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Jenkin A, Cooper EA, Lubowski DZ. Appendiceal intussusception: what is the appropriate extent of resection? ANZ J Surg 2024; 94:1647-1648. [PMID: 38874231 DOI: 10.1111/ans.19127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Ashley Jenkin
- Colorectal Unit, St George Hospital, Kogarah, New South Wales, Australia
- St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Edward A Cooper
- Colorectal Unit, St George Hospital, Kogarah, New South Wales, Australia
| | - David Z Lubowski
- Colorectal Unit, St George Hospital, Kogarah, New South Wales, Australia
- St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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2
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Long Y, Xiang YN, Huang F, Xu L, Li XY, Zhen YH. Appendiceal intussusception complicated by adenocarcinoma of the cecum: A case report. World J Clin Cases 2024; 12:1461-1466. [PMID: 38576819 PMCID: PMC10989461 DOI: 10.12998/wjcc.v12.i8.1461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/06/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Appendiceal intussusception is a pathological condition in which the appendix is inverted into the cecum, which may cause symptoms that resemble those of other gastrointestinal disorders and may induce intestinal obstruction. The rarity of this case presentation is the co-occurrence of appendiceal intussusception and cecal adenocarcinoma, a combination that to our knowledge has not previously been reported in the medical literature. This case provides new insights into the complexities of diagnosing and managing overlapping pathologies. CASE SUMMARY A 25-year-old woman presented with persistent periumbilical pain and bloody stools. An initial biopsy showed cecal cancer; however, subsequent colonoscopy and computed tomography findings raised the suspicion of appendiceal intussusception, which was later confirmed postoperatively. This unique case was characterized by a combination of intussusception and adenocarcinoma of the cecum. The intervention included a laparoscopic right hemicolectomy, which led to the histopathological diagnosis of mucinous adenocarcinoma with appendiceal intussusception. The patient recovered well postoperatively and was advised to initiate adjuvant chemotherapy. This case highlights not only the importance of considering appendiceal intussusception in the differential diagnosis, but also the possibility of appendicitis and the atypical presentation of neoplastic lesions. CONCLUSIONS Physicians should consider the possibility of appendiceal intussusception in cases of atypical appendicitis, particularly when associated with neoplastic presentation.
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Affiliation(s)
- Yu Long
- Department of Colorectal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guzihou Province, China
- Department of Colorectal Surgery, Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Yi-Ning Xiang
- Department of Pathology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Fei Huang
- Department of Colorectal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guzihou Province, China
| | - Lei Xu
- Department of Colorectal Surgery, Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Xiao-Yun Li
- Department of Colorectal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guzihou Province, China
| | - Yun-Huan Zhen
- Department of Colorectal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guzihou Province, China
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Recurrent appendiceal intussusception mimicking ileocecal invagination in a 7-year-old girl. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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4
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Yang Y, Jia D, Jiang C. Multiple intestinal hemangioma concurrent with low-grade appendiceal mucinous neoplasm presenting as intussusception-a case report and literature review. World J Surg Oncol 2022; 20:44. [PMID: 35193589 PMCID: PMC8864818 DOI: 10.1186/s12957-022-02519-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/28/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cases with intussusception caused by either intestinal hemangiomas or appendiceal mucinous neoplasms are extremely rare. CASE PRESENTATION In this study, we reported a 47-year-old male presented with paroxysmal abdominal pain and postprandial bloating for 3 days. CT results indicated a high possibility of secondary intussusception in ascending colon. Histopathology indicated a mixed type of cavernous and capillary hemangioma, combined with low-grade appendiceal mucinous neoplasms (LAMNs) and intestinal obstruction. The patient underwent laparotomy and right hemicolectomy. Finally, the patient was followed up for 4 months with no disease progression. CONCLUSIONS Rare studies reported the intestine hemangiomas coincided with appendix low-grade mucinous tumor. Its manifestations are not specific, which is a challenge in the preoperative diagnosis. For cases with intussusception that was not observed in time, it may lead to intestinal necrosis and diffuse peritonitis. Additionally, the ruptured mucinous tumor in the appendix may lead to pathogenesis of pseudomyxoma peritonei. Therefore, accurate diagnosis and appropriate surgery-based treatment contribute to the improvement of prognosis and severe outcomes among these patients.
