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Cureus May 2024Amyand's hernia is a rare variant of inguinal hernia characterized by the presence of the vermiform appendix within the hernia sac. It represents a unique diagnostic and...
Amyand's hernia is a rare variant of inguinal hernia characterized by the presence of the vermiform appendix within the hernia sac. It represents a unique diagnostic and management challenge for surgeons due to its low incidence and varied clinical presentations. Here, we present a case of a 45-year-old man with a one-year history of right inguinoscrotal swelling, diagnosed as a right indirect inguinal hernia. Preoperative imaging revealed the presence of omentum within the hernia sac. Intraoperatively, both the omentum and the vermiform appendix were found within the sac without evidence of inflammation. The patient underwent successful Lichtenstein meshplasty without appendicectomy. This case highlights the importance of considering Amyand's hernia in the differential diagnosis of inguinal hernias and the significance of intraoperative findings in guiding surgical management. Further studies and case reports are needed to enhance our understanding of this rare clinical entity and optimize patient outcomes.
PubMed: 38947645
DOI: 10.7759/cureus.61348 -
ZooKeys 2024A new species of Willem, 1901 associated with hermit crabs living on seashores of Quintana Roo State, Mexico, is described and illustrated. It is blind, with 9-11...
A new species of Willem, 1901 associated with hermit crabs living on seashores of Quintana Roo State, Mexico, is described and illustrated. It is blind, with 9-11 postlabial setae, unguis with a pair of lateral teeth, empodial appendix lanceolate and almost as long as unguis, tenaculum with 4 + 4 teeth and 3-4 setae on corpus, manubrium with 11-14 pairs of manubrial setae on anterior surface and 17-18 pairs on posterior surface, and mucro bidentate. An updated key for the identification of 29 American species of complex is included.
PubMed: 38947167
DOI: 10.3897/zookeys.1205.114394 -
International Journal of Surgery Case... Jun 2024Goblet cell adenocarcinoma of the appendix is a rare diagnosis with features of both adenocarcinomas and carcinoid tumors. Commonly presenting with chronic abdominal...
INTRODUCTION
Goblet cell adenocarcinoma of the appendix is a rare diagnosis with features of both adenocarcinomas and carcinoid tumors. Commonly presenting with chronic abdominal pain, appendicitis, or abdominal distention, it can also be incidentally discovered during appendectomies.
CASE PRESENTATION
A 50-year-old man with right lower abdominal pain was admitted to our hospital, which is a critical care center. A computed tomography(CT) scan showed ileal narrowing, but endoscopy found no strictures. He was admitted with suspected bowel obstruction and improved with an ileal tube. Laparoscopic surgery revealed a tumor of the appendix. Histologically, he was diagnosed goblet cell adenocarcinoma, suggesting tumor infiltration of nerve fibers impairing peristalsis.
DISCUSSION
Goblet cell adenocarcinoma of the appendix has unique histology and a poor prognosis. Treatment typically involves surgery and chemotherapy. This case highlights challenges in preoperative diagnosis, with the tumor causing bowel pseudo-obstruction by invading the intestinal wall and nerve plexus. Extensive infiltration of Auerbach's plexus was observed, consistent with the length of intestinal stenosis.
CONCLUSION
This case describes goblet cell adenocarcinoma of the appendix leading to bowel pseudo-obstruction due to ileal end stenosis. It emphasizes the importance of considering this diagnosis in cases of bowel obstruction without an obvious mass.
PubMed: 38945017
DOI: 10.1016/j.ijscr.2024.109938 -
Journal of Ultrasound in Medicine :... Jun 2024To determine the diagnostic and therapeutic value of contrast-enhanced ultrasound-guided endoscopic retrograde appendicitis treatment (ERAT) in patients with...
OBJECTIVE
To determine the diagnostic and therapeutic value of contrast-enhanced ultrasound-guided endoscopic retrograde appendicitis treatment (ERAT) in patients with uncomplicated appendicitis.
METHODS
A retrospective analysis was performed on clinical and ultrasound data collected from 105 pediatric patients with uncomplicated appendicitis between January 2020 and December 2023. The ultrasound findings before and after treatment, as well as postoperative follow-up and recurrence rates, were summarized and analyzed.
RESULTS
Successful intubation was achieved in 96 patients (91.4%). The conventional ultrasound appendix visualization rate was 39.6% (38/105), while the appendix visualization rate after contrast-enhanced ultrasound-guidance was 75% (72/105). Contrast-enhanced ultrasound revealed various appendiceal morphologic changes in 89 patients, such as twisting, tortuosity, stiffness, rough inner wall, dilated diameter, and narrowing of the lumen. Additionally, local filling defects, which indicated the presence of fecal stones or debris deposition, were noted in 68 patients. No leakage of the contrast agent occurred. Post-treatment evaluation showed improvement in appendiceal diameter, lumen, and filling defects (P < .01). The follow-up rate was 82 of 89 patients (92.1%), all of whom recovered well without a recurrence. The recurrence rate was 7.9% (7/89). Among the patients with recurrences, five patients resolved after medical treatment and two patients recovered after surgical treatment.
