Torsion of the vermiform appendix: a case report.
This case report describes a rare condition, namely a torsion of the vermiform appendix. Its clinical condition is indistinguishable from acute appendicitis.
Adult↗
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Intussusception of the vermiform appendix: a preoperative diagnosis in an adolescent girl.
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.
Adolescent↗
Appendix interposition in the treatment of severe posterior urethral injuries.
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.
Animals↗
Diverticulosis of the appendix: radiographic and clinical features.
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.
Appendix↗
Use of the appendix for a catheterization stoma in partial quadriplegics.
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.
Adult↗
Asymptomatic intussusception of the appendix due to endometriosis.
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.
Adult↗
Gentamicin penetration into diseased appendix tissue.
Gentamicin concentrations in appendix tissue, serum, and peritoneal fluid were obtained in suspected cases of gangrenous or perforated appendicitis. Despite widely ranging gentamicin concentrations, no infectious complications developed. Correlations were made between the pathologic state of the tissue and the tissue gentamicin concentrations. Correlations were also made with tissue gentamicin concentrations and the time after the antibiotic dose to the time of sampling.
Adult↗
Torsion of the appendix mimicking ovarian torsion.
BACKGROUND: Appendiceal torsion is rare and generally seen more frequently in children than adults. Untreated it can lead to necrosis, ulceration, and subsequent peritonitis. CASE: A middle-aged female presented with a 5-day history of cramping abdominal pain and nausea and vomiting. Abdominal wall guarding and rebound tenderness was noted on examination. Computerized tomography showed an 8 x 4 cm mass anterior to the uterus, suggestive of degenerating fibroid versus ovarian dermoid cyst. Laparoscopy was performed for presumed ovarian torsion. Torsion of the appendix was discovered and treated by laparoscopic appendectomy. CONCLUSION: Patients with presumed ovarian torsion should undergo urgent laparoscopy for diagnosis and attempted ovarian salvage. The possibility of conditions that may require different surgical interventions, such as appendiceal torsion, should be considered.
Appendix↗
Neurosecretory cells of the lamina propria of the appendix and their possible relationship to carcinoids.
Carcinoid tumours of the appendix are generally thought to be derived from enterochromaffin cells; in-situ abnormalities of these cells are, however, rarely observed in the mucosal epithelium. One hundred appendices, removed consecutively at surgery, were stained with an alcian blue-PAS diastase-lead haematoxylin sequence and, in 69, cells were found in the lamina propria with a cellular and architectural morphology identical to those of an archetypal appendiceal carcinoid tumour. These cells appeared to contain neurosecretory granules, were diazo-positive and showed argentaffinity. They were further characterized by the localization of cytoplasmic neurone specific enolase and the presence of neurosecretory granules was confirmed by electron microscopy. These cells are designated subepithelial neurosecretory cells (SNC). It is suggested they are an integral component of the subepithelial nervous plexus and are in progenitors of appendiceal carcinoid tumours. A neuroectodermal origin of the SNC-and hence appendiceal carcinoid tumours-is proposed.
Appendiceal Neoplasms↗
Septa in the appendix: a previously undescribed condition.
A previously undescribed condition of the appendix, consisting of complete and incomplete septa is reported in 25 cases. The abnormality occurred in persons younger than 30 years. In all cases the lesion was found to be associated with acute appendicitis. Possible factors discussed with respect to aetiology and pathogenesis are: a congenital abnormality similar to intestinal atresia; post-inflammatory fusion of ulcerated, swollen mucosal folds; ischaemia caused by thrombosed vessels; mucosal folding in the process of expulsion of appendiceal contents.
Adolescent↗
The innervation and neuroendocrine cell population of the appendix in total colonic aganglionosis.
