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PubMedDate not supplied

Laparoscopic appendectomy in patients with endometriosis.

STUDY OBJECTIVE: To report the frequency and spectrum of histologically proved diseases of the appendix in patients undergoing laparoscopic surgery for chronic pelvic pain in conjunction with endometriosis in a tertiary referral center. DESIGN: Patient database with retrospective chart review (Canadian Task Force classification II-3). SETTING: University ambulatory endoscopic surgery center-tertiary referral center. PATIENTS: Two hundred thirty-one women. INTERVENTIONS: Appendectomy during laparoscopic surgery for endometriosis. MEASUREMENTS AND MAIN RESULTS: We reviewed the medical records of 231 patients who underwent appendectomy during laparoscopic treatment of endometriosis performed from January 1994 through July 2004. Of the 231 patients with pelvic endometriosis, concomitant appendiceal pathology was present in 115. CONCLUSION: The appendix may be involved and may contribute to pelvic pain in patients with endometriosis.

Adolescent↗
PubMed2005

Intussusception as a cause of bowel obstruction in adults.

BACKGROUND: Due to its unspecific presentation, intussusception is often diagnosed with delay in adults. METHODS: From 1986 to 2002, ten patients (men/women: 8/2, median age: 53.6 years) were managed for intussusception. Clinical, radiological and surgical management data were retrospectively analyzed. RESULTS: All patients presented with abdominal symptoms (pain: 10/10, nausea and vomiting: 3/10, diarrhoea: 2/10, "red-currant jelly stool": 2/10) during a median time of 8.3 months (2 days - 6 years) and with a trend for longer duration of symptoms for benign compared to malignant underlying disease (2 years vs 1 month). Two cases had developed acute bowel obstruction at the time of surgery. CT-scan was always performed, with correct diagnosis in seven cases. Ultrasonography (4/10), contrast enema (5/10) or coloscopy (4/10) either missed the intussusception or served merely to confirm the CT diagnosis. At surgery, an underlying lesion (six malignant and four benign tumours) was identified and removed in all cases (four small bowel, three right colon, two ileocaecal and one left colon resections). Eight were undiagnosed previously. CONCLUSIONS: Intussusception is rare in adults, but should be considered in cases of chronic or acute bowel obstructions. Early surgical management allows detection and potential cure of underlying tumours.

Abdominal Pain↗
PubMed1995

[Acute diarrhea in horses with special regard to salmonellosis and typhlocolitis].

Casuistics of 200 patients with acute diarrhea (72 horses with salmonellosis, 55 horses with typhlocolitis, 73 horses with unspecific diarrhea) have been analyzed. It was shown, that horses with salmonellosis have been fallen ill with a primary disease for a longer period of time before the beginning of diarrhea than those with typhlocolitis and that in cases of salmonellosis antibiotics very often were used during the preliminary treatment. Frequently a primary illness of the colon was seen with typhlocolitis. Besides the frequent use of butylscopolamin during the pretreatment was noticed. The clinical and laboratory parameters showed many differences between the three groups of patients as well as a dependency on the course of healing. Particularly it was important, that horses with salmonellosis had fever and a leukopenia at the beginning of diarrhea, while in horses with typhlocolitis a leukopenia without fever at the beginning of diarrhea was seen, whereas fever only appeared a few days later in moribund patients. Finally an evaluation of the therapies was carried out.

Animals↗
PubMed1987

Diverticular disease of the cecum and ascending colon. A review of 881 cases.

A total of 881 cases of diverticula of cecum and the ascending colon were reviewed, including 30 new cases at the authors' institution. The average patient age was 43.6 years. The preoperative diagnosis was correct in only 7 per cent of the cases. Appendicitis accounted for 68 per cent of the preoperative diagnoses. Even at the time of surgery, the diagnosis was correct in only 58.7 per cent. Carcinoma was incorrectly diagnosed in 37.2 per cent. Operative procedures varied markedly. Diverticulectomy was performed in 28.2 per cent of the cases, 3.6 per cent had invagination of the diverticula, and 37.6 per cent had right hemicolectomy. The overall mortality rate was 2.5 per cent. The authors advocate local resection of the diverticulum, when possible, and a right hemicolectomy or segmental resection when the diagnosis is in doubt or when local resection or invagination will jeopardize the ileocecal valve or the blood supply to the intestine.

