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The case of a solitary diverticulum of the appendix found on routine barium enema is presented. The types of diverticula, their presentations and their potential outcomes and significance are discussed.
Perforation and peritonitis as complications of severe Crohn's disease are rare. Case reports of two young female patients are given who have been treated in 1983 because of peritonitis after perforation of Crohn's disease. The only therapeutic approach making sense is elimination of the intestine affected by the disease and repeated control laparotomies with for treatment of peritonitis and controlling sufficiency of the anastomosis. These patients are at high risk because of treatment with cortisone.
Seventy-one patients with volvulus of fatty appendix of the colon (sigmoid colon--52 patients, caecum--12, ascending colon--5, vermicular appendix--2 patients) were treated. Volvulus of epiploic appendix was seen in 67.6% operated patients, inflammatory changes--in 28.1% (primary inflammation was diagnosed in 4.2% patients). Symptoms of fat metabolism disorders were detected in 44 patients. There are no specific symptoms. Diagnostic laparoscopy permitted to improve diagnosis of epiploic appendices diseases. Target surgical approach permitted to reduce rate of postoperative complications and to improve results of treatment.
Two cases of acute intestinal pseudo-obstruction diagnosed over a 6-year period are reported. One patient had acute colonic pseudo-obstruction (Ogilvie's syndrome) associated with severe cardiopulmonary disease and the other a rare idiopathic small bowel pseudo-obstruction: both were treated successfully. The various treatments and a short review of the literature are presented.
The records of forty-three patients with clinically diagnosed appendiceal abscess were reviewed to compare operative vs nonoperative therapy. Thirteen patients were operated on shortly after admission. Eleven of these had appendectomy or drainage of an abscess; two patients had right hemicolectomy. There were no serious complications, and median hospitalization was 7.2 days. Thirty patients were initially treated nonoperatively. Twenty-six of these did well and were discharged a median of 11 days after admission. Four patients required operations for failure to respond. One patient died of a pulmonary embolism. Four patients returned with recurrent appendicitis and underwent appendectomy. Three patients were later found to have other disease processes. Good results can be obtained with either form of therapy. Patients not operated on should be examined to exclude lesions masquerading as appendiceal abscesses.
On the basis of their experience in right colonic emergencies, the Authors report two cases of diverticular disease presenting with acute abdomen. Pointing out the difficulty of a correct pre- and intraoperative diagnosis, different surgical procedures are analysed.
A giant appendix is an extremely rare and improbable finding during surgery in suspected cases of acute appendicitis. Although this condition is primarily suggestive of neoplasia, it is usually due to an inflammatory or infectious disease. We report a case of Crohn's disease limited to the appendix, which was diagnosed after a short right ileocolectomy. Only 156 similar diagnoses have been reported in the literature to date. This disease appears to have a benign course and therefore differs from classical Crohn's ileocolitis. For this reason, these patients do not require any specific investigation or follow-up.
The clinical manifestations of a diarrhoeic syndrome of horses with ulceration of the mucosae of the colon and caecum are described. Patients could be divided into three groups according to their presenting symptoms and the disease is probably caused by the thrombo-embolism associated with migrating larvae of Strongylus vulgaris. The differential diagnosis, prognosis and treatment are outlined with particular reference to the use of antithrombotic agents.
The Authors report a case of benign mucocele which was brought to their attention for emergency treatment. Following a review of the literature, they examine the clinical, anatomopathological, pathogenetic and therapeutic problems related to this rare disease. In conclusion, it is important to assess the benign nature or otherwise of the pathology before proceeding to the most suitable and radical form surgery.
Tyzzer's disease seems to be a not uncommon cause of diarrhoea in rabbits in Britain. It may occur either epizootically or enzootically in affected rabbit units. The more acute form may present difficulties in diagnosis.
A 9-year-old llama examined because of hind limb paresis was found to have parelaphostrongylosis. Despite treatment with ivermectin, fenbendazole, cimetidine, and ceftiofur, the llama developed gastrointestinal ulceration and pulmonary aspergillosis and was euthanatized. Parelaphostrongylus tenuis is a parasite of white-tailed deer, but ruminants can serve as aberrant or dead-end hosts after accidentally ingesting snails or slugs carrying third-stage larvae of the parasite. Gastrointestinal ulceration and pulmonary aspergillosis can develop secondarily in llamas with chronic disease. Treatment of gastrointestinal ulceration in llamas is difficult, because efficacy of commonly used antiulcer drugs in llamas has not been established.
Diverticulosis of the vermiform appendix, either single or multiple, congenital or acquired, is rather infrequent and usually asymptomatic. However, it may be complicated by flogosis configuring an acute abdomen hardly recognizable from an acute appendicitis not related to the diverticular disease. The Authors report a case of acute appendicular diverticulitis surgically treated. A brief review of the literature is also reported.
Right colon diverticulitis, representing 1-3.6% of cases of diverticular disease is an uncommon cause of right lower quadrant pain. Its presentation is difficult to distinguish from acute appendicitis. Patients are between 35 and 50 years old, have a history of 2-3 days of abdominal pain and few gastrointestinal symptoms. The diagnosis is best confirmed by computed tomography and colonoscopy. Conservative treatment is justified in uncomplicated disease, whereas perforations, abcesses and inflammatory tumors require resection. We describe the cases of six patients treated at our institution from 1991 to 1996. Presentation, geographic variations, diagnostic procedures and management are discussed.
Pseudo-obstruction of the colon (Ogilvie's syndrome) occurred in 18 patients as an acute abdominal emergency. It was characterized by massive distension of the caecum or the entire colon in the absence of any organic cause. Usually there was an underlying extraintestinal disease. Diagnosis of this entity depends on careful radiological investigation of the abdomen, whereby barium enema reveals the absence of organic obstruction. Increasing distension in untreated patients may lead to spontaneous perforation of the caecum.
A case of a malakoplakia of the appendix in a sixty-year-old woman is reported. No involvement of the organs or important general diseases were present and the patient, after the appendicectomy, promptly recovered. Only three cases of malakoplakia of the appendix have previously been described in the literature and they are briefly summarized.
Six patients with unusual inflammatory lesions of the colon are presented. Several of these cases demonstrated unusual presentations of an unusual disease. The clinical and radiologic features (which together are of paramount importance in suggesting the correct diagnosis) are discussed. Important differential diagnostic considerations are listed.
We have discussed a case of appendiceal diverticulitis diagnosed at laparotomy, and reviewed the histologic and clinical findings. Although infrequently encountered, appendiceal diverticulitis must be entertained in the differential diagnosis of pain in the right lower quadrant, especially in the adult patient.
This case report presents a rare complication of Crohn's disease in a 28-year-old presenting with an umbilicourachovesicoenteric fistula. Preoperative studies demonstrated communication of the umbilicus, bladder, ileum, and cecum. Preoperative nutritional support and en bloc resection with restoration of continuity primarily was performed with a successful outcome.