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PubMed1983

Diverticula of the vermiform appendix. Alternatives of clinical presentation and significance.

The vermiform appendix can be the site of development of diverticula which may suffer either inflammatory complications with or without appendicitis or may only be an incidental finding in an uninflamed appendix. This is a retrospective study of 10 of 575 cases of consecutive appendices removed and examined within a year, with single or multiple appendiceal diverticula with diverticulitis and peridiverticulitis. In six of the 10, the lumen of the appendix did not show any inflammatory changes. In conclusion, one could assume that inflammatory complications of the appendiceal diverticula, although they may mimic acute appendicitis, are quite distinct clinical entities. Acute appendicitis in the presence of appendiceal diverticula may carry an earlier and higher rate of perforation and appendiceal diverticula, as an incidental finding, may justify appendectomy on occasion.

Adolescent↗
PubMed1989

Melanosis coli. Prevalence, distribution, and histologic features in 200 consecutive autopsies at Kuopio University Central Hospital.

The occurrence of large-bowel melanosis was evaluated by microscopy in 200 large bowels at autopsy. Melanin was seen as yellow-brown pigment in the macrophages of the lamina propria. The pigment stained with diastase-alcian blue PAS, Fontana, and iron stains. One hundred nineteen of 200 (59.5 percent) bowels showed melanosis, which was equally common in both sexes. Usually more than one segment was involved (most commonly, four segments). Melanosis was common in the proximal part of the colon, but much rarer in distal parts (sigmoid and rectum). Affected segments were successive; negative segments between positive ones were exceptional. If the rectum was affected, all five proximal segments were affected in 11 of 12 cases. The intensity of melanosis was directly related to the number of segments involved. In the oral part of the colon, affected males had a higher intensity of melanosis than affected women, but about the same intensity in the sigmoid and rectum. The fraction of patients with melanosis increased with age. Of men and women in the age group of 20 to 54 years, 32 and 44 percent were affected, and above the age of 75 years, 76 and 67 percent, respectively.

Adult↗
PubMed1984

Cecal volvulus. Low mortality at a city hospital.

The case records of 12 patients with cecal volvulus over a 20-year period were reviewed. The patients averaged 46.7 years old; 75 per cent were white and 67 per cent were male. Patients presented with signs and symptoms of intestinal obstruction. Pain and distention were present in more than half of the patients. X-rays assisted in making the diagnosis of cecal volvulus in only five of the patients. Diagnosis was made in the remainder at the time of surgical exploration. At operation, one cecum was necrotic and required resection. Five patients underwent cecostomy, two cecopexy, and four simple detorsion. Post-operatively, one patient developed a wound infection. There were no deaths. Follow-up for seven patients averaged 75 months each. One patient who had undergone simple detorsion developed another cecal volvulus. All who were contacted were alive and well. At St. Luke's Hospital, cecal volvulus generally occurs in middle-aged white males. Cecostomy or cecopexy adequately treats cecal volvulus when the cecum remains viable. This study demonstrates that prompt surgical intervention, before strangulation of the colon occurs, results in low mortality even in city hospital patients.

Adult↗
PubMed1987

Cecal diverticulitis. A review of the American experience.

The etiology of cecal diverticulitis remains unclear. The majority of diverticula are solitary and probably false and may be the result of the same degenerative process seen in the more common left-sided diverticulosis. A minority are true diverticula and may be of congenital origin. Cecal diverticulitis is clinically indistinguishable from acute appendicitis although patients with cecal diverticulitis tend to be older (average age, 40 years), have a longer duration of symptoms, and present less often with nausea and vomiting. In patients with previous appendectomy and in those with more indolent symptoms, barium enema may be helpful in making the diagnosis. If nonoperative treatment is chosen, careful follow-up with air contrast barium enema and colonoscopy should be carried out. The majority of patients require surgery and two types of cecal diverticulitis are encountered at laparotomy. The usual type, accounting for two thirds of cases, is easy to recognize, has an inflamed projection from the cecal wall, and is dealt with by a limited local diverticulectomy. Some authors advocate nonsurgical treatment for this first group of patients. Incidental appendectomy is advocated to avoid confusion should symptoms occur postoperatively. The hidden variant presents as a large, indurated phlegmon and is difficult to distinguish from a perforated cecal carcinoma. With the hidden variant, right hemicolectomy is the surgical treatment of choice and carries a 1.4 percent mortality.

Cecal Diseases↗
PubMed1987

Percutaneous drainage of appendiceal abscess. An alternative to conventional treatment.