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Affiliation(s)
- Yanhua Yang
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, 266071, China
| | - Dongmei Jia
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, 266071, China
| | - Chen Jiang
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, 266071, China.
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Musa DH, Mohammed AA. Intussusception of the vermiform appendix caused by mucinous tumor of the appendix: Case report. Int J Surg Case Rep 2020; 67:51-53. [PMID: 32007864 PMCID: PMC7000417 DOI: 10.1016/j.ijscr.2020.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 11/18/2022] Open
Abstract
Acute appendicitis is the commonest surgical emergency worldwide. Surgery is usually needed which could be done by open or laparoscopic techniques. Tumors of the appendix may cause intussusception of the appendix.
Introduction Intussusception of the appendix occurs when part of the appendix passes the part next to it or the whole appendix to the cecum. It is classified as primary or secondary, or can be classified to partial or complete. Most cases are secondary and partial. Patients usually presents with right lower abdominal pain and most cases are diagnosed during surgery. Case presentation A 27-year-old female presented with right iliac fossa pain and nausea for 2 days. Abdominal examination showed tenderness, guarding, and rebound tenderness at the right iliac fossa. The WBC count was 11,000 c/mm and the urinalysis was normal. At surgery, there was intussusception of the vermiform appendix in its middle part with palpable mass attached to its wall. Appendicectomy was performed successfully. The result of the histopathology was consistent with mucinous cystadenoma of the appendix with no evidence of malignancy. Conclusion Surgery is the main form of treatment as most of the cases are diagnosed during surgery, the operation type may include appendicectomy or more extensive surgery is required such as right hemicolectomy depending on the cause. Surgery can be performed laparoscopically. Trials of colonoscopic reduction are not recommended.
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Affiliation(s)
- Dildar Haji Musa
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq
| | - Ayad Ahmad Mohammed
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq.
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Sun P, Jiang F, Sun H, Zhao X, Ma J, Li C, Yang H, Cui Y. Minimally invasive surgery for appendiceal intussusception caused by mucocele of the appendix: case report and review of the literature. J Gastrointest Oncol 2020; 11:102-107. [PMID: 32175111 DOI: 10.21037/jgo.2019.12.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Appendiceal intussusception caused by mucocele of the appendix is extremely rare. In the current study, a 32-year-old woman was admitted to the department of general surgery of our hospital, complaining of persistent right, lower quadrant pain without an obvious cause for 17 hours. Physical examination indicated significant pain and tenderness in the right, lower abdominal quadrant. Blood analysis indicated that leukocyte count, the percentage of neutrophils and the serum C-reactive protein were increased. Abdominal and pelvic computed tomography revealed a well-encapsulated cystic mass surrounded by the caecum and intussusception. The appendiceal intussusception caused by mucocele of the appendix was revealed during the laparoscopic exploration. Appendectomy and partial cecectomy were conducted using the laparoscopic approach. Postoperative pathological examinations showed ileocecal intussusception and chronic inflammation, appendiceal mucocele and acute suppurative appendicitis. The patient showed satisfactory recovery that was observed during 15-months of follow-ups. This case highlights that laparoscopic appendectomy and partial cecectomy may be a beneficial, minimally invasive approach for appendiceal intussusception caused by mucocele of the appendix.
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Affiliation(s)
- Peiming Sun
- Department of General Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Fuquan Jiang
- Department of General Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Hongwei Sun
- Department of General Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Xiaobo Zhao
- Department of Pathology, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Junmei Ma
- Department of General Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Chenglin Li
- Department of General Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Heming Yang
- Department of General Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Yan Cui
- Department of General Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
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Zenger S, Bilgiç Ç, Buğra D. Laparoscopic partial cecum resection in appendiceal intussusception. Turk J Surg 2019; 35:74-77. [PMID: 32550307 PMCID: PMC6791683 DOI: 10.5578/turkjsurg.3633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 08/09/2017] [Indexed: 11/15/2022]
Abstract
Appendiceal intussusception (AI) is a difficult disease to diagnose. Various features of the disease were analyzed in a 35-year-old female patient admitted with abdominal pain and diagnosed with AI. The diagnosis was made with colonoscopy and abdominal computed tomography. Laparoscopic partial cecum resection was performed. Pathology examination revealed foci of endometriosis externa, which infiltrated the muscular layer of the appendix. AI should be kept in mind in the differential diagnosis of recurrent abdominal pain. Colonoscopy is an indispensable examination for differential diagnosis. Laparoscopic partial cecum resection, preserving the ileocecal valve, is an appropriate treatment approach in irreducible cases that are not suspected to be malignant.
