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Significant lower gastrointestinal hemorrhage from an ulcerated appendiceal stump after remote uncomplicated appendectomy is reported. The diagnosis was established by pathologic examination of the surgical specimen, but the area of bleeding was localized by preoperative colonoscopy. Angiography or isotope scan might also have identified the site of more rapid bleeding.
In the hands of an experienced surgeon, laparoscopic appendectomy is by no means a time-consuming procedure that might put the patient at risk. In particular it enables an all round inspection of the abdominal cavity, thus enabling both the detection of diverticular disease and tumors or processes within the true pelvis. The complication-free operation leaves behind only tiny scars, so that, in the event of abdominal complaints at some later date, a mistaken diagnosis of appendicitis might easily be established elsewhere. To help prevent this, the patient must be given the relevant information about the procedure. In addition, provision of the patient with a medical ID card is proposed.
Since January 1981, the so-called "3-day principle" in cases of suspected appendicitis has been applied in order to render the indications for surgery more precise. The retrospective analysis of a total of 1877 appendectomies performed between 1981 and 1990 demonstrated that the majority of histologically definite cases of acute appendicitis had been surgically treated on the day of admission to hospital. Furthermore, a second peak of histologically evident cases of acute appendicitis was seen with non-characteristic symptoms on the 3rd day. An additional remarkable finding was that 38.0% (!) of all appendices intraoperatively declared to be "innocent" showed histologically definite inflammatory alterations.
We report an unusual case of acute appendicitis caused by a mucinous cystadenoma of the cecum obstructing the lumen of the appendix. At laparoscopic appendectomy, an inflamed appendix was identified and resected. Subsequent histologic evaluation of the appendiceal base revealed mucin lakes. After discovery of a cecal mass at colonoscopy, the patient underwent definitive right hemicolectomy for treatment of a benign mucinous cystadenoma of the appendix.
The etiology and pathogenesis of ulcerative colitis are still unclear. There is, however, a growing consensus that the disease is characterized by a complex interaction between genetic and environmental influences. Many studies in the last few years have suggested that appendectomy reduces the risk of development and improves the course of ulcerative colitis. The underlying mechanism of this effect is unknown. The appendix seems to play a more important role in the development and modulation of the mucosal immune system than believed so far.
Acute appendicitis during pregnancy is a rare event, and large numbers of cases reported in the literature stem entirely from data stored in national registers. Between 1974 and 2000 relevant perioperative data on the treatment of appendicitis were collected consecutively and analyzed retrospectively. Surgical and obstetric data relating to the medical history, the clinical, intraoperative, and histologic findings, and the course of the pregnancy were recorded. Altogether, 9793 appendectomies were performed, 94 of which were in pregnant women (24.5% during the first trimester, 51% during the second trimester, and 24.5% during the third trimester). This represents 0.2% of the 46,960 deliveries during the period under observation. Fifty percent of the case histories during the second trimester were atypical. The overall perforation rate was 14.9%; it was 8.7%, 12.5%, and 26.1% during the three trimesters, respectively. Maternal mortality was 0%; the combined miscarriage/abortion rate was 8.5% (n = 8); and infant mortality was 3.2% (n = 3). The postoperative spontaneous abortion rate was 13.0% and the additional therapeutic/requested abortion rate 21.7% during the first trimester. In view of the elevated postoperative abortion rate and the facility of the clinical diagnosis during the first trimester, the indication for invasive diagnostic measures and surgery requires careful consideration. During the second and third trimesters the difficulty of establishing a clinical diagnosis makes it necessary to undertake exploratory surgery early.
This article presents a case of appendicitis 7 years after open appendectomy. Together with the apparent CT findings we discuss the current literature of this issue.
A modified technique for laparoscopic appendectomy is described. The telescope features two channels, one for the optical system and the second for forceps, scissors, and endoloops. The operation is performed through the working channel. The coaxial instrument is inserted through the umbilicus. One or two additional 1.7-mm instruments stabilize the appendix during the procedure. This technique leaves practically no scars.
A case of a 24-year-old male with fatal cerebro-renal oxalosis assumed to be due to infusions of the sugar surrogate xylitol after appendectomy is reported. The diagnosis was established only after intensive histological investigations following the autopsy. The clinical picture was characterized by an acute seizure, coma and renal failure 2 days after the first xylitol infusion. Death occurred due to cerebral dysregulation as a very rare complication after parenteral administration of xylitol. Subendothelial double refractive calcium oxalate crystals were found in the walls of cerebral blood vessels, in particular in the stem ganglion regions and in the cortical renal tubules. The most common type of primary oxalosis was excluded by sequencing analysis. The young age, the minor surgical intervention and the otherwise unremarkable history are special features of this case. Since the genetic background of xylitol intolerance is still unclear, it is suggested that it should be banned as a sugar surrogate in clinical practice.
