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Touati MD, Saidani A, Kallel MA, Brahem E, Belhadj A, Chebbi F. Actinomycosis as a rare cause of acute appendicitis: Case report and comprehensive literature review. Int J Surg Case Rep 2024; 121:109975. [PMID: 38941730 PMCID: PMC11260565 DOI: 10.1016/j.ijscr.2024.109975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/23/2024] [Accepted: 06/26/2024] [Indexed: 06/30/2024] Open
Abstract
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.
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Affiliation(s)
- Med Dheker Touati
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia.
| | - Ahmed Saidani
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Med Ali Kallel
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Emna Brahem
- Department of Pathological Anatomy and Cytology, Abderrahmen-Mami Hospital, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Anis Belhadj
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Faouzi Chebbi
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
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Hanganu CB, Isswiasi S, Adigun A, Farag K, Nichita V, Anwaar M, Esawi A, Sen R, Bavikatte A, Drye E. Through Different Lenses: A Retrospective Analysis of the Agreement Between Laparoscopic and Histopathological Evaluations of the Appendix. Cureus 2024; 16:e65785. [PMID: 39082046 PMCID: PMC11288700 DOI: 10.7759/cureus.65785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Appendicectomy is the most frequently performed emergency general surgical procedure. Previous research has highlighted discrepancies between initial intraoperative laparoscopic diagnoses and subsequent histopathology reports following appendicectomy. In the United Kingdom (UK), routine histopathological examination is the established practice, ensuring precise diagnosis of appendiceal specimens. This retrospective analysis aims to compare intraoperative laparoscopic assessments of the appendix with corresponding histopathology findings. METHODOLOGY We conducted a retrospective analysis of 418 consecutive emergency laparoscopic appendectomies at Peterborough City Hospital in the UK between April 2018 and June 2019 for suspected appendicitis. Intraoperative findings were compared with histopathological examination outcomes using kappa statistics. RESULTS Of the 418 appendectomies analysed, we found a substantial agreement between surgeons and pathologists (kappa = 0.71, P < 0.001) in detecting overall abnormalities of appendices. This agreement was also high for detecting inflamed appendices (kappa = 0.72, P < 0.001). However, of the six neoplastic lesions confirmed in the pathologists' final report, only two were suspected during laparoscopy. CONCLUSIONS While laparoscopic assessments of the appendix demonstrate a statistically significant and improved agreement with histopathological findings in detecting abnormal and inflamed appendices, the ability of surgeons to identify neoplasia appears suboptimal based on our small sample of neoplasia cases. The data strongly support the continued practice of routine histopathological examination following appendicectomy due to its crucial role in avoiding missed diagnoses and ensuring better patient outcomes.
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Affiliation(s)
| | - Sanad Isswiasi
- General Surgery, West Suffolk Hospital, Bury St Edmunds, GBR
| | - Abiodun Adigun
- Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, GBR
| | - Kyrllos Farag
- General Surgery and Oncoplastic Breast Surgery, West Suffolk Hospital, Bury St Edmunds, GBR
| | | | | | - Ahmed Esawi
- General Surgery, West Suffolk Hospital, Bury St Edmunds, GBR
| | - Rishi Sen
- General Surgery, West Suffolk Hospital, Bury St Edmunds, GBR
| | | | - Elisabeth Drye
- General Surgery, Peterborough City Hospital, Peterborough, GBR
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Bohara S, Khadka M, Bhat PS, Syangtang P, Karki B, Shrestha B, Acharya SA, Khetan K, Rayamajhi J, Rawal SB. Appendicular actinomycosis: The first reported case of an uncommon finding of a common ailment from Nepal. Clin Case Rep 2023; 11:e7996. [PMID: 37786458 PMCID: PMC10541570 DOI: 10.1002/ccr3.7996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
Key Clinical Message Actinomycosis is a rare cause of appendicitis with an incidence of 0.3-1 incident per year per 100,000 people. A significant preoperative diagnostic challenge exists and is usually diagnosed incidentally on histopathological examination. Abstract Appendicular actinomycosis, a rare, chronic granulomatous infection caused by actinomyces species, holds a significant preoperative diagnostic summons and is often diagnosed serendipitously during the regular histopathological examination. Herein, we present a case of a 36-year-old female who presented with features suggestive of acute appendicitis, underwent laparoscopic appendicectomy, and was diagnosed with appendicular actinomycosis from the histopathological examination.