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Affiliation(s)
- Serkan Zenger
- VKV Amerikan Hastanesi, Genel Cerrahi Kliniği, İstanbul, Türkiye
| | - Çağrı Bilgiç
- VKV Amerikan Hastanesi, Genel Cerrahi Kliniği, İstanbul, Türkiye
| | - Dursun Buğra
- VKV Amerikan Hastanesi, Genel Cerrahi Kliniği, İstanbul, Türkiye
- Koç Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, İstanbul, Türkiye
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Affiliation(s)
- Maria Sousa
- General Surgery, Hospital of Braga, Braga, Portugal
| | - Jorge Cotter
- School of Health Sciences, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, University of Minho, Braga/Guimarães, Portugal
| | - Pedro Leão
- General Surgery, Hospital of Braga, Braga, Portugal
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9
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Phan DHL, Hong MKY, Morgan MJ. Appendiceal intussusception causing appendicitis. ANZ J Surg 2017; 88:E851-E852. [PMID: 28295983 DOI: 10.1111/ans.13931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/18/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Du H L Phan
- Colorectal Surgery, Bankstown-Lidcombe Hospital, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael K-Y Hong
- Colorectal Surgery, Bankstown-Lidcombe Hospital, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew J Morgan
- Colorectal Surgery, Bankstown-Lidcombe Hospital, The University of New South Wales, Sydney, New South Wales, Australia
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11
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Betancourth-Alvarenga JE, Vázquez-Rueda F, Murcia-Pascual FJ, Ayala-Montoro J. [Acute abdomen secondary to appendiceal intussusception]. An Pediatr (Barc) 2014; 82:e56-9. [PMID: 24565985 DOI: 10.1016/j.anpedi.2014.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 01/09/2014] [Accepted: 01/14/2014] [Indexed: 11/30/2022] Open
Abstract
Appendiceal intussusception is a rare condition that can occur at any age. Only a few cases have been reported, and most are found during surgery. The therapeutic approach is usually surgical, ranging from an appendectomy to a hemicolectomy, primarily for biopsy and to rule out possible malignancy. Three cases of children under 14 years who underwent surgery for acute abdominal pain located in the right iliac fossa are presented; one with preoperative diagnosis by ultrasound, and the other two with positive intraoperative findings of intussusception of the cecal appendix, with acute appendicitis being histologically confirmed.
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Affiliation(s)
- J E Betancourth-Alvarenga
- Unidad de Gestión Clínica de Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España.
| | - F Vázquez-Rueda
- Unidad de Gestión Clínica de Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España; Facultad de Medicina, Universidad de Córdoba, Córdoba, España
| | - F J Murcia-Pascual
- Unidad de Gestión Clínica de Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España
| | - J Ayala-Montoro
- Unidad de Gestión Clínica de Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España
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Appendiceal intussusception to the cecum caused by mucocele of the appendix: Laparoscopic approach. Int J Surg Case Rep 2012; 3:445-7. [PMID: 22706297 DOI: 10.1016/j.ijscr.2012.04.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 04/29/2012] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Appendiceal intussusception is a very rare disease that is found in only 0.01% of patients who have undergone an appendectomy. Clinical symptoms vary and some patients are asymptomatic. Laparoscopic surgery for appendiceal tumors is still controversial. We present a case of intussusception of the appendix with a mucinous cystadenoma treated by laparoscopic surgery. PRESENTATION OF CASE We report a case of 47 year-old-women patient who presented with a six month history of intermittent right lower abdominal pain. Abdominal computer tomography CT showed appendiceal mass with intussusception. A laparoscopic right hemicolectomy was performed because the tumor involved the entire appendix. Histopathological examination revealed mucocele due to mucinous cystadenoma of appendix. DISCUSSION Appendiceal intussusception to the cecum caused by mucocele of the appendix is extremely rare. It is very difficult to diagnose the presence of an intussuscepted appendix pre-operatively and investigations will usually include colonoscopy and CT scan. An appendicular intussusception should not be reduced by colonoscopy. Laparoscopic surgery for appendiceal tumors is still controversial; the main concerns to be addressed are the adequacy of resection and intraperitoneal rupture of the tumor. Our patient successfully underwent laparoscopic surgery without any complications. CONCLUSION Appendiceal intussusception to the cecum caused by mucocele of the appendix is a rare cause of abdominal pain and difficult to diagnose. The laparoscopic surgery for appendiceal tumors is safe, feasible, and even may be beneficial.
