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Wiadomosci Lekarskie (Warsaw, Poland :... 2021The authors have analyzed medical histories of two patients, treated in health care facilities of Kharkiv region from 2008 to 2020. These patients underwent urgent...
The authors have analyzed medical histories of two patients, treated in health care facilities of Kharkiv region from 2008 to 2020. These patients underwent urgent appendectomy, given the existing clinic of acute appendicitis. Morphological examination of the surgical material allowed us to diagnose adenocarcinoma in one case, and neuroendocrine tumor in combination with endometriosis in the other case. Morphological examination of the surgical material in the first case revealed a moderately differentiated adenocarcinoma and diffuse neutrophilic infiltration in all layers of the appendix, and in the second case - a well-differentiated neuroendocrine tumor (G3), combined with the signs of phlegmonous-ulcerative appendicitis and loci of endometriosis. In both cases, there were no specific for the oncological process anamnestic and clinical-instrumental data, and these tumors were manifested by the clinic of acute appendicitis. Only morphological examination of the surgical material allowed identifying the pathological process. Clinical and morphological analysis of cases from the practice of malignant tumors of the appendix (neuroendocrine tumor and adenocarcinoma) will be useful and interesting for the medical community and should stimulate cancer vigilance in physicians.
Topics: Adenocarcinoma; Appendectomy; Appendiceal Neoplasms; Appendicitis; Appendix; Female; Humans
PubMed: 34090305
DOI: No ID Found -
ANZ Journal of Surgery Apr 2022The cause of appendicitis is unknown. A review is presented across diverse sources relating to the biology of the appendix and its perturbations. A mechanistic model of...
The cause of appendicitis is unknown. A review is presented across diverse sources relating to the biology of the appendix and its perturbations. A mechanistic model of the function of the appendix is presented, and its application to the syndromes and consequences of appendicitis is described.
Topics: Appendicitis; Appendix; Humans; Immunity, Mucosal; Syndrome
PubMed: 35152541
DOI: 10.1111/ans.17522 -
Journal of Clinical Laboratory Analysis Dec 2022Chitinase 3-Like 1 (CHI3L1) has been used as an inflammatory biomarker for a variety of diseases, but its expression in acute appendicitis and appendix carcinomas...
BACKGROUND
Chitinase 3-Like 1 (CHI3L1) has been used as an inflammatory biomarker for a variety of diseases, but its expression in acute appendicitis and appendix carcinomas remains unclear.
METHODS
Sixty cases of patients were studied, including 46 acute appendicitis and 14 appendix carcinomas. We divided the acute appendicitis group into acute uncomplicated appendicitis (AUA), suppurative appendicitis (SA), and gangrenous appendicitis (GA). The appendix carcinoma group was divided into appendiceal neuroendocrine neoplasms (ANENs) and appendiceal mucinous neoplasms (AMN). Controls were 32 healthy donors. Blood neutrophil to lymphocyte ratio (NLR), CHI3L1, C-reactive protein (CRP), interleukin-6 (IL-6), and serum amyloid A (SAA) were measured in the patients. Meanwhile, immunohistochemistry and immunofluorescence were used to identify the expression level and location of CHI3L1 in different cell types in appendix tissues.
RESULTS
Compared with the controls, CHI3L1 serum levels were up-regulated in SA, GA, and AMN groups, while no significant difference was observed in the AUA and ANEN groups. Immunofluorescence revealed that CHI3L1 expression was high in macrophages and adenocarcinoma cells of appendix tissues but not in the neuroendocrine carcinoma tissues. Moreover, levels of NLR and CRP in the SA and GA groups were considerably higher than in the control group. IL-6 and SAA in SA, GA, ANENs, and AMN groups were also increased compared with the control group. In addition, CHI3L1 displayed good performance in predicting appendicitis, with an AUC of 0.862.
CONCLUSION
CHI3L1 was highly expressed in acute appendicitis and appendiceal mucinous neoplasms, which can be used as a novel biomarker predicting appendicitis.