Adolescent↗
PubMed1983

The effect of ileotransversostomy on carrageenan-induced colitis in guinea pigs.

By oral administration of degraded carrageenan a colitis-like disease can be induced in guinea pigs which almost exclusively affects the caecum. To study the effect of degraded carrageenan on the distal colon and rectum, an ileotransversostomy was performed. In the non-operated group of animals ulcerative lesions and changes in the mucosal surface structure were observed only in the caecum and proximal colon after administration of degraded carrageenan. Animals with ileotransversostomy had similar lesions, but the distal colon and rectum were also severely affected, with formation of crypt abscesses in the rectum. This study indicates that the long transit time in the caecum, which enables bacterial decomposition and/or absorption of degraded carrageenan, is the reason that only the proximal colon is affected in non-operated animals. After ileotransversostomy degraded carrageenan reaches the distal colon in an active form that produces ulcerative changes.

Animals↗
PubMed1998

Changing diagnostic and therapeutic approaches to the 'Ogilvie syndrome'.

The only thing that has remained unchanged about the genuinely described 'Ogilvie syndrome' is its name. Recently it was considered to be an acute colonic pseudoobstruction, a clinical entity mimicking the mechanic ileus of the distal large intestine, without organic obstruction. It is almost always secondary to other diseases. Not all details of the pathogenesis are known, but it has become clear that the direct factor leading to the disturbance of the motility is a vegetative imbalance. X-ray findings are highly characteristic and critical in the planning of treatment. The danger for the patients is the progression of the state or the long duration of the process. Conservative treatment is suitable only for early cases, without complications. In case of failure non-invasive endoscopic or endoscopically assisted minimally invasive procedures may be mandatory. These methods have seen rapid advance in recent years. Uncertain diagnoses or complications call for open surgery. Cecostomy is the solution of choice anyway. The mortality is high in this group of elderly polymorbid patients. Authors compare six of their cases with data collected from the literature.

Adult↗
PubMed1997

Fecal incontinence in children: treatment with percutaneous cecostomy tube placement--a prospective study.

PURPOSE: To evaluate the technique used for and long-term results of percutaneous cecostomy tube placement for the treatment of fecal incontinence in children. MATERIALS AND METHODS: After an initial pilot study in 15 patients, 42 additional patients with fecal incontinence aged 2-20 (mean, 11.5) years and weighing 9.9-109.0 (mean, 39.2) kg underwent percutaneous cecostomy tube placement. Twenty-nine patients had spina bifida, nine had imperforate anus, three had cloacal anomalies, and one had Hirschsprung disease. Mean follow-up was 265 days (range, 8-503 days). RESULTS: Tube placement was successful in all patients. One patient developed local inflammation after accidental early retention-suture removal, which was treated with suture replacement and intravenous antibiotics. Another developed postprocedural ileus, which resolved. Late complications included constipation in one patient (treated with diet alteration), granulation tissue in seven patients (treated with silver nitrate cautery), and accidentally dislodged tubes in three patients (two successfully replaced at home and one replaced at the radiology suite). Vomiting related to the phosphate enema occurred in two patients. Resolution of soiling was achieved in all patients. CONCLUSION: Percutaneous cecostomy and antegrade enemas are very successful in achieving fecal continence and patient independence and acceptability, with minimal early and late complications.

Adolescent↗
PubMed2004

[Appendiceal mucocele].

Appendiceal mucocele is a rare condition encountered it only 0.07-0.4% of all appendectomies. The male to female ratio is 1:4 and an average age at the time of diagnosis is over 50 years. Mucocele of the appendix is defined as appendiceal obstruction leading to lumen distension with accumulation of mucoid material. The disease ranges from benign forms to malignant cystadenocarcinoma. The cause of the obstruction may be classified based on histology into four groups. These groups include simple mucocele, mucosal hyperplasia, cystadenoma, and cystadenocarcinoma. Abdominal ultrasound and CT scan may suggest the diagnosis. The authors discuss two cases of simple appendiceal mucocele. A 48-year-old man presented with acute right lower quadrant pain. Ultrasound examination was performed and the structure in the right iliac fossa was reported as an periappendiceal abscess. The patient underwent acute exploratory laparotomy, which revealed an appendiceal mucocele filled with gelatinous material. It was performed ileocoecal resection. A 65-year-old man presented with abdominal distension and discomfort of several week duration. At laparotomy, a smooth cystic tumor of the appendix was found. This patient underwent appendectomy alone. Pathology revealed an simple appendiceal mucocele.