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Aslinia FM, Bagi P, Sorkin JD, Williams RB, Knodell RG, Sorkin LF, Greenwald BD, Steele A, Raufman JP. Anatomic classification of the endoscopic appearance of the normal appendiceal orifice: a novel tool for recognition and documentation of cecal intubation. Clin Anat 2011; 25:496-502. [PMID: 21913231 DOI: 10.1002/ca.21276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 06/22/2011] [Accepted: 08/13/2011] [Indexed: 12/16/2022]
Abstract
Complete colonoscopy for cancer screening requires cecal intubation. Failure to reach and examine the cecum may result in missed right colon pathology. We developed and validated a novel classification scheme for the endoscopic appearance of the normal appendiceal orifice (AO). We analyzed 1,456 AO images and grouped them into four categories based on distinguishing features: "diverticuloid," "umbilicoid," "crescent," and "linear." An expert panel classified the images and modified these categories, combining crescent and linear categories into "curvilinear." A 100-image subset was classified twice by a validation cohort consisting of gastroenterology faculty and fellows. Inter-observer agreement among the expert panel, and intra- and inter-observer agreement among the validation cohort were analyzed using Fleiss' kappa statistic. The distribution of AO images was 67% curvilinear, 19% umbilicoid, and 10% diverticuloid; 85 images (4%) were not classifiable. There was substantial inter-observer agreement among the expert panel (κ, 0.72). Inter-observer agreement among the validation cohort was moderate (κ, 0.53 and 0.55 for the first and second viewing, respectively). Intra-observer κ values among the validation cohort were 0.69 for the overall classification, 0.65 for diverticuloid, 0.70 for umbilicoid, and 0.70 for curvilinear, indicating substantial agreement. This simple, validated classification scheme for the endoscopic appearance of the normal AO can be used both as a research and clinical tool to measure endoscopic quality, improve cecal examination, and document successful cecal intubation.
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Affiliation(s)
- Florence M Aslinia
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
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14
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Ashrafi M, Joshi V, Zammit M, Telford K. Intussusception of the appendix secondary to mucinous cystadenoma: A rare cause of abdominal pain. Int J Surg Case Rep 2010; 2:26-7. [PMID: 22096680 DOI: 10.1016/j.ijscr.2010.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/16/2010] [Accepted: 11/16/2010] [Indexed: 10/18/2022] Open
Abstract
A 35-year-old woman was seen as an outpatient with a 3-month history of pain in the right iliac fossa. A CT scan of her abdomen revealed the presence of a mucocele of the appendix. Intra-operatively, an appendico-appendicular intussusception was found. Histology confirmed the presence of a mucinous cystadenoma with the presence of acellular mucin on the serosal surface of the appendix. This association has rarely been described in the literature. Prompt surgical intervention is advocated to prevent the subsequent development of pseudomyxoma peritonei. We present a case of intussusception of the appendix with a mucinous cystadenoma as its lead point.
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Affiliation(s)
- M Ashrafi
- Department of General Surgery, University Hospital of South Manchester NHS Trust, Southmoor Road, Manchester M23 9LT, United Kingdom
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A case of endometriosis of the appendix with adhesion to right ovarian cyst presenting as intussusception of a mucocele of the appendix. Surg Laparosc Endosc Percutan Tech 2009; 18:622-5. [PMID: 19098675 DOI: 10.1097/sle.0b013e318180f67f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Endometriosis of the appendix is rare, and we present a case of endometriosis of the appendix with adhesion to right ovarian cyst presenting as intussusception of a mucocele of the appendix in a 35-year-old woman with no associated sign of endometriosis. Colonoscopy revealed intussusception-like change and mucosal defect in the mucosa at the orifice of the appendix. Abdominal computed tomography showed a low-density lesion, which seemed to be right ovarian cyst. However, as the appendix was located near this site, differentiation between ovarian cyst and mucocele of the appendix was difficult. Laparoscopic examination disclosed blue berry spots on the Douglas cul-de-sac and right ovarian cyst, and the appendix was atrophied and hardened and tightly adhered to the right ovary. Laparoscopic appendectomy and partial cecectomy was performed, and on pathologic examination, thickening and fibrosis of the muscle layer owing to endometriosis were judged to have caused intussusception-like changes.
