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A patient with massive gastrointestinal hemorrhage found to be bleeding from a diverticulum of the appendix is presented. Appendectomy was curative and pathologic changes were those associated with colonic diverticular hemorrhage. A review of the literature reveals this to be a previously unreported cause of gastrointestinal bleeding.
The isolation of viable lymphocytes from fresh human appendices is described. Under standardized experimental conditions of cell preparation no selective enrichment of either T- or B-lymphocytes was observed. The mean percentage of T-lymphocytes as judged by spontaneous rosette formation found in 34 appendices examined was 50.0%. After overnight incubation surface-Ig was detected by immunoradioautography on 46.8% of the recovered lymphocytes from 10 appendices. For the detection of surface-Ig specifically purified antibodies to heavy chains mu, gamma and alpha were used. Of the 46.8% surface-Ig positive lymphocytes the class distribution was as follows: IgM 17.7%, IgG 24.4% and IgA 4.7%. The isolated lymphocytes showed a variable mitotic response to PHA (stimulation index ranging from 3.3 to 200.9) as well as to allogeneic lymphocytes in a one-way mixed lymphocyte culture. So far, a distinct correlation could not be found between the histological degree of inflammation and the class or mitotic response of appendix lymphocytes.
A meniscus was produced in a gas-filled appendix by the outline of the obstructing appendicolith. This meniscus appearance should be specific for appendicitis since it represents the obstructing stone. This sign can be elicited by oblique or other projections, perhaps with fluoroscopic control.
A case of calcified and infected mucocele of the appendix is reported. The appearance of the calcification, the presence of gas with an air fluid level on plain films, and the opacification of the lumen of the mucocele by opaque enema allowed the correct radiologic diagnosis to be made.
Vermiform appendix is an unusual site of diverticulosis. We present 3 examples of this entity and briefly review its pathogenesis and clinical significance. As a general rule, appendiceal diverticula are multiple, acquired naturally, and rarely associated with complications.
The existence of chronic appendicitis is controversial. In this prospective study, we investigated possible changes in the innervation of the appendix under different pathological conditions and correlated histological findings with clinical observation. Thirty appendectomy specimens and 14 appendices obtained from organ donors or patients who underwent right hemicolectomy were immediately fixed in Bouin's solution and processed for immunocytochemistry using an antiserum directed against the panneuronal marker protein gene product 9.5 (PGP 9.5). The density of PGP 9.5 immunostaining was evaluated by digitized morphometry. Significant differences in the density of the PGP 9.5-immunoreactive area were detected in the mucosal layer. In the nonacute appendicitis group, PGP 9.5 was increased (10.99 +/- 3.15%) as compared to acute appendicitis (3.89 +/- 1.77%) and controls (4.98 +/- 1.25%). The significant increase of PGP 9.5 in nonacute appendicitis may suggest axonal sprouting leading to hyperinnervation of the mucosa. This may be a neuronal factor in the pathophysiology of the disease and pain symptoms.
The appendix was used as an efferent limb of the ileocolonic pouch (Mainz pouch) in two patients who underwent radical cystectomy for invasive bladder cancer. The pouch has a low pressure character and sufficient capacity as well as complete continence. This procedure is relatively simple to perform and considered to be a useful modification of ileocolonic pouch.
A case of hepatomegalia due to multiple metastases of unknown origin to the liver is described. At autopsy the primary tumor, an adenocarcinoid tumor of the appendix, was identified along with multiple metastases to the lymph nodes and widespread peritoneal carcinoidosis. Hepatic metastases from an appendiceal adenocarcinoid tumor has not been described previously. In the liver and lymph nodes the tumor had an insular growth pattern and was composed predominantly of cells of carcinoid type, whereas the carcinoidosis was composed almost entirely of signet-ring cells. It is suggested that differentiation of the metastases of appendiceal adenocarcinoids is modulated by factors in the recipient organ.
We report the case of a 29-year-old man in whom isolated involvement of the appendix with granulomatous colitis or Crohn's disease manifested as a cecal mass. Appendectomy was performed. At operation the terminal ileum did not appear to be grossly involved. Careful long-term follow-up is essential in these patients to detect recurrent disease.