Topics: Humans; Acute Disease; Appendiceal Neoplasms; Appendicitis; Appendix; C-Reactive Protein; Carcinoma; Interleukin-6; Neoplasms, Cystic, Mucinous, and Serous; Neuroendocrine Tumors; Chitinase-3-Like Protein 1
PubMed: 36447423
DOI: 10.1002/jcla.24790 -
Journal of Laparoendoscopic & Advanced... Apr 2021We are presenting a very minimally invasive technique for laparoscopic appendectomy (needlescopic appendectomy [NAP]) in children and adolescents using suture grasper...
We are presenting a very minimally invasive technique for laparoscopic appendectomy (needlescopic appendectomy [NAP]) in children and adolescents using suture grasper device, epidural needle, and homemade isolated long diathermy probe without any conventional laparoscopic instruments. NAP was attempted in 48 patients with uncomplicated acute appendicitis at Al-Azhar, Tanta University Hospitals and other allied hospitals during the period from May 2017 to November 2018. The study included patients with acute appendicitis and patients scheduled for interval appendectomy. Exclusion criteria were patients with concealed appendix, patients with appendicular abscess or appendicular mass, patients with acute appendicitis complicated with generalized peritonitis, and patients unfit for laparoscopy. The appendix was brought outside through the umbilical port and the operation was completed extracorporeally. In cases of appendicitis with tethered cecum, the whole procedure was completed intracorporeally. Forty-eight patients with acute uncomplicated appendicitis were treated by NAP. They were 36 males and 12 females with a mean age of 9 ± 3.7 years (range = 4-15 years). Two cases with concealed appendix and one case with appendicular mass were diagnosed during initial laparoscopy and excluded from the study. Thirty-two cases (71.11%) were completed intracorporeally and 13 cases (28.89%) were completed by extracorporeal NAP. The mean operative time was 33.29 ± 3.95 minutes (range = 27-40 minutes) for intracorporeal NAP and 20.9 ± 7.01 minutes (range = 14-40 minutes) for extracorporeal NAP. Degrees of cosmetic satisfaction of the patients and parents were excellent in 93.33% ( = 42/45 patients), and very good in 6.67% ( = 3/45 patients) of patients. NAP using needles only is a new technique that is very minimally invasive, very cheap, safe, reproducible, and easy to be done with outstanding cosmetic results.
Topics: Abscess; Acute Disease; Adolescent; Appendectomy; Appendicitis; Appendix; Child; Child, Preschool; Diathermy; Female; Hand Strength; Hospitals, University; Humans; Hyperthermia, Induced; Laparoscopy; Male; Microsurgery; Needles; Operative Time; Patient Satisfaction; Peritonitis; Surgical Instruments; Umbilicus
PubMed: 33651634
DOI: 10.1089/lap.2020.1011 -
African Journal of Paediatric Surgery :... 2022Appendicitis is one of the most common paediatric surgical emergencies occurring in about 7% of healthy children. To make a definitive diagnosis preferably avoiding...
INTRODUCTION
Appendicitis is one of the most common paediatric surgical emergencies occurring in about 7% of healthy children. To make a definitive diagnosis preferably avoiding unnecessary X-ray radiation exposure, ultrasound is the ideal modality. The aim of this study is to evaluate the diagnostic value of sonographic findings in children with acute appendicitis and comparing them with surgical findings to demonstrate the safety, simplicity and accuracy of this procedure in emergency departments as the first diagnostic procedure.
MATERIALS AND METHODS
One hundred and eight children aged 1-15 years suspected of acute appendicitis in our tertiary hospital emergency department enrolled the study. Patients presenting as acute abdomen suspected as having acute appendicitis underwent abdominal ultrasonography (US) at first. Sonographic findings were compared to surgical and pathologic results, and sensitivity and specificity of each sonographic parameter in paediatric appendicitis were evaluated.
RESULTS
The analysis of sonographic results showed that 67.6% of patients had acute appendicitis, 13.9% had perforated appendicitis and 18.5% had normal appendix. On the other hand, there were acute appendicitis in 63.9% of patients, perforated appendicitis in 12% and normal appendix in 8.3% in surgical reports. Sensitivity of uncompressible appendicitis, appendicitis, maximal outer diameter (MOD) above 6 mm, maximal mural thickness (MMT) above 3 mm, round appendix was 98.68%, 28.04%, 94.74%, 61.84% and 68.42%, respectively. Specificity of incompressible appendicitis, appendicitis, MOD above 6 mm, MMT above 3 mm, round appendix was 64.71%, 96.15%, 64.71%, 82.35% and 94.12%, respectively. Overall sensitivity and specificity of US in appendicitis were 97.56% and 69.23%, respectively.