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16
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Intussusception of the appendix: comprehensive review of the literature. Am J Surg 2009; 198:122-8. [PMID: 19249733 DOI: 10.1016/j.amjsurg.2008.08.023] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 08/26/2008] [Accepted: 08/26/2008] [Indexed: 01/07/2023]
Abstract
BACKGROUND Intussusception of the appendix is a rare disease that constitutes a diagnostic challenge to the surgeon. The literature on this condition is limited to case reports. The demographics, presentation, and treatment remain debatable in the absence of a comprehensive review of the literature. DATA SOURCES This article reports a case of a 40-year-old woman who presented with intussusception of the appendix caused by endometriosis. A comprehensive review of the English literature in PubMed was performed. The trends in incidence, sex predilection, presentation, and treatment of appendiceal intussusception were derived based on the reports of 191 patients. COMMENTS The incidence was more common in adults (76%) than in children (24%). Female patients (72%) were 2 times more affected in adults than in children, whereas male patients (58%) seem to be more affected in the pediatric population. Intussusception of the appendix has most commonly a chronic presentation (63%). Endometriosis (33%) and inflammation (76%) were the most common pathologic findings in adults and children, respectively. Only 49% of patients were treated by simple appendectomy; 49% patients underwent partial colectomy; and 2% of patients had their appendixes endoscopically removed.
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Kang DB, Kim SH, Oh JT, Kim KD, Jo HJ, Lee JK, Park WC. Laparoscopic Management of Appendiceal Intussusception Caused by Fecaliths. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2009. [DOI: 10.3393/jksc.2009.25.5.352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Dong Baek Kang
- Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Seung Ho Kim
- Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Jung Taek Oh
- Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Kang Deuk Kim
- Department of Radiology, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Hyang Jeong Jo
- Department of Pathology, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Jeong Kyun Lee
- Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Won Cheol Park
- Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
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Failure of appendectomy to resolve appendiceal intussusception. J Pediatr Surg 2008; 43:1554-6. [PMID: 18675653 DOI: 10.1016/j.jpedsurg.2008.03.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 03/10/2008] [Accepted: 03/10/2008] [Indexed: 11/20/2022]
Abstract
Appendiceal intussusception is a rare entity that primarily affects children. The optimal surgical management is not known. We describe a child with appendiceal intussusception treated by simple appendectomy who suffered recurrent intussusception of the cecum at the base of the appendiceal stump. He was cured by resection of a rim of cecum around the appendiceal staple line. Partial cecectomy with appendectomy may be the most effective operation for appendiceal intussusception.
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Waseem T, Sabir NUD, Hussain S, Amir E, Arif S. Rare association: ileocaeco-colic intussusception secondary to mucinous cystadenoma of the appendix in an adult. ANZ J Surg 2008; 77:1021-2. [PMID: 17931271 DOI: 10.1111/j.1445-2197.2007.04303.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Talat Waseem
- Department of Surgery, Ittefaq Hospital Trust, Near H-Block, Model Town, Lahore, Pakistan
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20
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Swanger R, Davis S, McBride W, Rachlin S, Sonke PY, Brudnicki A. Multimodality imaging of an appendiceal intussusception. Pediatr Radiol 2007; 37:929-32. [PMID: 17611749 DOI: 10.1007/s00247-007-0541-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 04/19/2007] [Accepted: 05/16/2007] [Indexed: 11/27/2022]
Abstract
Appendiceal intussusception is a rare entity. The majority of cases reported in the literature address surgical and colonoscopic approaches to treatment of the condition. The existing radiologic literature largely describes the sonographic and double-contrast enema findings of appendiceal intussusception. We present a case of appendiceal intussusception and describe the air-contrast enema, sonographic and CT findings.