Cystadenomas of the appendix are an unusual clinical entity. Despite a recognized constellation of findings, the diagnosis is not usually made prior to surgical exploration. A 65-year-old man is reported in whom preoperative evaluation, including sonography and angiography, resulted in the correct diagnosis confirmed at surgery. The appropriate use of newer diagnostic modalities will establish the preoperative diagnosis and facilitate surgical intervention. Appendectomy is curative for this condition, as neither regional nor distant lymph node metastases or hematogenous spread have been reported. When symptoms due to pseudomyxoma peritoneai occur, a continued aggressive surgical approach is justified.
An analysis of 101 tumors of the appendix is presented. During the period under study (from 1949 to 1972), 8,699 appendectomies had been performed. Only 17 of the 101 tumors were malignant. In this group, there were two primary carcinomas, 12 metastatic carcinomas, and three lymphomas. Most of the tumors (84) were benign, including 43 carcinoids, 32 mucoceles, five neuromas, two leiomyomas, and two villous adenomas, Some of the clinical and pathologic features of carcinoids, adenocarcinoma, and mucoceles are discussed. The most significant observation in this study is the statistically significant evidence that, even without associated acute appendicitis, mucoceles 2 cm or more in diameter probably do cause clinical symptoms, which may be alleivated by appendectomy.
Sixty-five patients who had the documented histologic diagnosis of chronic ulcerative colitis were selected in order to study appendiceal involvement in this disease. There were 28 males and 37 female patients with an average age of 30 years. The incidence of appendiceal involvement involving the right colon was found to be 47 per cent. In all of these cases the appendiceal involvement occurred in association with the disease process in the cecum or the right colon. In seven patients a classic picture of ulcerative appendicitis in active phase was found. In 78 per cent of patients a similarity between the disease stages in the colon and in the appendix was observed.
Primary adenocarcinoma of the appendix is the rarest form of malignant tumor of the appendiceal stump is described. As with other malignancies, surgical treatment is described. As with other malignancies, surgical treatment is most effective during the early stages of disease. In our series most of the patients who had metastatic disease had fairly rapid downhill courses. The choice of right hemicolectomy with node dissection in all cases is suported.
Antiperistaltic appendiceal conduit based on its vascular pedicle was used as hepaticoporto-appendico-jejunostomy (HAJ) in 9 infants with advanced stage of biliary atresia. Operative procedure was simple and less time consuming. The postoperative cholangitis was conspicuously absent, possibly due to the role played by the presence of lymphoid follicles in the wall of the appendix. Our early experience with this technique shows that antiperistaltic appendiceal conduit works quite satisfactorily. The procedure has been successfully utilised to reduce the problems contributing post-operative morbidity and mortality in cases with the advanced disease. The HAJ procedure provides a conduit for bilioenteric drainage, that closely resembles to normal anatomy.
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.
A 2-year old boy with torsion of colonic duplication, which had a proximal communication with the cecum via an incomplete duplicated appendix, is presented. The clinical picture and complications of this rare association are discussed.
A 23-year-old woman presented with acute appendicitis. At laparoscopy the appendix appeared to be strangulating itself. The pathologic evaluation demonstrated mucosal coagulation necrosis, confirming the early ischemic changes of the infarctive process visualized laparoscopically.
Intestinal atresia involving the ileocecal region is a very rare intestinal malformation, and the presence or absence of the ileocecal valve influences its surgical management. We report the case of a male newborn with a provisional diagnosis of distal ileal atresia, in whom laparotomy revealed that the entire ileocecal region was atretic with an absent ileocecal valve and appendix vermiformis. We resected the dilated terminal ileum together with the atretic segment and performed an ileocolic anastomosis between the terminal ileum and the transverse microcolon without valve reconstruction. When last seen, 8 months after the operation, the baby was developing normally. Ileocolic anastomosis without valve replacement appears to be sufficient if an ileocecal valve is completely absent and only a short segment of the terminal ileum is lost.