CONCLUSION
According to the findings of this study, sensitivity of US in diagnosing appendicitis is higher than other studies, but its specificity was lower. Ultrasonographic accuracy and efficacy to diagnose acute appendicitis in children are high enough to allow clinicians to do it as an imaging modality of first choice, and also, in problematic cases to assist correct clinical diagnosis avoiding unnecessary X-ray exposure, decreasing negative appendectomies, decreasing perforation rate and lowering the cost of patients. Furthermore, negative US do not justify immediate computed tomography because clinical re-evaluation and a second US can help greatly the clinicians in the correct diagnosis.
Topics: Acute Disease; Appendectomy; Appendicitis; Appendix; Child; Humans; Ultrasonography
PubMed: 34916345
DOI: 10.4103/ajps.AJPS_124_20 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Sep 2023Appendix neuroendocrine tumors (NETs) are the most common tumors of the appendix and are most often diagnosed incidentally. The aim of this study was to retrospectively...
BACKGROUND
Appendix neuroendocrine tumors (NETs) are the most common tumors of the appendix and are most often diagnosed incidentally. The aim of this study was to retrospectively evaluate appendix NETs diagnosed incidentally in our clinic.
METHODS
Of 8304 patients who underwent appendectomy with the diagnosis of acute appendicitis in Ankara Training and Re-search Hospital, General Surgery Clinic between January 2009 and January 2022, 33 had histopathology results evaluated as appendix NET, and a retrospective analysis was made of these cases. The patients were evaluated in terms of age, gender, tumor infiltration, tumor location, tumor size, surgical margin, tumor World Health Organization grade, surgery performed, lymph node metastasis, Ki67 index, number of mitosis, follow-up time, and survival.
RESULTS
The rate of appendix NET was found to be 0.4%. The 33 cases comprised 15 (45.5%) males and 18 (54.5%) females with a mean age of 35.48 years (range: 16-84 years). Positive surgical margin was determined in 1 (3.03%) case, in which right hemicolectomy was performed. All other cases were followed up after appendectomy. The median follow-up was 89 (7-145) months. No recurrence was observed in any case. Mortality developed during follow-up in one case due to non-tumoral causes.
CONCLUSION
Appendix NETs are generally asymptomatic and appear incidentally after appendectomy due to acute appendicitis. Appendix NETs diagnosed incidentally are generally below 2 cm and have a good prognosis.
Topics: Female; Male; Humans; Adult; Neuroendocrine Tumors; Appendiceal Neoplasms; Retrospective Studies; Appendix; Appendicitis
PubMed: 37681719
DOI: 10.14744/tjtes.2023.78038 -
International Journal of Surgery Case... Aug 2022Acute appendicitis of the subhepatic appendix is uncommon, and a preoperative diagnosis is difficult without a thorough understanding of the various anatomical...
INTRODUCTION
Acute appendicitis of the subhepatic appendix is uncommon, and a preoperative diagnosis is difficult without a thorough understanding of the various anatomical locations. Cross-sectional imaging is indispensable for prompt diagnosis and subsequent treatment. Surgery is the standard treatment for perforated appendicitis in the subhepatic region. In this study, we present a case of subhepatic appendicitis with an unusual presentation.
CASE PRESENTATION
A 28-year-old man presented to our emergency department with a 3-day history of diffuse right abdominal discomfort, diarrhea, fever, and vomiting. Physical examination revealed rebound soreness and guarding in the right upper and lower quadrants. Laboratory tests revealed high levels of C-reactive protein and serum bilirubin and neutrophilic leukocytosis. Abdominal computed tomography revealed an undescended cecum and a subhepatic appendix with an intraluminal appendicolith, fat stranding, and peri-appendiceal fluid. The patient underwent open exploration and appendicectomy, during which the subhepatic perforated appendix was excised. The patient's recovery was uneventful.
