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Congenital caecal cystic duplication presenting with caecal volvulus in an elderly woman.

Congenital caecal cystic duplication of the gastrointestinal tract usually present during infancy or young childhood. We have identified a patient who presented at 91 years of life with a caecal volvulus caused by a large communicating caecal cystic duplication. Review of the literature shows that caecal cystic duplications become symptomatic early when they cause complications, but until this report, volvulus was not a recognised presentation of caecal cystic duplication.

Aged↗

[Calcifying aortic valve stenosis and occult gastrointestinal hemorrhage (Heyde syndrome): description of 2 cases].

The coincidence of aortic valve stenosis and cryptogenic gastrointestinal bleeding usually from angiodysplasia of the cecum and ascending colon has been called Heyde syndrome. The pathophysiologic link between both remains unclear and may be due to subtle changes in plasmatic coagulation. There are some statistic and numerous casuistic reports, and recently the existence of the syndrome has been questioned. We describe two cases of aortic valve stenosis and cryogenic gastrointestinal bleeding in which bleeding subsided after replacement with a bioprosthesis. We give an overview of the current literature.

Aged↗

Lower abdominal inflammatory myofibroblastic tumor -an unusual presentation- a case report and brief literature review.

A 9-year-old girl presented with lethargy, malaise & chest pain. Her blood counts confirmed hypochromic microcytic anemia. She was prescribed iron supplements. Subsequently she was admitted to our hospital with fever and increasing chest and abdominal pain. She was treated with antibiotics, and a diagnosis of "early chest infection" was made. Over the following 2 weeks she failed to improve, and her anemia worsened. She was readmitted, and found to have a mass in her lower abdomen with pressure symptoms on her bowel and bladder. A white-cell scan showed increased uptake in right lower quadrant. An ultrasound and a CT scan confirmed a mass adjacent to her bladder. Needle biopsy showed it to be an unusual localization of an inflammatory myofibroblastic tumor (IMT) of cecum. A presentation with chest pain, fever, anemia and pressure symptoms was highly unusual of a lower abdominal IMT mass. She had a successful excision of the tumor, with resolution of her symptoms.

Abdominal Pain↗

Acute appendicitis after laparoscopic treatment of acute epiploic appendagitis.

Epiploic appendagitis (EA) is a rare cause of right lower quadrant (RLQ) abdominal pain. We report an unusual case of acute gangrenous appendicitis that developed after laparoscopic treatment of an EA. A 62-year-old man underwent laparoscopy for RLQ abdominal pain. EA was found and a resection was performed. The appendix, which was macroscopically normal, was left undisturbed. One week later, the patient was operated on for acute gangrenous appendicitis. Histologic examination separately confirmed both diagnoses. The definitive outcome was uneventful. The exact origin of this unusual case is unknown: Could acute appendicitis have been secondary to laparoscopic manipulation or initially missed? We conclude that acute appendicitis may be either missed or induced by laparoscopy for RLQ abdominal pain.

Abdomen, Acute↗

Prolonged abdominal wall pain caused by transfascial sutures used in the laparoscopic repair of incisional hernia.

The use of transfascial sutures in the laparoscopic repair of incisional hernia has considerably facilitated the accurate intraperitoneal placement and fixation of the synthetic mesh. The laparoscopic procedure has a number of advantages, including less morbidity and pain. Moreover, the use of a mesh prosthesis results in a low rate of hernia recurrence. Despite the benefits associated with this technique, several (minor) complications have been documented. Herein we describe a case of prolonged abdominal wall pain after laparoscopic hernia mesh repair that was caused by the use of transfascial sutures.

Abdominal Pain↗

Retained appendicolith after laparoscopic appendectomy: the need for systematic double ligature of the appendiceal base.

Appendicoliths are considered to be strong indicators of appendicitis and the complications of appendicitis. We report the case of a 29-year-old woman who underwent a laparoscopic appendectomy for appendicitis with an appendicolith. The appendix was divided with a single ligature at the appendiceal base, and an appendicolith escaped into the pelvis. Thereafter, the patient suffered recurrent pelvic abscess. The diagnosis of retained appendicolith was made by repeated CT scans that revealed a mobile spontaneous calcification within the abscess. This postoperative complication could have been avoided if a systematic division of the appendix had been performed between double ligatures.