Aged↗
PubMed2003

[Short bowel ileus due to a stenotic ileocecal tumor of tuberculous origin].

Abdominal tuberculosis is a rare disease. Therapy usually consists in drug treatment while surgery is only performed in complicated cases. We report on a 75 year-old man who presented with clinical and radiologic signs of bowel obstruction. The patient complained of weight loss and B-symptoms. There was a history of drug treatment for tuberculosis of the neck and throat in the medical department four weeks prior to admission. Intraoperatively a coecum stenosis was found due to a large tumor that macroscopically appeared with a diffuse carcinomatosis of the peritoneum. A right hemicolectomy was performed. Histopathology findings revealed a granulomatous inflammation with epithelioid cells. Signs of peritoneal carcinomatosis were not seen. The patient recovered well after an additional tuberculostatic treatment and was discharged after 14 days. At present he is free of symptoms. Even after tuberculostatic treatment lymphatic tuberculosis might show signs of progression that can lead to an abdominal presentation.

Aged↗
PubMed2000

Large bowel volvulus in childhood.

BACKGROUND: Large bowel volvulus is extremely uncommon in children. The probable pathogenesis, predisposing factors and management of large bowel volvulus in children are debatable. METHODS: Seven consecutive cases of large bowel volvulus occurring over a 6-year period are reported. RESULTS: Two patients with caecal volvulus, one with transverse and subsequent sigmoid volvulus, one with transverse colon volvulus and three children with sigmoid volvulus are reported. Four girls and one boy with cerebral palsy, one female with Moya Moya disease and spastic paraplegia and an otherwise healthy boy presented at a mean age of 8.3 years (range: 3-15 years). The common presentation was abdominal distension (n = 6), tenderness (n = 6), constipation (n = 7) and bloody mucoid discharge per rectum (n = 6). Plain abdominal X-ray and barium enema were diagnostic. Resection with primary ileocolic, colocolic or colorectal anastomosis was performed in all cases. The mean follow-up was 3.4 years (range: 1-6 years) and there was no mortality. CONCLUSIONS: Large bowel volvulus in children may be due to congenital anomalous or absent ligamentous fixation of the large bowel, and abnormal mesocolon or a common ileocolo-mesentery. Large bowel obstruction due to volvulus must be considered in the differential diagnosis in a child presenting with constipation associated with bloody mucoid discharge per rectum. Resection of the involved segment and primary anastomosis is the definitive treatment for large bowel volvulus in children.

Adolescent↗
PubMed2002

Management of appendiceal masses.

OBJECTIVE: To evaluate the outcome of patients treated for appendiceal abscess, and managed either conservatively or surgically, and to describe the short and long-term outcome as well as incidence of interval appendicectomy in those treated conservatively. DESIGN: Retrospective study. SETTING: University hospital, Sweden. PATIENTS: Ninety-three patients with the diagnosis of appendiceal abscess, 50 treated conservatively and 43 who were operated on, with a mean age of 46 (14-93) years. Mean (range) follow-up for patients operated on was 65 (11-135) and for those treated conservatively 66 (6-136) months. MAIN OUTCOME MEASURES: Course of acute disease, recorded complications, recurrence of appendicitis and incidence of interval appendicectomy during follow-up. RESULTS: The duration of pain before admission was 4 (0.5-82) days for those operated on and 7 (2-60) days for those treated conservatively. A palpable mass was more common in the conservatively managed group. Complications were common among patients who were operated on. No interval appendicectomies were done during the second half of the study period. 4 of the patients treated conservatively (8%) had an underlying tumour diagnosed at follow-up. CONCLUSIONS: Operative management of patients with appendiceal masses seems to be associated with a high risk of postoperative complications and the risk of a more extensive surgical procedure. If possible, a conservative approach should be advocated. Because of inaccurate radiological imaging during the acute phase and the risk of an underlying malignancy, routine follow-up is necessary. Routine interval appendicectomy cannot be recommended.

Abscess↗
PubMed1991

Diagnosis and management of vesicoenteric fistulas.