There is little published information on changes in the appendix in Hirschsprung's disease despite the presence within the mucosa of nerves and neuroendocrine cells together forming a 'neuroendocrine ganglion'. The innervation and neuroendocrine cell population of 11 appendices (two from patients with total colonic aganglionosis, six from patients with short segment Hirschsprung's disease and three normal controls) were examined using H & E, a standard Grimelius silver stain and immunocytochemistry for S-100 protein, neuron-specific enolase, neurofilament and synaptophysin. Compared with both normal and short segment Hirschsprung's disease controls, the total colonic aganglionosis appendices showed decreased numbers of nerve bundles around the muscle layers and within the submucosa, markedly decreased numbers of smaller fibres within the circular muscle and absence of the finer fibres within the lamina propria. There was no change in the overall number of epithelial neuroendocrine cells but subepithelial neuroendocrine cells, normally found in association with mucosal nerve fibres, were totally absent. The concomitant loss of nerve fibres and neuroendocrine cells from the lamina propria in total colonic aganglionosis suggests a different embryological origin for epithelial and sub-epithelial neuroendocrine cells.
Appendix↗
Diverticulosis of the appendix: a case report.
A case of diverticulosis of the appendix is described. The clinical significance is discussed.
Aged↗
Diverticular disease of the vermiform appendix and its clinical relevance.
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.
Appendix↗
Mucocele of the appendix with magnetic resonance imaging findings.
Mucocele of the appendix is a rare lesion caused by abnormal accumulation of mucus. Although preoperative diagnosis is important to avoid rupture of a mucocele, the diagnosis is often made at surgery. We report a case of an appendiceal mucocele that mimicked a hydrosalpinx on CT and MRI.
Appendix↗
Ileal atresia and absence of appendix.
A case of ileal atresia with absence of vermiform appendix in a female newborn is reported. At the region about 105 cm from the Treitz's arch, intestinal atresia was observed with an associated V-shaped deformity of the mesentery. Polyp-like protuberance was observed in the area a few centimeters from the blind end of the distal intestine. Histologically, keratinizing squamous cells, bile pigments, lanugo hair, and alcian-blue stained materials and cells were observed in the serosal layer of the tip of the proximal blind segment and mesenterium connecting to this portion. Thrombi were not observed in the mesenterium connecting to the proximal blind segment, gap segment, and distal blind segment. Squamous cells and lanugo hair were found in the green meconium taken from the large intestine. Polyp-like protuberance was surfaced by normal intestinal mucosa, and in its inside there were two layers consisting of folded muscular tissue. In this report, we describe the detailed pathology of ileal atresia and discuss its possible cause.
Abnormalities, Multiple↗
Torsion of the vermiform appendix: a case report and review of literature.
A case of torsion of the vermiform appendix is described. It is a rare cause of an acute abdomen with a clinical presentation that is indistinguishable from acute appendicitis.
Adolescent↗
Angiodysplasia of the appendix.
Angiodysplasia of the gastrointestinal tract is thought to be one of the most common causes of lower gastrointestinal bleeding in the elderly, and, in the majority of cases, lesions are located in the cecum or ascending colon. The authors report an extremely rare case of appendicular angiodysplasia. A 76-yr-old woman was hospitalized with massive recurrent red anal bleeding. Selective superior mesenteric arteriography revealed an extravasation of contrast material from the appendicular artery, and this finding proved to be bleeding from an angiodysplasia of the appendix. An appendectomy was performed, and anal bleeding did not recur postoperatively. A review of the literature revealed this to be an extremely rare case of angiodysplasia.
Aged↗
Flow cytometric DNA analysis of adenocarcinomas of the vermiform appendix. Brief report.
The DNA ploidy status and S-phase fraction of eight adenocarcinomas of the vermiform appendix diagnosed in Iceland during 1974-1990 were analyzed by flow cytometry. Four cases were classified as Dukes' stage B2 and four cases as Dukes' stage D. Seven tumors were diploid and one was aneuploid. The DNA aneuploid tumor was the only one which metastasized outside the abdominal cavity. The S-phase fraction in general was low. The results of this study do not indicate any significant correlation between ploidy status and clinical behavior.
Adenocarcinoma↗