Abdominal Abscess↗

Appendiceal mucocele. Contraindication to laparoscopic appendectomy.

Indications and contraindications to laparoscopic surgery continue to be refined. Laparoscopic appendectomy for acute appendicitis is frequently selected by patients and surgeons, and clinical studies show it to be a reasonable alternative. In this case study, laparoscopic surgery was used to resect an appendiceal mucocele caused by a nonperforated mucinous adenocarcinoma. Implants of mucinous tumor were found widely disseminated on peritoneal surfaces at laparotomy 9 months later. As a result of this case study, the authors suggest that when an appendiceal mucinous tumor is encountered at laparoscopy, a special situation requiring totally atraumatic appendectomy is indicated. This clinical situation should be considered an indication for conversion to open appendectomy. All appendiceal tumors, including the most benign-appearing adenomas, can result in diffuse peritoneal implantation. This is the first report of an appendiceal mucinous tumor resected by laparoscopy associated with subsequent diffuse peritoneal carcinomatosis. This patient presentation reaffirms that dissemination of cancer may be associated with laparoscopic resection of structures containing a malignancy.

Adenocarcinoma, Mucinous↗

Localized giant inflammatory polyposis of the cecum associated with distal ulcerative colitis.

This case report describes a 68-year-old man who presented with bronchiolitis obliterans organizing pneumonia (BOOP) and gastric carcinoma. During evaluation, including a colonoscopy, he was found to have distal colitis and a giant polypoid lesion in the cecum that was diagnosed as localized giant inflammatory polyposis (LGIP) by magnifying colonoscopy. The patient was treated over a period of 3 years without surgery, and the LGIP was reduced in size during the follow-up period. Magnifying observation was useful to distinguish LGIP from a neoplastic lesion.

Aged↗

Recovery from idiopathic thrombocytopenic purpura (ITP) following right hemicolectomy for mucocele of appendix.

A 61-year-old woman with a 2-year medication-free history of idiopathic thrombocytopenic purpura was referred to our hospital complaining of right lower abdominal pain. The platelet count was about 3-4x10(4)/mm3. This patient was diagnosed with mucocele of the appendix on computed tomography and colonoscopy. We performed only right hemicolectomy without splenectomy. The pathological diagnosis was mucinous cystadenoma of the appendix. The platelet count increased to 18.1x10(4)/mm3 on postoperative-day 7, and remained stable, at 20-24x10(4)/mm3, for 14 months after the operation. Platelet-associated immunoglobulin G decreased remarkably after the operation, to 30.2 ng/10(7) cells, from 240 ng/10(7) cells preoperatively. We describe the first case of recovery from idiopathic thrombocytopenic purpura following right hemicolectomy performed for mucocele of the appendix. Considering our patients clinical course, it is possible that mucinous cystadenoma of the appendix may have influenced the thrombocytopenia. Findings in this patient suggest that mucocele of the appendix may be associated with a new diagnosis and idiopathic thrombocytopenic purpura treatment.

Appendectomy↗

Nonrotation of the midgut with appendiceal mucocele in an adult.

Nonrotation of the midgut in adults and appendiceal mucocele are both rare pathological conditions. We report here the first case of nonrotation of the midgut associated with appendiceal mucocele. The patient was a 51-year-old man admitted to hospital with ileus. An upper gastrointestinal series and a barium enema revealed nonrotation of the midgut without midgut volvulus and with a mass in the ileocecal area. Laparotomy revealed an appendiceal mucocele adhering to the urinary bladder and the rectum. The mucocele had partly ruptured; yellowish mucinous material had entered the abdominal cavity, resulting in pseudomyxoma peritonei. Histological examination revealed a mucinous tumor of the appendix with borderline malignancy. In this patient, the ileus was caused by the appendiceal mucocele rather than being caused by nonrotation of the midgut.

Appendix↗

Adult intussusception due to lymphangioma of the colon.