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Affiliation(s)
- Ronald Swanger
- Department of Radiology, New York Medical College, Valhalla, NY 10595, USA.
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Tavakkoli H, Sadrkabir SM, Mahzouni P. Colonoscopic diagnosis of appendiceal intussusception in a patient with intermittent abdominal pain: A case report. World J Gastroenterol 2007; 13:4274-7. [PMID: 17696262 PMCID: PMC4250632 DOI: 10.3748/wjg.v13.i31.4274] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Intussusception of the appendix is a rare condition. Most cases are diagnosed during operation of the patients suspected to have appendicitis. In this report we present a seventy one year-old man with a history of periumbilical intermittent abdominal pain for several months. None of the paraclinical tests were useful for determining the diagnosis. Colonoscopy performed during the last episode of abdominal pain revealed the prolapsed appendix in the cecum and the patient was sent to the operating room. Macroscopic appearance of the appendix was normal and microscopic examination revealed follicular hyperplasia and acute focal appendicitis. Appendiceal intussusception should be considered in differential diagnosis of intermittent abdominal pain and colonoscopic diagnosis could be very important to avoid dangerous or unnecessary decision making.
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Affiliation(s)
- Hamid Tavakkoli
- Department of Gastroenterology, Alzahra Hospital, Isfahan University of Medical Sciences (IUMS), Poursina Hakim Research Institute, Isfahan, Iran.
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Ram AD, Peckham C, Akobeng AK, Thomas AG, David TJ, Patel L. Inverted appendix mistaken for a polyp during colonoscopy and leading to intussusception. J Cyst Fibros 2005; 4:203-4. [PMID: 15993655 DOI: 10.1016/j.jcf.2005.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Revised: 04/21/2005] [Accepted: 03/23/2005] [Indexed: 11/24/2022]
Abstract
A spectrum of appendiceal diseases, ranging from simple mucous distension to acute perforated appendicitis, are seen in patients with CF. We report a 6 year old boy with CF and recurrent periumbilical pain. During colonoscopy, a fleshy pedunculated mass at the junction of the ascending colon and caecum was mistaken for a polyp and excised. However, histopathological examination suggested it was a segment of inverted appendix. The remnant of the inverted appendix was subsequently found to be associated with an intussusception.
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Affiliation(s)
- Ashok D Ram
- Department of Paediatric Surgery, Central Manchester and Manchester Children's University Hospitals, UK
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Abstract
Intussusception of the appendix is an uncommon condition and the diagnosis is rarely made preoperatively. Intussusception of the appendix may mimic a neoplastic lesion. Colonoscopy is a valuable tool for diagnosis of the appendiceal intussusception. A 17-yr-old female admitted with repeated abdominal pain, nausea, vomiting and febrile sensation. We diagnosed as appendiceal intussusception by colonoscopy, which showed a polypoid tumor (about 1.5 cm) in the cecum. This sessile polypoid mass looks like foreskin or glans. We present colonoscopic finding of appendiceal intussusception and review the literature.
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Abstract
A variety of miscellaneous conditions affect the appendix, both as incidental findings and as causes of clinical signs and symptoms that often mimic appendicitis. Congenital abnormalities of the appendix are rare; the two most commonly reported are congenital absence and appendiceal duplication. Diverticular disease may be an incidental finding, but when inflamed, can be clinically confused with appendicitis. Endometriosis of the appendix, which usually occurs in the setting of generalized gastrointestinal endometriosis, often presents as acute appendicitis, but may present as intussusception, lower intestinal bleeding, and, particularly during pregnancy, perforation. Peritoneal endosalpingiosis often involves the appendiceal serosa and occasionally the wall but has no clinical manifestations in contrast to endometriosis. Vasculitis may be either isolated to the appendix or part of a systemic vasculitis, most often polyarteritis nodosa. Neural proliferations of the appendix include lesions associated with von Recklinghausen's disease, as well as mucosal and axial neuromas that are theorized to progress to fibrous obliteration of the appendix. Mesenchymal tumors of the appendix are most often of smooth muscle type, usually leiomyoma but rarely leiomyosarcoma; nonmyogenic neoplasms such as gastrointestinal stromal tumor, granular cell tumor, Kaposi's sarcoma, and miscellaneous other curiosities occur rarely. Lymphoma affects the appendix exceptionally; in children, Burkitt lymphoma is most common whereas in adults, large cell lymphomas and low grade B-cell lymphomas predominate. Secondary involvement of the appendix by leukemia has been reported. Secondary involvement of the appendix by carcinomas of the female genital tract, particularly ovary, and diverse other sites are in aggregate common but only rarely a clinical or pathological difficulty. Occasionally, however, appendiceal neoplasia that is secondary from another site may dominate the clinical picture and lead to potential pathologic misdiagnosis as primary appendiceal disease.
