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At least 109 records · Page 6Linked to original sources

Intussusception of the appendix with a calcified fecalith.

We treated a patient with a complete invagination of the appendix which contained one large laminated calcified fecalithy. Colonofiberscopy showed a dimpling submucosal tumor, which was palpated as a bony hard tumor at laparotomy. This finding suggested that the fecalith caused an intussusception of the appendix and that such an intussusception should be suspected when there is a bony hard dimpling submucosal tumor in the cecum.

Appendectomy

Adenocarcinoid of the vermiform appendix. A clinicopathologic study of 20 cases.

Adenocarcinoid of the appendix is a tumor that shares the histologic features of both carcinoids and adenocarcinomas. The metastatic ability of the tumor is uncertain. Twenty consecutive cases of adenocarcinoids were compared with 88 cases of conventional appendiceal carcinoids. Metastatic tumor spread was found in six of 20 cases of adenocarcinoids, but in none of the conventional carcinoids. Metastasizing tumors were characterized by a moderate to severe nuclear atypia and a high mitotic count. These features were present in only two of the nonmetastasizing tumors, one of which was treated by hemicolectomy. Adenocarcinoids showing moderate or severe nuclear atypia, a mitotic count of two or more mitoses/10 high power fields, or spread beyond the appendix should be treated by hemicolectomy. If these features are not present, simple appendectomy is adequate.

Adenocarcinoma

Diverticular disease of the appendix.

Diverticular disease of the appendix involves about 1 per cent of all appendices removed. Considering the large number, the subject appears to have been neglected in medical literature. Since the symptomatology is similar to that of appendicits and diverticula are frequently very small, they could go unnoticed. A comparison of 30 cases of diverticular disease and 30 cases of acute appendicitis reveals a few fine differences. The patients with diverticular disease are at least a decade older, the duration of pain in these patients is longer, and the diverticula and appendix may or may not be inflamed.

Adolescent

An unusual malformation of the vermiform appendix simulating endometriosis: a case report with discussion of differential diagnosis.

A 48-year-old nulliparous woman with a long history of pelvic endometriosis underwent a gynecologic operation, and a swollen and indurated appendix was removed because of suspected endometriosis. Pathologic examination revealed no endometriosis, but examination of the distal appendix showed structural disorganization of its entire wall, with lack of proper differentiation of its normal coats and irregular overgrowth of fibroadipose, fibromuscular, and neural elements. Differential diagnoses, including endometriosis, carcinoid tumor and neurofibromatosis, are discussed.

Appendiceal Neoplasms

Electron microscopic study of microfold cells (M cells) in normal and inflamed human appendix.

Electron microscopic observation was made on microfold cells (M cells) in the covering epithelium of the lymphoid follicle (dome epithelium) of the intestine. Materials consisted of ten human appendices, five of those were inflamed and obtained from children with acute appendicitis. The remainder was not inflamed macroscopically, and there was one human Peyer's patch for control. The results indicate that in the human appendix, the elevated surface type of M cells named by protruding apical cytoplasm to the lumen was more conspicuous than the depressed surface type. The latter type was named by shorter irregular microvilli than those of neighboring cells, and was present dominantly in human Peyer's patch. M cells with enfolded lymphocytes consisted of the stumpy type and the slim type in the whole shape. M cells in the inflamed appendix showed their apical cytoplasm swelling like a balloon and microfolds disappearing, and seemed vulnerable to inflammation. It is considered that the M cell surface structure changes not only in accordance with enfolded lymphocytes and the uptake of antigenic materials, but also according to the organ in which M cells are present and whether inflammation is present or not.

Acute Disease

Endometriosis of the appendix. Report of twelve cases and review of the literature.

Twelve cases of endometriosis of the vermiform appendix are discribed and reviewed. The incidence of 0.80 per cent is higher than has been previously reported. None of the patients displayed symptoms of acute appendicitis, however, five (42 per cent) patients had symptoms suggestive of chronic or cyclic appendicitis. Laboratory tests were nondiagnostic of this lesion. There did not appear to be a correlation between the histologic location of the endometriosis and the symptoms of chronic or cyclic appendicitis. All cases of endometriosis of the appendix were discovered as a result of incidental appendectomy.

Adult

Penetrating injuries of the appendix.

Although rare, penetrating injuries of the appendix pose an interesting finding at laparotomy. Associated penetrating gastrointestinal injuries are common. Four additional cases of trauma to the appendix from penetrating wounds are described.

Abdominal Injuries

Adenocarcinoma of the appendix.

Thirty-two patients with primary adenocarcinoma of the appendix were studied in this collective review. Immediate operation was performed in 21 patients with a diagnosis of acute appendicitis. At operation, tumor of the appendix was only identified in 50 percent of the 32 patients studied. Survival was unrelated to the histologic tumor type, but significantly correlated with the extent of tumor spread. Right hemicolectomy led to a significant increase in survival compared with appendectomy alone and to a significant decrease in risk of recurrence. In Dukes' B2 and C patients, differences in the survival curves were in favor of right hemicolectomy. Long-term survival was obtained by repeat laparotomy with resection of mucinous material in patients with pseudomyxoma peritonei.

Adenocarcinoma

Segmental aganglionosis of the appendix.