Twenty-seven consecutive patients with ultrasonically verified appendiceal abscesses, measuring from 2 to 10 cm in diameter, were studied. Ultrasonically guided percutaneous drainage was performed in 19 by means of one to five punctures, and in eight with one or two catheters. In 16 and 7 patients, respectively, the abscesses resolved without further intervention. Four patients were operated on, two for suspected (but unverified) abscess perforation, one for bowel obstruction, and one because of failed drainage, resulting in a success rate of 85 percent. Hospitalization ranged from 3 to 23 days; however, normal sonograms were not obtained until after nine to 62 days. Follow-up revealed no diagnostic errors. Two patients (8 percent) had recurrent appendicitis, and late sequelae were observed in four patients, three of these after surgery. Ultrasonically guided percutaneous drainage of appendiceal abscesses with the technique described is indicated whenever feasible, as a safe, gentle, and relatively atraumatic procedure with few complications and late sequelae.

Abscess↗
PubMed1987

Solitary diverticulum of the cecum and right colon. Report of six cases.

Diverticulum of the cecum is a rare, benign, generally asymptomatic lesion that manifests itself only following inflammatory or hemorrhagic complications. A personal series of six cases discusses the difficulty of differential diagnosis at both the preoperative and intraoperative levels. The preferable treatment is simple resection.

Aged↗
PubMed1986

Paracecal hernia: a cause of intestinal obstruction.

During a two-year period, five patients were treated by us for acute intestinal obstruction caused by an incarcerated paracecal hernia. All patients underwent surgery early, so none required bowel resection. The possibility of an internal hernia as a cause of intestinal obstruction and a profound knowledge of the pericecal anatomy, however, are necessary for successful diagnosis and treatment of paracecal hernias.

Adult↗
PubMed1986

Pseudomyxoma peritonei. A localized, benign variant of appendiceal origin.

A case of a huge, self-contained cyst of pseudomyxoma peritonei arising from the rupture of a benign cystadenoma of the appendix is reported. Curative surgical removal involved both small bowel and right colon resection. The pathologic spectrum of the appendiceal mucoceles, from mucosal hyperplasia to benign cystadenoma and malignant cystadenocarcinoma, is presented. The variants of pseudomyxoma peritonei (benign-malignant, localized-diffuse) are discussed and correlated with the appendiceal lesions. Clinicopathologic relationships and treatment options also are covered.

Appendiceal Neoplasms↗
PubMed1986

Calcified rims. Uncommon radiologic finding and potential pitfall due to organization of deposits of oyster shell tablets.

In a patient undergoing double-contrast barium enema (DCBE) for evaluation of recent onset of diarrhea, a curvilinear strand of calcifications outlining a filling defect of the cecum, initially thought to represent a neoplasm, later was discovered to be due to precipitation and organization of orally ingested calcium in an adherent fecalith. Colonoscopy and repeated x-ray evaluation avoided the pitfall. This case illustrates the need for analysis and correlation of the type of calcifications characterizing a mass in light of the clinical history. Errors in interpretation can be avoided by asking the patient about oral medications and obtaining delayed films. Colonoscopy may be the diagnostic test in doubtful cases.

Aged↗
PubMed1983

Major hemorrhage and perforation due to a solitary cecal ulcer in a patient with end-stage renal failure.

A case of solitary cecal ulcer with major hemorrhage followed by perforation after treatment with intra-arterial vasopressin in a patient with end-stage renal failure is presented. Though vasopressin has been used with success in the treatment of colonic hemorrhage, caution should be applied in patients with a bleeding cecal ulcer as the vasoconstriction produced by vasopressin may cause perforation in an area whose blood supply is already compromised.

Cecal Diseases↗
PubMed1983

Colonoscopic decompression and intubation of the cecum for Ogilvie's syndrome.

Cecal distention due to pseudo-obstruction of the left colon may result in perforation or necrosis of the right colon with catastrophic consequences. This problem occurs in people who are ill from other causes; therefore, the mortality and morbidity is high in Ogilvie's syndrome whether treated operatively or nonoperatively. The treatment of choice has been tube cecostomy when cecal diameter exceeds 12 cm on supine films. Fiberoptic colonoscopy has provided a new treatment modality for this condition. The cecum can be decompressed safely in most cases. Recurrent distention can be avoided by transanal intubation of the cecum. A case is discussed, and the technique of cecal intubation is described.

Cecal Diseases↗
PubMed1982

Benign ulceration of the cecum presenting with massive hemorrhage: report of a case and review of the literature.

Massive gastrointestinal hemorrhage secondary to benign cecal ulceration is a rare occurrence. The diagnosis of bleeding from this benign condition is rarely entertained and is often a finding on a pathologic examination. A case of massive hemorrhage from a cecal ulcer is presented, and the literature is reviewed. The role of angiographic demonstration of the lesion, if angiography is readily available, is emphasized, but surgery is the definitive therapy.

Cecal Diseases↗
PubMedDate not supplied

Nonspecific ulcers of the colon.

Two cases of nonspecific cecal ulceration are presented. The lesions tend to occur in the right colon, produce pain or bleeding, and generally are best managed surgically. Etiology of the ulcers is unknown, but a vascular theory of origin is favored.

Adult↗