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Affiliation(s)
- Joseph Misdraji
- James Homer Wright Pathology Laboratories, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Karabulut R, Sönmez K, Türkyilmaz Z, Yilmaz Y, Akyürek N, Başaklar AC, Kale N. Mucosa-associated lymphoid tissue lymphoma in the appendix, a lead point for intussusception. J Pediatr Surg 2005; 40:872-4. [PMID: 15937835 DOI: 10.1016/j.jpedsurg.2005.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract Appendiceal intussusception and mucosa-associated lymphoid tissue lymphoma are both uncommon entities, and this is the first report of the two occurring concomitantly in an 8-year-old boy. This report of a mucosa-associated lymphoid tissue lymphoma localized in the appendix has not been reported previously.
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Affiliation(s)
- Ramazan Karabulut
- Department of Pediatric Surgery, Faculty of Medicine, Gazi University, Ankara 06500, Turkey.
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26
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Vogelaar FJ, Molenaar IQ, Adhin S, Steenvoorde P. Invagination of the appendix: diagnostic laparoscopy? Dig Dis Sci 2004; 49:351-2. [PMID: 15104383 DOI: 10.1023/b:ddas.0000017464.50532.d5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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27
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Complete invagination of the appendix progressing to ileocecocolic intussusception. Gastroenterology 2002; 123:2165. [PMID: 12454890 DOI: 10.1053/gast.2002.1232165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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28
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Honmyo U, Shimada S, Yamamoto S, Oshima S, Maeda M, Yoshinaka I, Mizumoto S, Murakami A, Misumi A. Reversible protruded lesion regarded as idiopathic appendiceal intussusception. Dig Endosc 2001. [DOI: 10.1046/j.1443-1661.2001.00095.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Ubehiko Honmyo
- Department of Surgery II, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Shinya Shimada
- Department of Surgery II, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Shin‐ichi Yamamoto
- Department of Surgery II, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Shigeki Oshima
- Department of Surgery II, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Masaomi Maeda
- Department of Surgery II, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Ichiro Yoshinaka
- Department of Surgery II, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Seiichi Mizumoto
- Department of Surgery II, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Akitoshi Murakami
- Department of Surgery II, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Atsunobu Misumi
- Department of Surgery II, Kumamoto University School of Medicine, Kumamoto, Japan
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Attard TM, Askin FB, Cuffari C. Appendiceal inversion as a lead point for ileocolic intussusception in a child with cystic fibrosis. J Pediatr Gastroenterol Nutr 2000; 31:300-2. [PMID: 10997376 DOI: 10.1097/00005176-200009000-00018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- T M Attard
- Department of Pediatrics, The Johns Hopkins Hospital Children's Center, Baltimore, Maryland 21287-2631, USA
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Gupta P, Chwals W, Guandalini S. Intussusception of the appendix: another poorly recognized cause of rectal bleeding. J Pediatr Gastroenterol Nutr 2000; 30:320-3. [PMID: 10749420 DOI: 10.1097/00005176-200003000-00021] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- P Gupta
- Department of Pediatrics, University of Chicago Children's Hospital, Illinois, USA
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Galatioto C, Angrisano C, Blois M, Goletti O, Buccianti P, Lorenzetti L, Massimetti M, Palla G, Seccia M, Cavina E. Surg Laparosc Endosc Percutan Tech 1999; 9:362. [DOI: 10.1097/00019509-199910000-00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Yoshikawa A, Kuramoto S, Mimura T, Kobayashi K, Shimoyama S, Yasuda H, Kaminishi M, Yamakawa M, Oohara T, Murakami T. Peutz-Jeghers syndrome manifesting complete intussusception of the appendix and associated with a focal cancer of the duodenum and a cystadenocarcinoma of the pancreas: report of a case. Dis Colon Rectum 1998; 41:517-21. [PMID: 9559639 DOI: 10.1007/bf02235769] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The unusual occurrence of an "inside-out" appendix reported here is a case of complete intussusception of the appendix of a 45-year-old woman with Peutz-Jeghers syndrome in whom the diagnosis of intussusception was made preoperatively. At laparotomy, the lead point of intussusceptum was revealed to be a Peutz-Jeghers syndrome polyp of the appendix. There was also a cystic lesion in the pancreas, and subsequent distal pancreatectomy revealed a cystadenocarcinoma of the pancreas. Two jejunal Peutz-Jeghers syndrome polyps and two duodenal Peutz-Jeghers syndrome polyps were found via intraoperative endoscopies. The duodenal polyps were endoscopically removed, whereas a jejunal wedge resection was performed for the adjoining jejunal polyps. One of the two duodenal polyps possessed an adenocarcinoma focus. To our knowledge, this is the first report of complete intussusception of the appendix caused by a Peutz-Jeghers syndrome polyp.