Vesicoenteric fistulas represent challenging clinical problems and may be characterized by difficulty in diagnosis as well as controversy in management. We present our experience with 56 patients with vesicoenteric fistulas. The results of our series were compared with a report of 1,100 in the literature during the past 20 years. Fecaluria (48 per cent), abdominal pain (43 per cent) and pneumaturia (41 per cent) were the most common presenting symptoms among the patients we studied. Fistulas were most frequently attributable to diverticulitis (52 per cent), Crohn's disease (18 per cent), carcinoma of the colon (11 per cent) or other pelvic malignant conditions (9 per cent). The most accurate diagnostic modalities in our series were cystoscopy (88 per cent), cystography (56 per cent) and barium enema (32 per cent). The combined findings of these studies led to the diagnosis of a fistula in all patients. Intravenous urography, intestinal endoscopy and computed tomography were less useful, providing a diagnosis in only 5, 6 and 11 per cent, respectively. Surgical treatment was single staged in 57 per cent and multistaged in 35 per cent, while 8 per cent of the patients underwent intestinal diversion only. Comparison of the single versus multistaged approaches revealed that the total complication rate, frequency of additional procedures, rate of infectious complications and length of hospitalization were no higher for the single stage group. Based on these findings, we advocate single stage repair, except in those patients who have unusual complications.

Barium Sulfate↗
PubMedDate not supplied

[A case of intestinal occlusion caused by endometriosis of the cecum].

The purpose of this study is to heighten awareness of intestinal endometriosis, a disease that may mimic other abdominal pathologies (bowel carcinoma, intestinal inflammatory disease, diverticulitis), sometimes found in the emergency setting. The Authors report a case of acute bowel obstruction due to coecal endometriosis with appendix mucocele, peritoneal pseudomyxoma and ovarian endometrioma. The patient was operated on in the emergency setting, a right colectomy was performed and she then received pharmacological suppressive treatment with Gn-RH analogues and danatrol. We remark that preoperative diagnosis is very difficult in those cases that do not have a past history of pelvic endometriosis. An accurate anamnesis regarding the chronology of pain onset (typically only during the menstruation at first), but especially intraoperative histopathologic examination are useful for diagnosis. An increased awareness of intestinal endometriosis in reproductive age women with acute bowel obstruction, associated with an accurate anamnesis of menstrual history may allow pre- or intraoperative diagnosis, which is the clue to a less aggressive operation. Postoperative follow up and hormonal therapy are mandatory.

Adult↗
PubMed2002

[Unusual retrovesical cystic lesion: appendiceal mucocele].

OBJECTIVE: Retrovesical cystic lesions are uncommon, although its incidence is growing due to the use of current diagnostic techniques. Its clinical features are unspecific and can mimic other conditions of the lower urinary tract making the differential diagnosis of this disease entity is difficult. A case of appendiceal mucocele, an unusual retrovesical lesion, is presented. METHODS/RESULTS: A 9 x 14 cm right retrovesical cystic lesion suggestive of a seminal vesicle cyst was detected in a 57-year-old patient with polyalkyuria. The patient was symptomatic, therefore surgical exploration was performed and the lesion was resected. The histological analysis of the surgical specimen demonstrated an appendiceal mucocele with no signs of atypia. The literature is reviewed, with special reference to the diagnostic and therapeutic aspects of this lesion. CONCLUSIONS: We underscore the need to utilize the diagnostic armamentarium (transrectal US, CT, MRI, deferens vesiculography, urethrocystoscopy, colonoscopy, opaque enema, IVP, etc.) to identify retrovesical cystic lesions. Preoperative diagnosis is necessary in appendiceal mucocele to avoid rupture during the surgical procedure and prevent peritoneal pseudomyxoma. Occasionally, however, the definitive diagnosis of these retrovesical lesions can be made only by punction biopsy or surgical exploration.

Appendectomy↗
PubMed1993

Retrospective analysis of the results of 151 exploratory laparotomies in horses with gastrointestinal disease.