CONCLUSION
Contrast-enhanced ultrasound-guided ERAT for uncomplicated appendicitis is safe and effective. Specifically, the appendix is increased, which facilitates an evaluation of therapeutic effectiveness. ERAT serves as a valuable supplementary modality to determine the need for surgical treatment of acute appendicitis, which is of significant clinical value.
PubMed: 38943425
DOI: 10.1002/jum.16515 -
International Journal of Surgery Case... Jun 2024Actinomycosis is a rare, chronic bacterial infection caused by Actinomyces species. While it commonly affects the cervicofacial region, thorax, and abdomen, appendicular...
INTRODUCTION AND IMPORTANCE
Actinomycosis is a rare, chronic bacterial infection caused by Actinomyces species. While it commonly affects the cervicofacial region, thorax, and abdomen, appendicular involvement is extremely uncommon. This case report details the presentation, diagnosis, and management of a 45-year-old female patient with acute appendicitis secondary to actinomycosis.
CASE PRESENTATION
A 45-year-old woman, with an 8-year intrauterine device history, presented with three-day right iliac fossa pain, vomiting, and stable vital signs. Laboratory tests revealed an inflammatory syndrome. Suspecting acute appendicitis, a CT scan confirmed a swollen 10 mm appendix. Laparoscopic surgery revealed a phlegmonous appendix, leading to an uncomplicated appendectomy. Pathological examination confirmed actinomycotic granules, supporting the diagnosis of actinomycosis appendicitis. The patient received 18 million units of intravenous penicillin G daily for 6 weeks followed by a 6-month course of oral amoxicillin (1 g three times daily) thereafter, showing favorable progression with no symptoms. Normal clinical and ultrasound follow-ups were observed at one year.
CLINICAL DISCUSSION
Appendiceal actinomycosis is a rare condition. Women, especially those with intrauterine contraceptives, experience an increase in cases due to chronic inflammation. Typically underdiagnosed, actinomycosis mimics other conditions, presenting with nonspecific symptoms. Laboratory results offer limited assistance, and histological confirmation is crucial. Histopathological examination is mandatory for diagnosis confirmation. Management involves surgical resection and prolonged penicillin-based antibiotics, providing a favorable prognosis with low mortality.
CONCLUSION
This case underscores the importance of considering rare etiologies, such as actinomycosis, in the differential diagnosis of appendicitis. Timely recognition and management are crucial for optimal patient outcomes.
PubMed: 38941730
DOI: 10.1016/j.ijscr.2024.109975 -
Annals of Laparoscopic and Endoscopic... Jan 2024Flaps and grafts are used for filling dead space, ureteral substitution, and as mesh alternatives. The surgical robot is invaluable in urologic reconstructive surgery...
BACKGROUND AND OBJECTIVE
Flaps and grafts are used for filling dead space, ureteral substitution, and as mesh alternatives. The surgical robot is invaluable in urologic reconstructive surgery due to the ability of the robot to reach the deep pelvis, its minimally invasive access, the ability to use indocyanine green to identify structures and assess tissue perfusion and viability, and ergonomics for the surgeon. Robotic reconstruction can involve tissue transfer in the form of flaps and grafts to provide form and function to organs that have been damaged by iatrogenic injuries, trauma, infections, cancer, radiation injury, or congenital abnormalities. Common flaps and grafts can be readily adapted to the robotic approach. In this literature review, we examine the robotic use of flaps and grafts in reconstructive urology.
METHODS
A thorough literature review was conducted via a PubMed search for predefined terms.
KEY CONTENT AND FINDINGS
Flaps and grafts in reconstructive urology are used for interposition, ureteral substitution, and as mesh alternatives. Omental flaps are used for tissue interposition, or to provide structure and nutrients, and are easily employed with the robot. Various robotic applications of peritoneal flaps have been described. Vascular rectus abdominis musculocutaneous flaps are well-vascularized flaps that occupy dead space and provide structural support, which can be harvested readily with the robot. Sigmoid epiploica are an excellent flap for pelvic reconstruction. Gracilis flaps and fascia lata grafts are well-tolerated and provide space occupying tissue. Boari flaps aid in robotic ureteral reconstruction, especially in the setting of long defects. Oral mucosa is excellent for ureteral or bladder neck reconstruction. Rectal mucosa is well-tolerated and easy to harvest robotically for a variety of urinary tract reconstructive applications. The appendix or ileum can be interposed for repair of damaged ureters.
CONCLUSIONS
Various flaps and grafts have been adapted for robotic reconstructive urology. As the field develops, refinement of techniques and innovation in flaps and employment of the robot will propel this field forward. More studies, especially comparative studies, are needed to elucidate the flaps and grafts that are most likely to be successful with the least morbidity for each use case.