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Affiliation(s)
- A Yoshikawa
- Third Department of Surgery, University of Tokyo, Bunkyoku, Japan
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Sakaguchi N, Ito M, Sano K, Baba T, Koyama M, Hotchi M. Intussusception of the appendix: a report of three cases with different clinical and pathologic features. Pathol Int 1995; 45:757-61. [PMID: 8563937 DOI: 10.1111/j.1440-1827.1995.tb03393.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Three cases of intussusception of the appendix (IA) with distinctive pathologic changes were reported. All patients were women with different clinical presentations. Grossly, a complete intussusception was found in one case (case 1), while the others (cases 2 and 3) showed a partial intussusception. In case 1, almost the total segment of the appendix bearing the villous adenoma with focal malignant transformation became completely telescoped into the cecum. In case 2, no underlying appendiceal lesion was disclosed. In case 3, appendiceal endometriosis was found as the point of traction. Awareness of such a rare complication associated with various appendiceal lesions provides a clue for making an accurate diagnosis and selecting appropriate surgical management.
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Affiliation(s)
- N Sakaguchi
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
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Abstract
Neoplasms occur in 0.5 per cent of appendices. Ultrasonography or computed tomography is beneficial, but preoperative detection is rare. At operation, the diagnosis is considered in under half of cases. Mucocele, localized pseudomyxoma peritonei, benign tumours and most appendiceal carcinoids are cured by appendicectomy alone. Right hemicolectomy is indicated for: (1) invasive adenocarcinoma; (2) tumours close to the caecum; (3) lesions larger than 2 cm; (4) mucin production; (5) invasion of the lymphatics, serosa or mesoappendix; and (6) cellular pleomorphism with a high mitotic rate. Tumours of 1-2 cm, small mucinous carcinoids, adenocarcinoma confined to the mucosa, and tumours in children may be treated by appendicectomy alone at the surgeon's discretion. The 5-year survival rate associated with classical carcinoid is more than 90 per cent. The prognosis of mucinous carcinoid is intermediate between that of classical carcinoid and well differentiated adenocarcinoma. The prognosis of adenocarcinoma is determined by Dukes' stage and is similar, stage for stage, to that of colorectal carcinoma.
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Affiliation(s)
- G T Deans
- Department of Surgery, Belfast City Hospital, UK
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Schmidt JS, Maier D, Raj P, Remine SG. Laparoscopic management of appendiceal intussusception associated with villous adenocarcinoma. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1994; 4:369-73. [PMID: 7833525 DOI: 10.1089/lps.1994.4.369] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The authors present a case of appendiceal intussusception, a rare finding that can be associated with appendiceal neoplasms. A 74-year-old woman with right lower quadrant abdominal pain was found to have an appendiceal intussusception associated with a villous adenocarcinoma and was managed with a laparoscopic assisted right hemicolectomy. This case is presented along with a review of the symptoms, diagnosis, classification, and appropriate management of this entity via laparoscopy.
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Affiliation(s)
- J S Schmidt
- Department of Surgery, Health Cleveland, Fairview General Hospital, Ohio
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