Of 149 horses that underwent 151 exploratory laparotomies for gastrointestinal disorders from September 1987 to May 1991, 107 (72%) were discharged from the hospital: 100 (66%) survived for > 7 months, 94 of which returned to their intended use. Survival rate (64/80) for horses with caecum/large colon obstruction was significantly (P = 0.003) higher than for horses with small intestinal obstruction (33/64). Prolonged surgery was associated with significantly (P < 0.001) lower survival rates than short surgical time. In the large intestine, survival rate (15/29) for strangulated obstructions was significantly (P < 0.001) lower than for simple obstructions (52/58). Generalised septic peritonitis (9 horses) and bowel obstruction associated with adhesions (8 horses) were the most frequent fatal post-operative complications. The rate (6/44) of post-operative adhesions after small intestinal obstruction was significantly (P = 0.006) higher than that (2/68) following large intestinal obstruction. The rate (8/55) of post-operative adhesion formation in horses that required enterotomy/enterectomy was significantly (P = 0.003) higher than that (0/57) in horses that did not require gut wall incisions. Incisional suppuration developed in 42 horses and occurred with a significantly (P = 0.028) higher rate (32/72) after caecum/large colon lesions than after obstruction at other sites, (10/42) but was not associated with known contamination at the time of surgery (P = 0.806).

Animals↗
PubMedDate not supplied

Appendiceal mucocele: sonographic findings.

BACKGROUND: Appendiceal mucocele (AM) is a relatively rare disease, and its sonograms (US) have not been sufficiently analyzed. METHODS: We studied the US findings of five patients with AM, with special attention to AM size, shape, internal echoes, and the mode of back echoes. RESULTS: All five cases showed an elongated mass in the lower right abdomen. Internal echoes were present in all cases and M-mode US confirmed the movement of those echoes. The echogenecity of the lesion changed according to the frequency of the transducer used. Only one case showed posterior echo enhancement, and no case showed lateral shadowing. CONCLUSION: AM appears as an elongated echo-poor mass without posterior echo enhancement. The cyst wall is less distinct than what one would expect for a cyst. When encountering such a mass in the lower right abdomen, one should strongly suspect an AM. In such cases, appropriate diagnostic and therapeutic strategies are especially necessary to prevent rupture that results in development of pseudomyxoma peritonei.

Aged↗
PubMed2004

Primary epithelial neoplasms and other epithelial lesions of the appendix (excluding carcinoid tumors).

Epithelial tumors of the appendix range from low-grade mucosal-based tumors which, when confined to the appendix, have an excellent prognosis but, once outside the appendix, have a fair prognosis and often a prolonged disease course, to high grade invasive carcinomas that are rapidly fatal. Low grade mucinous neoplasms may rupture and spread to the peritoneum as pseudomyxoma peritonei, and the nomenclature of these tumors has been the subject of considerable disagreement among pathologists; the designation "low grade appendiceal mucinous neoplasm" has recently been proposed for reasons discussed herein. Demonstrating rupture of these neoplasms may require particularly diligent gross and microscopic evaluation as the rupture site often heals over leaving only subtle evidence of its presence. Invasive adenocarcinomas are often mucinous and may also spread to the peritoneum. Against this backdrop, the clinical and pathologic features of low grade appendiceal mucinous neoplasms and mucinous adenocarcinomas, as well as other types such as typical colorectal type and signet-ring cell type, are reviewed. In addition, emerging entities, serrated polyps and serrated adenomas, whose significance is only beginning to be understood, are considered. Retention cysts, hyperplastic polyps, and diffuse mucosal hyperplasia, although not necessarily neoplastic, are reviewed here as they may enter into the differential diagnosis of appendiceal mucinous neoplasms.

Appendiceal Neoplasms↗
PubMedDate not supplied

[Ileocecal tuberculosis during hemodialysis simulating carcinoma of the colon].

Extrapulmonary tuberculosis is more frequent in hemodialysis patients than in the general population but intestinal localization is an unusual presentation of this infectious disease. We report a 60 year old patient on regular hemodialysis with intestinal tuberculosis masquerading as colon cancer. The patient presented with rectal bleeding, abdominal pain and fever and the radiological findings were compatible with ileocecal carcinoma. After surgery histological examination showed non-caseating granulomas but mycobacterial culture was not available. We performed a colonoscopy and obtained a biopsy of colonic mucosa for culture and other analyses. We identified acid-fast bacilli with Ziehl-Neelsen staining of formaldehyde preserved, paraffin-embedded tissue from the hemicolectomy and the colonic mucosal biopsy. Treatment with isoniazid, rifampicin and pyrazinamide for nine months was successful and well tolerated. Intestinal tuberculosis is a rare entity that we must keep in mind in a patient with abdominal pain, unexplained fever, digestive bleeding and particularly with a positive tuberculin reaction. When culture is not possible we can obtain intestinal samples by colonoscopy and use appropriate staining of paraffin-embedded tissues.

Adenocarcinoma↗