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A case with carcinoid tumor of the appendix was encountered incidentally during an elective cesarean section. The tumor was discovered as a result of the routine exploration of the whole abdomen. The investigation for metastasis proved no evidence of spread and the patient was treated solely by surgery.
Perforation of the uterus by an intrauterine contraceptive device (IUD) is a rare, and serious complication, occurring in 1/350 to 1/2500 insertions. Perforation by IUDs can involve several neighboring organs such as the bladder and rectosigmoid. We report two cases of IUD perforations involving the appendix, both inserted during lactation. The first case is an asymptomatic patient in early pregnancy and the second is a woman whose original presentation was chronic lower abdominal pain. The presence of copper in the abdominal cavity can lead to adhesion formation and subsequent abdominal pain, bowel obstruction or infertility. Thus, we believe that when an IUD is located in the abdominal cavity it should be removed even in an asymptomatic patient. In addition, these cases might suggest postponing the use of this contraceptive method in lactating women.
Villous adenoma confined to the distal appendix has not been previously reported in conjunction with acute apendicitis. The presence of an adenoma indicates a need for further investigation due to an association with neoplasia elsewhere.
Appendix has routinely been utilized by the urologists as an intermittent catheterization route to empty a continent urinary reservoir. However it is utilized very rarely for ureteric substitution. We present here our experience with the use of an appendicular conduit for substitution of a complete ureteric stricture and discuss the implications of its use for ureteric reconstruction.
AIM: We report an unusual case of mucinous metaplasia and epithelial dysplasia occurring in endometriotic epithelium in the appendix. METHODS AND RESULTS: A 39-year-old woman developed an appendiceal endometriosis in which the endometrial glands displayed extensive areas consisting of mucinous epithelium and Paneth cells. Focally the mucinous epithelium showed low-grade epithelial dysplasia. These changes occurred in portions of the endometriotic tissue closest to the appendiceal lumen. Both the intestinal and endometrial epithelial components were surrounded by typical endometrial-type stroma showing positive reactivity for oestrogen receptor. CONCLUSIONS: Formation of the mucinous epithelium most likely represents a metaplastic process of the endometrial epithelium rather than a result of a simple 'collision' of the appendiceal and endometrial epithelium. Further support for this being a metaplastic process was the presence of glandular structures containing a mixture of mucinous cells, goblet cells, Paneth cells, ciliated and nonciliated endometrial cells, and ciliated and nonciliated mucinous cells, all showing the same positive reactivity for oestrogen receptor. The disposition of mucinous epithelium in the foci of endometriosis in this case suggests that the appendiceal mucosa or extracellular mucin may play a role as an inducer of mucinous cell metaplasia in endometriotic epithelium.
This report presents a case of precursor T-cell acute lymphoblastic leukemia/lymphoma (ALL) involving the uterine cervix, myometrium, endometrium, and appendix. The patient was a 38-year-old woman with a history of ALL who had been in remission for 4 years following chemotherapy. The malignant lymphoid infiltrate was characterized by blasts, showing scant cytoplasm, irregular hyperchromatic nuclei, and occasional prominent nucleoli. They were immunoreactive for CD45RB, CD3, CD43, CD34, and focally for TdT. Curiously, the blasts replaced the endometrial stroma and spared the associated epithelium. The patient was again treated with chemotherapy but her disease did not respond. She succumbed to her disease approximately 10 months after her initial evaluation for symptoms related to ALL relapse. Precursor T-cell ALL most commonly presents as a mediastinal mass in adolescent males. Although any organ may be affected, involvement of the female reproductive organs is rare. This case shows some of the varied manifestations of precursor T-cell ALL and highlights the necessity of considering the female reproductive tract as a possible location of relapsing disease.
In this brief report, the authors present a case of duplication of the vermiform appendix with appendicitis occurring in both appendices and causing small bowel obstruction.
Mucocele of the appendix is uncommon, and preoperative diagnosis is rare. This case report presents the clinical, ultrasound and computed tomographic imaging findings mimicking those of an ovarian cyst. Appendectomy resulted in no complications.
This is a case report of a fourteen year old boy with Crohn's disease of the terminal ileum, and a carcinoid tumor of the appendix. This association is very rare and, to our knowledge, has not been previously reported.
We describe a technique used to provide urinary continence to a group of teenagers with neuropathic bladders. The technique gives continence to a urinary reservoir by utilising the appendix as a continent catheterisable conduit. Of the first five patients to have this procedure performed in this institute, four became fully continent. We feel that this procedure can be of great benefit to both children and adults with urinary incontinence.
Ultrasonography in a 73-year-old woman revealed two cystic structures in the region of the right adnexa. Magnetic resonance imaging suggested two morphologically distinct, space-occupying lesions, findings confirmed at operation and histological examination of the surgical specimen, which demonstrated a serous cystadenoma of the right ovary and a mucocele of the appendix.
A rare intestinal malformation is reported in a boy 11 years old with a 3-year history of abdominal pain and chronic anemia. Laparotomy revealed a large cecal mass extending beyond the ileocecal valve in the place of the appendix, with bleeding mucosal ulcers.