We present herein a case report of adult intussusception due to lymphangioma of the colon. On May 27, 2000, a 39-year-old woman with right lower abdominal pain was admitted to our hospital. Preoperative imaging studies, by ultrasonography, computed tomography (CT), and barium enema examination, showed right colon intussusception with a multilocular cystic tumor as a leading point. Emergency operation was performed. During the operation, normograde ileocecal intussusception with a 9 x 6-cm soft submucosal tumor of the cecum was recognized. Ileocecal resection was performed, and the patient's postoperative course was uneventful. Pathological diagnosis of the resected specimen was a cystic type lymphangioma of the cecum. Recently, lymphangioma of the colon has been diagnosed more frequently by colonoscopy and endoscopic ultrasonography. However, only a few cases of colon intussusception due to lymphangioma have been reported in the literature to date. Large lymphangioma of the colon is rare, but it should be taken into consideration that it is one of the organic lesions that causes adult intussusception.

Adult↗

Ureteral metastasis from appendiceal cancer: report of a case.

We report a case of primary appendiceal cancer that metastasized to the ureter. The patient was a 51-year-old woman who complained of persistent left back pain and right lower abdominal pain. After a detailed examination she was diagnosed to have cancer of the appendix, multiple liver metastases, and left hydronephrosis. Since an obstruction of the ileocecum was obvious, she underwent an ileocecal resection and a resection of the spindle-shaped tumor invading the left ureter. Lymph node metastases were found at the root of the superior mesenteric artery. The spindle-shaped tumor was considered to be due to invasion of the appendiceal cancer to the left ureter. The patient died 5 months postoperatively.

Adenocarcinoma↗

Atresia of the ileocecal junction with agenesis of the ileocecal valve and vermiform appendix: report of a case.

Intestinal atresia involving the ileocecal region is a very rare intestinal malformation, and the presence or absence of the ileocecal valve influences its surgical management. We report the case of a male newborn with a provisional diagnosis of distal ileal atresia, in whom laparotomy revealed that the entire ileocecal region was atretic with an absent ileocecal valve and appendix vermiformis. We resected the dilated terminal ileum together with the atretic segment and performed an ileocolic anastomosis between the terminal ileum and the transverse microcolon without valve reconstruction. When last seen, 8 months after the operation, the baby was developing normally. Ileocolic anastomosis without valve replacement appears to be sufficient if an ileocecal valve is completely absent and only a short segment of the terminal ileum is lost.

Abnormalities, Multiple↗

The management of appendiceal mass in children: is interval appendectomy necessary?

In this study we aimed to show that performing interval appendectomy is unnecessary in the management of appendiceal mass in children. Between 1990 and 1996, 866 patients were treated for appendicitis. Abdominal ultrasonography (USG) was performed in patients who were admitted with abdominal pain, vomiting, and fever accompanying a mass in the right lower quadrant. Seventeen patients (12 boys and 5 girls, with a mean age of 9.5 years) with a mass in the appendiceal lodge and no abscess formation were treated conservatively. Appendectomy was performed on any patients with perforated or unperforated appendicitis who had an appendiceal abscess with a mass in the right iliac fossa. Three-agent antibiotic therapy was administered for at least 1 week. These patients were discharged after a mean hospital time of 9.7 days if regression of the mass was seen ultrasonographically. They were followed up for 1-60 months by physical examination and USG, and 11 of the 17 also underwent barium enema. USG demonstrated disappearance of the mass and barium enema showed a normal appendix in 10 of the 11 patients. No recurrent appendicitis was detected during follow-up for 1-7 years. This study shows that appendiceal masses that are perforated, but localized with no fluid content revealed by USG, can be treated conservatively even if they are detected late.

Adolescent↗

Cystic duplication of the cecum with segmental dilatation of the ileum: report of a case.

Duplication cyst and segmental dilatation are rare congenital anomalies of the gastrointestinal tract, both of which are known to result in intestinal obstruction. We describe herein a case of intestinal obstruction in a neonate, caused by a duplication cyst in the cecum. A small dilated segment of ileum was also present at the site where Meckel's diverticulum would be expected, which was not causing obstruction to the luminal contents. Although it is well known that either of these conditions may coexist with a number of congenital malformations, their concurrent occurrence has never been reported before.

Abnormalities, Multiple↗