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BMC Surgery Jun 2022Autoamputation of the appendix, i.e., complete separation of a part of the appendix without any surgical intervention, has been rarely documented in the literature in... (Review)
Review
BACKGROUND
Autoamputation of the appendix, i.e., complete separation of a part of the appendix without any surgical intervention, has been rarely documented in the literature in recent years. Herein, we report a case where the amputated part of the appendix was viable after autoamputation and reviewed the related literature.
CASE PRESENTATION
A 39-year-old female patient was admitted to our hospital complaining of abdominal pain and subsequently underwent an emergency laparoscopic appendectomy (LA). Intraoperatively, we found an abnormally short appendix protruding from the cecum and a strip-like tissue attached to the mesoappendix, considered a duplex appendix, was resected. Finally, in conjunction with the histopathology findings and the past medical history, the patient was diagnosed with "Pseudo-duplication of the Appendix".
CONCLUSIONS
Autoamputation of the appendix resulting in preserved tissue viability and absence of necrosis at both ends, can be termed as "Pseudo-duplication of the Appendix". This condition is very rare in clinical practice and has not been reported in China, to the best of our knowledge. It has been established that the autoamputated appendix can produce chronic inflammation, intestinal fistulae and even cancer, affecting the patient's quality of life. Accordingly, a clear diagnosis and timely management are essential. In this report, we established a novel classification for "Pseudo-duplication of the Appendix", hoping that our report will help surgeons better understand this anatomical anomaly of the appendix, to help during the differential diagnosis process and avoid confusion.
Topics: Abdominal Pain; Adult; Appendectomy; Appendicitis; Appendix; Female; Humans; Quality of Life
PubMed: 35761272
DOI: 10.1186/s12893-022-01700-1 -
Journal of Parkinson's Disease 2019Parkinson's disease (PD) has long been considered a brain disease, but studies now point to the gastrointestinal (GI) tract as a potential starting point for PD. In... (Review)
Review
Parkinson's disease (PD) has long been considered a brain disease, but studies now point to the gastrointestinal (GI) tract as a potential starting point for PD. In particular, the human vermiform appendix has been implicated in PD. The appendix is a tissue rich in immune cells, serving as part of the gut-associated lymphoid tissue and as a storehouse for the gut microbiome. The functions of the appendix converge with recent evidence demonstrating that gut inflammation and shifts in the microbiome are linked to PD. Some epidemiological studies have linked removal of the appendix to lowered PD risk, though there is controversy among these associations. What is apparent is that there is an abundance of aggregated forms of α-synuclein in the appendix relevant to PD pathology. α-Synuclein pathology is thought to propagate from gut to brain via the vagus nerve, which innervates GI tract locations, including the appendix. Remarkably, α-synuclein aggregates in the appendix occur not only in PD patients, but are also present in healthy individuals. This has led to the proposal that in the appendix α-synuclein aggregates are not unique to PD. Moreover, the molecular events leading to PD and the mechanisms by which α-synuclein aggregates transfers from gut to brain may be identifiable in the human appendix. The influence of the appendix on GI inflammation, autoimmunity, microbiome storage, and the lymphatic system may be yet unexplored mechanisms by which the appendix contributes to PD. Overall, the appendix represents a promising tissue site to advance our understanding of PD pathobiology.
Topics: Animals; Appendix; Gastrointestinal Microbiome; Humans; Immune System; Inflammatory Bowel Diseases; Lymphatic System; Parkinson Disease; alpha-Synuclein
PubMed: 31609697
DOI: 10.3233/JPD-191703 -
The Pan African Medical Journal 2022
Topics: Humans; Mucocele; Appendix; Appendectomy; Intestinal Diseases; Cecal Diseases; Appendiceal Neoplasms
PubMed: 36762160
DOI: 10.11604/pamj.2022.43.123.33175 -
PloS One 2023This study aimed to develop a convolutional neural network (CNN) using the EfficientNet algorithm for the automated classification of acute appendicitis, acute...
Comparison between single and serial computed tomography images in classification of acute appendicitis, acute right-sided diverticulitis, and normal appendix using EfficientNet.
