necessity of interval appendicectomy has been questioned by a growing amount of evidence in the surgical literature. The aim of this study was to review the available scientific evidence and to determine how appendiceal masses are currently being managed in the Mid-Trent region by general surgeons. PATIENTS & METHODS: A literature search using Medline, Embase, Cinahl, HMIC and Biosis was carried out. A personal or telephonic survey of all consultants and specialist registrars working in general surgery in the Mid-Trent region (n = 67) was conducted recording their management protocol of 3 different clinical scenarios--a 14-year-old boy, a 29-year-old female and a 68-year-old male. Responses of the questionnaire were entered to a database in Microsoft Access 2000 and analysed. RESULTS: The results showed that there was difference of opinion on the management of appendix mass in either scenario. Appendectomy (interval or emergency) is still practised by 75% of general surgeons in the Mid-Trent region and less that 25% manage asymptomatic appendix mass without interval appendectomy. Additionally, specialist registrars appear more likely not to offer patients interval appendicectomy after successful conservative management (P < 0.05). CONCLUSIONS: At present, there is no agreed consensus on the management of appendiceal mass. There is a need to develop a protocol for the management of this common problem.

Adolescent↗

PubMed1999

Primary mucinous cystadenocarcinoma of the appendix: CT findings.

OBJECTIVE: The preoperative diagnosis of a primary appendiceal tumor can be difficult because of its rarity and the paucity of material in the radiology literature. The purpose of this study was to describe CT findings in six patients with primary mucinous cystadenocarcinoma of the appendix. CONCLUSION: When CT reveals a cystic mass with enhancing wall nodularity in the expected area of the appendix, especially in older patients, the possibility of primary mucinous cystadenocarcinoma should be considered.

Aged↗

PubMedDate not supplied

Perforated appendix in an inguinal hernial sac: Amyand's hernia.

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".

Aged↗

PubMed1993

[An experience with a continent appendix stoma].

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.

Adenocarcinoma↗

PubMed1999

Gastro-intestinal Kaposi's sarcoma, with special reference to the appendix.

Kaposi's sarcoma (KS) of the gastro-intestinal tract is a common disease in the AIDS setting, although it is often asymptomatic. In this paper we wish to highlight the occurrence of gastro-intestinal KS with appendiceal involvement. Two of the patients presented with features of acute appendicitis, and KS of the appendix was not suspected at the time of surgery. In the remaining patient KS of the appendix was part of generalised gastro-intestinal involvement. It is important to remember that KS can cause appendicitis by producing a submucosal nodule that abuts into the lumen and thereby causes obstruction. KS of the gastro-intestinal tract may therefore masquerade as 'simple' appendicitis, or indeed remain asymptomatic.

Acquired Immunodeficiency Syndrome↗

PubMed1999

Is perforation of the appendix a risk factor for tubal infertility and ectopic pregnancy? An appraisal of the evidence.

OBJECTIVE: To critically assess the evidence that appendiceal perforation is a risk factor for subsequent tubal infertility or ectopic pregnancy. DATA SOURCES: Epidemiologic studies investigating the relationship between appendectomy and infertility or ectopic pregnancy were identified by searching the MEDLINE database from 1966 to 1997. Appropriate citations were also extracted from a manual search of the bibliographies of selected papers. STUDY SELECTION: Twenty-three articles were retrieved. Only 4 presented original data including comparisons to a nonexposed control group and they form the basis for this study. DATA EXTRACTION: Because the raw data or specific techniques of data analysis were not always explicitly described, indices of risk for exposure were extracted from the data as presented and were analysed without attempting to convert them to a common measure. DATA SYNTHESIS: Articles were assessed according to the criteria of the Evidence-Based Medicine Working Group for evaluating articles on harm. Review of the literature yielded estimates of the risk of adverse fertility outcomes ranging from 1.6 (95% confidence interval [CI] 1.1 to 2.5) for ectopic pregnancy after an appendectomy to 4.8 (95% CI 1.5 to 14.9) for tubal infertility from perforation of the appendix. Recall bias, and poor adjustment for confounding variables in some reports, weakened the validity of the studies. CONCLUSIONS: The methodologic weaknesses of the studies do not permit acceptance of increased risk of tubal pregnancy or infertility as a consequence of perforation of the appendix, so a causal relationship cannot be supported by the data currently available. Only a well-designed case-control study with unbiased ascertainment of exposure and adjustment for confounding variables will provide a definitive answer.

Appendicitis↗