DISCUSSION
Atypical presentations may indicate an unusual anatomical placement of the appendix. Preoperative diagnosis using cross-sectional computed tomography imaging and a thorough understanding of these situations frequently result in early diagnosis and expeditious surgical care.
CONCLUSION
Surgical crises resulting from aberrant anatomical variations of the appendix constitute a distinct diagnostic challenge. A strong index of suspicion for this uncommon presentation permits early surgical intervention and prevents delay-induced morbidity/mortality.
PubMed: 35961149
DOI: 10.1016/j.ijscr.2022.107480 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Apr 2022Acute appendicitis (AA) is a common cause of abdominal pain in developed countries. In patients with suspected AA, computed tomography (CT) is considered as the gold...
BACKGROUND
Acute appendicitis (AA) is a common cause of abdominal pain in developed countries. In patients with suspected AA, computed tomography (CT) is considered as the gold standard with the highest sensitivity and specificity, and it is also an im-portant modality, especially in patients with complicated AA. In this study, we aimed to evaluate age and laboratory findings, as well as specific CT findings in differentiating between perforated and non-perforated appendicitis.
METHODS
We retrospectively analyzed 252 patients diagnosed with AA and underwent appendectomy between November 2015 and December 2019 in Somalia Mogadishu Recep Tayyip Erdogan Education and Research Hospital. Patients under 18 years of age and those with no pre-operative CT scans were excluded from the study. The demographic, laboratory, CT findings, and pathological data of all patients were evaluated.
RESULTS
This study included 80 patients, 32 (40%) classified as perforated appendicitis (Group-1) and 48 (60%) as non-perforated appendicitis (Group-2). The C-reactive protein value was found to be statistically higher in Group-1 than in Group-2 (177.5±118.9 and 100.2±87.3 mg / L, respectively; p=0.001). The appendix lumen diameter (p=0.002), appendix wall defect (p<0.001), peritoneal thickening and enhancement (p<0.001), ascites (p=0.031), intra-abdominal abscess (p=0.003), jejunal thickening (p=0.019), ileal thick-ening (p=0.008), and ileus (p=0.035) values were significantly higher in Group-1. In the binominal logistic regression analysis performed with statistically significant data, an appendiceal wall defect (OR: 0.069, 95% CI=0.014-0.327, p=0.001) and peritoneal thickening and enhancement (OR: 0.131, 95% CI=0.024-0.714, p=0.019) were identified as independent variables for perforated appendicitis.
CONCLUSION
Among CT findings, appendix wall defects and peritoneal thickening and enhancement play an important role in detecting perforation.
Topics: Acute Disease; Adolescent; Appendectomy; Appendicitis; Appendix; Humans; Retrospective Studies
PubMed: 35485514
DOI: 10.14744/tjtes.2020.58991 -
Peritoneal Dialysis International :... Jul 2022
Topics: Appendix; Cystostomy; Humans; Laparoscopy; Peritoneal Dialysis; Urologic Surgical Procedures
PubMed: 35380068
DOI: 10.1177/08968608221090792 -
Journal of Surgical Case Reports Mar 2023Mucinous cystadenoma of the appendix is a rare condition characterized by abnormal mucus accumulation in the appendiceal. Laparoscopic appendectomy is a common approach...
Mucinous cystadenoma of the appendix is a rare condition characterized by abnormal mucus accumulation in the appendiceal. Laparoscopic appendectomy is a common approach worldwide and can be used in the management of mucinous cystadenoma with lower postoperative complication rates. A 30-year-old female had sharp pain localized to the right abdomen for 2 days. It was aggravated by movement and associated with nausea and vomiting. Laboratory findings were normal, but the abdominal computerized tomography scan demonstrated a cystic tumor in the right abdomen dorsal to the cecum and the ascending colon. Diagnostic laparoscopy showed a large cystic mass well-circumscribed encapsulated involving the appendix in the lower right abdomen. After demonstrating pathologic examination, the final diagnosis was mucinous cystadenoma of the appendix. Management of the appendicular mucinous cystadenoma can be successfully achieved through atraumatic laparoscopic excision of the tumor, it is safe, feasible and has a short postoperative recovery period.
PubMed: 36926628
DOI: 10.1093/jscr/rjad097