BACKGROUND: In patients with clinically suspected appendicitis, computed tomography (CT) is diagnostically accurate. However, the effect of routine CT of the appendix on the treatment of such patients and the use of hospital resources is unknown. METHODS: We performed appendiceal CT on 100 consecutive patients in the emergency department who, on the basis of history, physical examination, and laboratory results, were to be hospitalized for observation for suspected appendicitis or for urgent appendectomy. Outcomes were determined at surgery and by pathological examination in 59 patients, and by clinical follow-up two months later in 41 patients. Treatment plans made before CT were compared with the patients' actual treatment. We also determined the costs of surgery that revealed no appendicitis (from data on 61 patients), one day of observation in the hospital (from data on 350 patient-days in patients with suspected appendicitis), and appendiceal CT (from data on all pelvic CT examinations in 1996). RESULTS: Fifty-three patients had appendicitis, and 47 did not. The interpretations of the appendiceal CT scans were 98 percent accurate. The results of CT led to changes in the treatment of 59 patients. These changes resulted in the prevention of unnecessary appendectomy in 13 patients, admission to the hospital for observation in 18 patients, admission to the hospital for observation before necessary appendectomy in 21 patients, and admission to the hospital for observation before the diagnosis of other conditions by CT in 11 patients. The effects of performing appendiceal CT on the use of hospital resources included the prevention of unnecessary appendectomy in 13 patients (for a savings of $47,281) and the prevention of unnecessary hospital admission for 50 patient-days (for a savings of $20,250). After the cost of 100 appendiceal CT studies ($22,800) was subtracted, the overall savings was $447 per patient. CONCLUSIONS: Routine appendiceal CT performed in patients who present with suspected appendicitis improves patient care and reduces the use of hospital resources.
Intussusception of the vermiform appendix (IVA) in a 14-year-old girl is reported. The diagnosis was made preoperatively, which is rare: only five other cases have been reported. IVA can present with variable symptoms. This patient presented with episodes of recurrent severe paroxysmal pain and vomiting, each episode being separated by several uneventful weeks. The diagnosis of IVA could be made at the fourth attack of colic by the radiological visualization of a "spiral shell" filling defect at the bottom of the cecum that was reducible by intravenous injection of a spasmolytic. Laparotomy with appendectomy rescued the patient from these distressing episodes. Although IVA is an uncommon condition, one should be aware of its existence and include it in the differential diagnosis of acute abdominal syndromes. When confronted with a clinical picture of intussusception in older children or adolescents, one should especially remember this entity as a differential diagnosis with other causes of intussusception, especially tumors.
The aim of this study was to investigate the applicability of the Mitrofanoff principle in the treatment of severe posterior urethral injuries and determine the feasibility of this technique with its early and late postoperative results. A total of 27 New Zealand rabbits (12 male and 15 female) was used (mean weight 2,272 +/- 343 gm.). Using general anesthesia the proximal part of the posterior urethra was transected completely and a 1 cm. segment was excised. A 2 cm. segment of appendix with its intact vascular pedicle was meticulously mobilized and anastomosed to the proximal and distal site of the urethra. Excretory urograms, voiding cystourethrograms, urodynamic investigation and histopathological examination were performed postoperatively. The fertility of the male rabbits was examined in the late postoperative period as well. These results were compared with those of a control group. There was no problem concerning voiding patterns in the pedicled appendiceal flap group. Excretory urograms revealed a properly functioning urinary system. Voiding cystourethrograms showed a normal bladder capacity and voiding pattern, and an intact urethra. Urodynamic analysis was within normal limits except for a decrease in bladder volume. An intact urethral lumen without any strictures or fibrosis was demonstrated histopathologically. No calculus, mucus formation or urinary tract infection was observed in the late postoperative period. Fertility problems were noted in male rabbits. This animal experiment suggested that the pedicled appendiceal flap technique could be used for the treatment of severe forms of posterior urethral injuries.
We have reported three cases of appendiceal diverticulosis diagnosed by barium enema examination, and reviewed the radiographic and clinical findings. An awareness of this lesion is important, since diverticulitis of the appendix may occur in up to two thirds of patients with DA.
Continent reconstruction of the lower urinary tract using the appendicovesicostomy (Mitrofanoff principle) is an excellent means of managing many patients with altered bladder function, especially those with good bladder volume and low pressure. Motivated patients unable to perform urethral catheterization because of paresis or other reasons now have a method of urinary diversion free of an appliance, though additional procedures may be necessary if bladder volume is low and/or bladder pressure is high. We no longer routinely perform appendectomy during bladder substitution or bladder augmentation procedures. By removing the appendix, we may be discarding an appendage that might prove useful should future urinary reconstruction procedures be required.
We present the case of a 29-year-old woman with an asymptomatic intussuscepted appendix found incidentally during surgical evaluation for a pelvic mass in a patient with endometriosis. This case represents the rare nature of this presentation and the need to fully evaluate the gastrointestinal tract in patients with endometriosis.