This study aimed to develop a convolutional neural network (CNN) using the EfficientNet algorithm for the automated classification of acute appendicitis, acute diverticulitis, and normal appendix and to evaluate its diagnostic performance. We retrospectively enrolled 715 patients who underwent contrast-enhanced abdominopelvic computed tomography (CT). Of these, 246 patients had acute appendicitis, 254 had acute diverticulitis, and 215 had normal appendix. Training, validation, and test data were obtained from 4,078 CT images (1,959 acute appendicitis, 823 acute diverticulitis, and 1,296 normal appendix cases) using both single and serial (RGB [red, green, blue]) image methods. We augmented the training dataset to avoid training disturbances caused by unbalanced CT datasets. For classification of the normal appendix, the RGB serial image method showed a slightly higher sensitivity (89.66 vs. 87.89%; p = 0.244), accuracy (93.62% vs. 92.35%), and specificity (95.47% vs. 94.43%) than did the single image method. For the classification of acute diverticulitis, the RGB serial image method also yielded a slightly higher sensitivity (83.35 vs. 80.44%; p = 0.019), accuracy (93.48% vs. 92.15%), and specificity (96.04% vs. 95.12%) than the single image method. Moreover, the mean areas under the receiver operating characteristic curve (AUCs) were significantly higher for acute appendicitis (0.951 vs. 0.937; p < 0.0001), acute diverticulitis (0.972 vs. 0.963; p = 0.0025), and normal appendix (0.979 vs. 0.972; p = 0.0101) with the RGB serial image method than those obtained by the single method for each condition. Thus, acute appendicitis, acute diverticulitis, and normal appendix could be accurately distinguished on CT images by our model, particularly when using the RGB serial image method.
Topics: Humans; Appendicitis; Appendix; Retrospective Studies; Acute Disease; Diverticulitis; Tomography, X-Ray Computed
PubMed: 37224137
DOI: 10.1371/journal.pone.0281498 -
BMJ Case Reports Jun 2021An asymptomatic 39-year-old woman was noted to have occult bleeding by faecal immunohistochemical test. Investigations showed a 3 cm×2 cm caecal lesion by colonoscopy...
An asymptomatic 39-year-old woman was noted to have occult bleeding by faecal immunohistochemical test. Investigations showed a 3 cm×2 cm caecal lesion by colonoscopy that was consistent with abdominal CT scan findings of a 1.6 cm×1.9 cm×2.3 cm enhancing focus in the medial caecal wall. The patient underwent laparoscopic right hemicolectomy after diagnostic laparoscopy and intraoperative colonoscopy revealed an intussuscepted appendix. The final histopathology was an appendiceal intussusception secondary to endometriosis.
Topics: Adult; Appendix; Cecal Diseases; Diagnosis, Differential; Endometriosis; Female; Humans; Intussusception
PubMed: 34158326
DOI: 10.1136/bcr-2021-241592 -
Anatomical Record (Hoboken, N.J. : 2007) Apr 2011This review assesses the current state of knowledge regarding the cecal appendix, its apparent function, and its evolution. The association of the cecal appendix with... (Review)
Review
This review assesses the current state of knowledge regarding the cecal appendix, its apparent function, and its evolution. The association of the cecal appendix with substantial amounts of immune tissue has long been taken as an indicator that the appendix may have some immune function. Recently, an improved understanding of the interactions between the normal gut flora and the immune system has led to the identification of the appendix as an apparent safe-house for normal gut bacteria. Further, a variety of observations related to the evolution and morphology of the appendix, including the identification of the structure as a "recurrent trait" in some clades, the presence of appendix-like structures in monotremes and some non-mammalian species, and consistent features of the cecal appendix such as its narrow diameter, provide direct support for an important function of the appendix. This bacterial safe-house, which is likely important in the event of diarrheal illness, is presumably of minimal importance to humans living with abundant nutritional resources, modern medicine and modern hygiene practices that include clean drinking water. Consistent with this idea, epidemiologic studies demonstrate that diarrheal illness is indeed a major source of selection pressure in developing countries but not in developed countries, whereas appendicitis shows the opposite trend, being associated with modern hygiene and medicine. The cecal appendix may thus be viewed as a part of the immune system that, like those immune compartments that cause allergy, is vital to life in a "natural" environment, but which is poorly suited to post-industrialized societies.
Topics: Animals; Appendectomy; Appendicitis; Appendix; Biological Evolution; Environment; Humans; Industry; Phylogeny; Selection, Genetic
PubMed: 21370495
DOI: 10.1002/ar.21357 -
Journal of Anatomy Nov 2021The cecal appendix had been considered as a useless vestige since Darwin's work, but recent research questioned this idea demonstrating that the cecal appendix appeared...