Ignoring the pathologist's dictum that the appendix is not reliable for the identification of ganglion cells in suspected cases of total colonic aganglionosis, the author (K.D.A.) performed an ileostomy in a child whose appendix contained no ganglion cells. The ascending colon was later found to be ganglionic. The appendices from 36 cases of Hirschsprung's disease were examined and the number of ganglion cells in 10 high power fields was compared with 10 appendices from patients who did not have Hirschsprung's disease. There were no ganglion cells in any of the patients with total aganglionosis of the colon. Twenty-two patients with Hirschsprung's disease involving the sigmoid colon had an average of 3.0 ganglion cells per high power field (range 0.5 to 5.1). Five patients with longer segment aganglionosis had 2.2 cells per high power field (range 0 to 4.1). The index case fell into this group and was serially sectioned without finding any ganglion cells. The control group averaged 3.41 cells per high power field (range 1.4 to 5.9). There was no significant difference between the control group and the groups with less than total colonic aganglionosis. It is speculated that this case represents segmental Hirschsprung's disease with the skip area in the ascending colon.

Appendix

Use of the appendix stump in the treatment of meconium ileus.

Three neonates with meconium ileus who failed to respond to non-operative measures were successfully treated by appendicectomy and irrigation with Gastrografin into the small bowel via the appendix stump. The meconium was emptied out and the stump ligated. This method avoids enterotomy, enterostomies or resection of bowel. The post-operative course is simplified and hospital stay decreased. Removal of the appendix precludes future disease of this organ which may be problematic in patients with cystic fibrosis.

Appendectomy

Appendix interposition of the ureter.

Under specific circumstances the appendix vermiformis may be an appropriate organ for plastic repair of a large ureteral defect. We report a situation in which all of the criteria were met and in which a long ureteral defect was bridged successfully with the appendix.

Aged

Continent appendix stoma: a modification of the Mainz pouch technique.

The submucosally embedded in situ appendix guarantees an ideal continence mechanism in patients with ileocecal urinary reservoirs. To date this modification of the Mainz pouch technique has been performed successfully in 13 patients. The appendicocutaneous stoma was placed at the lower right abdominal quadrant in 12 patients and into the umbilical funnel in 1. Urodynamic investigations of the submucosally embedded appendix showed a maximum closure pressure of more than 80 cm. water in pressure profiles. Only 1 case of stomal stenosis required reoperation.

Adult

[Differential diagnosis of cystic intra-abdominal lesions: mucocele of the appendix].

The sonographic appearance of a mucocele of the appendix in a 69-year-old woman is presented. The mucocele showed an atypical localisation in the right upper quadrant just below the gallbladder. This own observation is compared with other case reports in the literature. The value of ultrasound examinations in the diagnosis "mucocele of the appendix" is discussed.

Aged

[Preoperative diagnosis, pathologic anatomy and clinical significance of mucoceles of the appendix from the gynecologic viewpoint].

Owing to their proximity to the true pelvis and their topography, mucoceles of the appendix frequently cause clinical symptoms which call a gynecologic condition to mind. Sonographically, the structures of mucoceles are often similar to those of ovarian tumors. Within 12 months four patients with mucoceles underwent surgery at Heidelberg University Gynecological Clinic following diagnosis of a gynecologic disease (two tentative diagnoses of ovarian carcinoma, one of advanced ovarian carcinoma, one chance finding during Wertheim's operation). The problems of this rare condition are discussed with reference to the clinical findings, the intraoperative site, and the different morphology and maturity. Pathoanatomically and biologically, however, the clinical picture is not uniform. In mucoceles there is an accumulation of mucus with cystic dilatation of the lumen of the appendix. This is usually due to a tumor, which may be anything from a simple mucous membrane hyperplasia with extreme mucous formation, or an adenoma, to a mucilaginous adenocarcinoma. The rupture of a mucocele or metastasization of a carcinoma often lead to peritoneal mucous spread or peritoneal metastasization: in their patterns of distribution these are similar to a pseudomyxoma peritonei or a metastasizing ovarian carcinoma.

Aged

Radiological features of mucocele of the appendix.

The clinical features of mucocele of the appendix are nonspecific, and a correct preoperative diagnosis based on abdominal pain, a palpable mass in the right lower quadrant, and conventional radiography is rare. The diagnosis of appendiceal mucocele has become easier with the utilisation of the recent imaging techniques ultrasonography and computed tomography. Six patients with mucocele of the appendix are presented, and the characteristic radiological features and differential diagnosis are discussed.

Adult

Myxoglobulosis of the appendix.

Myxoglobulosis is a rare morphologic variant of appendiceal mucocele characterized by intraluminal mucinous globules of the appendix. Most reported cases have presented clinically as an acute abdomen or as an incidental laparotomy or autopsy finding. We report a case of myxoglobulosis in a 32-year-old man who presented with an extra-appendiceal mass following a 10-year symptomatic course. Laparotomy disclosed a pericecal collection of opaque, white globules originating from a perforated appendix walled off by fibrous adhesions. The globules exhibited some histologic and staining properties at variance with those described in previous reports. These findings suggest that myxoglobulosis may be more heterogeneous pathogenetically than the distinctive gross appearance of the lesion would indicate.

Adult

Endosalpingiosis of the vermiform appendix.

Endosalpingiosis within the muscularis propria of the distal vermiform appendix was discovered in an appendectomy specimen removed during exploratory laparotomy for inflammatory tubal disease. Endosalpingiosis has not been previously reported in the appendix. The pathogenesis and possible significance of this lesion are discussed.

Adult

Intussusception of the appendix in a patient with cystic fibrosis.

This case report describes the clinical presentation and the radiographic, endoscopic, and pathologic findings in a patient with cystic fibrosis (CF) and intussusception of the appendix. This is the first time that intussusception of the appendix has been documented in a patient with CF. This disorder should be considered in the CF patient with cramping lower abdominal pain or rectal bleeding.

Adolescent