We present the case of a 30-year-old man who developed a small bowel obstruction from an acute midgut volvulus 8 days after undergoing a laparoscopic appendectomy. There was no evidence of congenital malrotation or midgut volvulus on the initial computed tomography (CT) scan or at laparoscopy. Subsequently, a midgut volvulus developed in the absence of congenital malrotation.
Appendicoliths are considered to be strong indicators of appendicitis and the complications of appendicitis. We report the case of a 29-year-old woman who underwent a laparoscopic appendectomy for appendicitis with an appendicolith. The appendix was divided with a single ligature at the appendiceal base, and an appendicolith escaped into the pelvis. Thereafter, the patient suffered recurrent pelvic abscess. The diagnosis of retained appendicolith was made by repeated CT scans that revealed a mobile spontaneous calcification within the abscess. This postoperative complication could have been avoided if a systematic division of the appendix had been performed between double ligatures.
BACKGROUND: Inadequate closure of the appendix stump can lead to abscess formation or peritonitis. This prospective randomized clinical trial was performed to evaluate the number of endoloops needed in laparoscopic appendectomy. METHODS: A total of 208 patients were randomized in two groups: 109 in group 1 using one and 99 in group 2 using two proximal endoloops. The groups were compared in terms of intra- and postoperative complications. RESULTS: Postoperative complications were found in five patients (4.6%) in group 1, consisting of intraabdominal abscesses (three patients), pulmonary embolism (one patient), and persisting port-site pain (one patient). In group 2, postoperative complications were found in five patients (5.1%), consisting of intraabdominal abscesses (four patients) and prolonged percutaneous drainage (one patient). There was no significant difference between the two groups. DISCUSSION: In acute appendicitis, a minimal inflamed appendix base can be safely divided using one endoloop.
BACKGROUND: The development of intraabdominal abscess (IAA) following laparoscopic appendectomy (LA) is associated with significant morbidity. The aim of the present study was to validate an IAA risk score constructed from a previous review of 156 consecutive LA. METHODS: The score was tested in 250 subsequent consecutive LA and in patients with a positive risk score. Broad-spectrum antibiotics were administered in order to avoid IAA. RESULTS: Factors related to IAA included clinically complicated appendicitis, leucocytosis >15,000/microl, a difference of >1 degrees C between axillary and rectal temperature, intraoperative findings such as (gangrenes and perforation), and intraoperative perforation of the appendix. In this series, broad-spectrum antibiotic therapy in patients with a positive IAA risk score reduced the incidence of IAA from 7.05% to 1.60%. CONCLUSION: This policy of identifying high-risk patient via the scoring system and instituting subsequent antibiotic therapy in patients at risk reduces the incidence of IAA following LA.
An intraabdominal abscess developed from a retained fecalith following laparoscopic appendectomy. We discuss the prevention and management of retained fecaliths in light of the numerous reports of retained gallstones.
We report the case of an appendiceal stump abscess that was treated by relaparoscopy 4 days after a laparoscopic appendectomy (LA). Surgeons should be aware of the possibility of appendiceal stump abscess occurring as an early complication of LA. When performing LA, the appendiceal stump should be as short as possible, and the ligation of the root of the appendix should be only moderately tight, so as not to cause ischemic change of the stump, indicated by discoloration or edema. The insertion of a drain for monitoring exudate, as well as sonography, and relaparoscopy are helpful for diagnosing and treating this complication.
We investigated, in retrospect, if there were differences in the frequency and types of abdominal surgery between newly diagnosed female fibromyalgia (n = 80) and rheumatoid arthritis (n = 47) patients performed before the formal diagnosis. There was no difference in the total number of abdominal operations between both groups. In the rheumatoid arthritis group more cholecystectomies (p = 0.01) were performed, probably due to the older age of these patients (58.5 vs 48.5 years). However, in the fibromyalgia group there were more hysterectomies (p = 0.04) and appendectomies (p = 0.05) than in the rheumatoid arthritis group.
Inguinal and scrotal suppuration following appendectomy is a rare event, occurring mostly when a patent processus vaginalis is present. Herein we report a small series of children operated for appendicitis and presented with acute inguinal and scrotal symptoms postoperatively. Although acute scrotum is commonly attributed to torsion of testis or its appendage, epididymo-orchitis and incarcerated hernia, following appendicitis scrotal and/or inguinal abscess should be considered.
An incision is described for adaptation to the young female requiring an appendectomy. The incision is designed to allow the use of brief bathing suits and to preserve the normal contoured appearance of teh abdominal wall.