The cecal appendix had been considered as a useless vestige since Darwin's work, but recent research questioned this idea demonstrating that the cecal appendix appeared among the mammals at least 80 million years ago and has made multiple and independent appearances without any obvious correlation with diet, social life, ecology, or size of the cecum. However, functions and probable selective advantage conferred by this anatomical structure still remain enigmatic. We found, through analyses of data on 258 mammalian species, that cecal appendix presence is correlated with increased maximal observed longevity. This is the first demonstration of a correlation between cecal appendix presence and life history. Interestingly, the classical evolutionary theory of aging that predicts an increased longevity when the extrinsic mortality is reduced has been questioned several times, but recent comparative studies asserted its validity in the taxa, which experience age-dependent and density-dependent mortality, as in mammals. Thus, the cecal appendix may contribute to the increase in longevity through a reduction of extrinsic mortality. A lower risk of fatal infectious diarrhea is one of the most plausible hypotheses that could explain it. However, several hypotheses coexist about the possible functions of the cecal appendix, and our results provide new insights about this much-disputed question. In addition, we show that the cecal appendix arose at least 16 times and was lost only once during the evolutionary history of the considered mammals, an asymmetry that supports the existence of a positive selective of this structure.
Topics: Aging; Animals; Appendix; Biological Evolution; Longevity; Mammals
PubMed: 34235746
DOI: 10.1111/joa.13501 -
BMC Infectious Diseases May 2021Schistosomiasis is very common in the southern part of the Yangtze River Basin in China. It is mainly manifested as appendicitis, ulcers, hematomas, and thickening of...
BACKGROUND
Schistosomiasis is very common in the southern part of the Yangtze River Basin in China. It is mainly manifested as appendicitis, ulcers, hematomas, and thickening of the intestinal tract. Schistosomiasis of the appendix is rare, mainly manifested as appendicitis, which is easy to be misdiagnosed.
CASE PRESENTATION
Here we report a rare case of a Chinese female whose intestinal mass manifested as intestinal polyps and was eventually diagnosed pathologically as schistosomiasis infection (appendix schistosomiasis). So far, there are rare relevant cases reported.
CONCLUSIONS
Intestinal schistosomiasis is easily misdiagnosed, and appendix schistosomiasis is rare. The final diagnosis requires pathology, especially surgical pathology.
Topics: Aged; Appendix; China; Colonoscopy; Diagnostic Errors; Female; Humans; Intestinal Polyps; Schistosomiasis
PubMed: 33964884
DOI: 10.1186/s12879-021-06125-4 -
The Pan African Medical Journal 2022Stump appendicitis is an acute inflammation of the residual appendix and one of the rare complications after appendectomy. Stump appendicitis is an under-reported and...
Stump appendicitis is an acute inflammation of the residual appendix and one of the rare complications after appendectomy. Stump appendicitis is an under-reported and poorly defined condition related to obstruction and inflammation of the residual appendix after an appendectomy, usually by a fecolith. It remains a clinical challenge because of delayed diagnosis and subsequent treatment with increased morbidity or mortality. Herein, we describe the case of a 42-year-old male who presented with periumbilical pain with progression to generalized abdominal pain and signs of peritonitis 14 months post appendectomy. An exploratory laparotomy revealed an inflamed, non-gangrenous perforated appendices stump. We discuss the challenges in the diagnosis and management thereof.
Topics: Male; Humans; Adult; Appendicitis; Appendectomy; Appendix; Fecal Impaction; Abdominal Pain; Inflammation
PubMed: 36523281
DOI: 10.11604/pamj.2022.43.43.37149 -
Annals of the Royal College of Surgeons... Sep 1990Anthropometric measurements were performed on 51 normal, supine, barium enema examinations to determine the position of the lower pole of the caecum and the base of the...
Anthropometric measurements were performed on 51 normal, supine, barium enema examinations to determine the position of the lower pole of the caecum and the base of the appendix relative to palpable bony landmarks (the anterior superior iliac spine and the symphysis pubis). Four quadrants were defined (iliac, umbilical, inguinal and pelvic) by the intersection of the right lateral line and the interspinous line (the line joining the left and right anterior superior iliac spines). The position of the lower pole of the caecum was iliac in 12%, inguinal in 37%, and pelvic in 51%. The appendix or appendix stump was visualised on 53% of the barium examinations. The position of the appendix was iliac in 15%, umbilical in 15%, inguinal in 11%, and pelvic in 59%. The positions of the lower pole of the caecum and base of the appendix are lower and more medial than previously described. 70% of appendices were found to lie inferior to the interspinous line, contrary to established surgical teaching, which assumes McBurney's point to be the surface landmark for the appendix.
Topics: Adolescent; Adult; Aged; Anthropometry; Appendicitis; Appendix; Barium Sulfate; Cecum; Female; Humans; Laparotomy; Male; Middle Aged; Pelvis; Radiography
PubMed: 2221765
DOI: No ID Found