PubMed: 38938988
DOI: 10.21037/ales-23-36 -
Diagnostics (Basel, Switzerland) Jun 2024Uterine tumor resembling ovarian sex-cord tumor (UTROSCT) is a rare form of uterine mesenchymal neoplasm. Although UTROSCT generally exhibits benign behavior with a... (Review)
Review
Uterine tumor resembling ovarian sex-cord tumor (UTROSCT) is a rare form of uterine mesenchymal neoplasm. Although UTROSCT generally exhibits benign behavior with a favorable prognosis, this neoplasm is nevertheless classified as being of uncertain malignant potential, given its low rate of recurrence and the fact that it rarely produces metastases (e.g., in the lymph nodes, epiploic appendix, omentum, small bowel, subcutaneous tissue, lungs). Its histogenesis is also uncertain. Typically, UTROSCT occurs in peri-menopausal or menopausal women, but it can sometimes be observed in young women. Usually, this neoplasm can be found in the uterine corpus as a nodular intramural lesion, while it is less frequently submucosal, subserosal, or polypoid/intracavitary. UTROSCT can cause abnormal bleeding, pelvic pain, enlarged uterus, and mass sensation, but sometimes it is found purely by chance. This neoplasm can be considered polyphenotypic on morphological, immunohistochemical, and genetic analyses. Generally, upon microscopic examination, UTROSCT shows a predominant pattern of the cords, nests, and trabeculae typical of sex-cord tumors of the ovary, while immunohistochemically it is characterized by a coexpression of epithelial, smooth muscle, and sex-cord markers. The aim of this review is to report clinical and pathological data and genetic alterations to establish their impact on the prognosis and management of patients affected by this rare entity.
PubMed: 38928686
DOI: 10.3390/diagnostics14121271 -
Genes May 2024Orchids of the genus also called slippers, are among the most valued representatives of the family due to their aesthetic qualities. Due to overexploitation,...
Orchids of the genus also called slippers, are among the most valued representatives of the family due to their aesthetic qualities. Due to overexploitation, deforestation, and illegal trade in these plants, especially in the vegetative phase, requires special protection. This genus is listed in Appendix I of the Convention on International Trade in Endangered Species of Wild Fauna and Flora. Their precise identification is of great importance for the preservation of genetic resources and biodiversity of the orchid family (). Therefore, the main objective of the study was to investigate the usefulness of the DNA barcoding technique for the identification of endangered orchids of the genus and to determine the effectiveness of five loci: K, L, ITS2, FH and HA as potential molecular markers for species of this genus. Among single locus barcodes, was the most effective at identifying species (64%). Furthermore, K, ITS2, K L, and K HA barcodes can be successfully used as a complementary tool to identify orchids while supporting morphological data provided by taxonomists.
Topics: DNA Barcoding, Taxonomic; Orchidaceae; Endangered Species; Phylogeny; DNA, Plant
PubMed: 38927625
DOI: 10.3390/genes15060689 -
The Veterinary Record Jun 2024Focused ultrasonographic imaging techniques are commonly used for cats and dogs; however, such techniques have not been described in rabbits.
BACKGROUND
Focused ultrasonographic imaging techniques are commonly used for cats and dogs; however, such techniques have not been described in rabbits.
METHODS
Focused abdominal ultrasonography was performed on 12 healthy conscious rabbits using four acoustic windows: xiphisternal, left and right renal and cystic. They were positioned in sternal recumbency on a table top, with a cut-out area to allow access to the ventral abdomen. Ultrasonographic images were obtained using a micro-convex probe (3‒11 MHz), and the organs identified in each image were recorded.
RESULTS
The liver, kidneys, stomach, duodenum, jejunum, caecum and colon were identified in all rabbits (12/12). In most rabbits, the following were identified: urinary bladder (11/12), gall bladder (11/12), spleen (10/12) and caudal vena cava or aorta (7/10). The right adrenal gland was identified in five of the 12 rabbits, but the left adrenal gland was identified in only one. The stomach filled at least one view in all rabbits, and the caecum filled the view in nine of 12 rabbits. Other structures thought to be identified included caecal flexures (9/12), appendix (9/12), ampulla coli (3/12), sacculus rotundus (3/12), colonic haustrae (2/12) and pancreas (2/12).
LIMITATION
Only neutered individuals were imaged, so the usefulness of the technique for imaging the reproductive organs could not be determined.
CONCLUSION
This technique enabled imaging of the major abdominal organs in most rabbits, demonstrating the potential value of focused imaging in this species.
PubMed: 38923531
DOI: 10.1002/vetr.4087 -
Cureus Jun 2024A femoral hernia containing the appendix within the sac is known as De Garengeot hernia. This condition is relatively rare but is important to recognize because it...
A femoral hernia containing the appendix within the sac is known as De Garengeot hernia. This condition is relatively rare but is important to recognize because it combines the complications of both femoral hernia and acute appendicitis, which are two distinct surgical emergencies. Clinical findings of a strangulated or incarcerated hernia may obscure signs of acute appendicitis. The presence of the inflamed appendix within the femoral hernia sac complicates the management of both conditions and requires careful surgical planning. We report a case of an 87-year-old female with De Garengeot hernia, complicated by perforated appendicitis and strangulated small bowel with perforation.
PubMed: 38919861
DOI: 10.7759/cureus.62994