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Affiliation(s)
- Sujan Bohara
- Department of Cardiovascular SurgerySahid Gangalal National Heart CentreKathmanduNepal
| | - Manoj Khadka
- Department of SurgeryNepalese Army Institute of Health ScienceKathmanduNepal
| | - Pawan Singh Bhat
- Department of General and Gastrointestinal SurgeryNepal MedicitiLalitpurNepal
| | - Prajwal Syangtang
- Department of SurgeryNepalese Army Institute of Health ScienceKathmanduNepal
| | - Badal Karki
- Department of General SurgeryMadan Bhandari Hospital, and Trauma CenterUrlabariNepal
| | - Bhagawan Shrestha
- Department of SurgeryNepalese Army Institute of Health ScienceKathmanduNepal
| | | | - Khusbhu Khetan
- Department of Laboratory medicine and pathologyNepal MedicitiLalitpurNepal
| | - Jyoti Rayamajhi
- Department of General and Gastrointestinal SurgeryNepal MedicitiLalitpurNepal
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Agholi M, Esfandiari F, Heidarian HR, Khajeh F, Sharafi Z, Masoudi E, Rayani M. The Histopathological Findings in Appendectomy Specimens in an Iranian Population. Galen Med J 2023; 12:1-10. [PMID: 38774854 PMCID: PMC11108667 DOI: 10.31661/gmj.v12i.2482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Appendicitis is one of the most common causes of acute abdominal surgeries. The importance of parasitic etiologies in the pathogenesis of appendicitis is not well known in appendectomy specimens on a large scale in southwestern Iran. The current study aimed to retrospectively assess the demographic data and histopathological records of appendicitis in a 28-year period in Fars province, southwestern Iran. MATERIALS AND METHODS Histopathological records of 13,013 patients who had undergone surgeries for appendicitis at Dr. Ali Shariati Hospital, affiliated with the Fasa University of Medical Sciences from December 1993 to January 2021 were reviewed and data concerning the patients' demographic data and histopathological records were retrieved from each record. More than 6800 archived microscopic glass slides were also reviewed. RESULTS From a total of 13,013 histopathological records of surgical excisions of appendicitis that were reviewed over a 28-year period, 8,189 (62.9%) were male and 4,842 (37.1%) were female. Patients' age ranged from 2 to 98 years, with a mean age of 24.68±19.87 years. The most common inflammatory changes were 5,687 (43.7%), 1,228 (9.4%), 670 (5.1%), 522 (4%), and 363 (2.8%) cases of acute appendicitis, suppurative appendicitis, early acute appendicitis, gangrenous appendicitis, and perforated appendicitis respectively. Microscopically, no viral inclusions, fungal elements, and histopathologic findings of bacterial causes were found. Parasitic infections such as helminthiasis were detected in 74 (0.6%) cases aged from 6 to 63. Enterobiasis (Syn. oxyuriasis, pinworm infection) accounted for 73 (98.6%) of the 74 helminthiases, while ascariasis accounted for 1 (1.4%). Out of 74 cases, 29 (39.2%) showed evidence of appendicitis. CONCLUSION The results suggest that although parasitic agents are minor causes of appendicitis, these agents should be kept in mind during differential diagnosis. However, whether every parasitic infection leads to appendicitis is controversial.
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Affiliation(s)
- Mahmoud Agholi
- HIV/AIDS Research Center, Fasa University of Medical Sciences, Fasa, Iran
- Department of Parasitology and Mycology, Fasa University of Medical Sciences, Fasa,
Iran
| | - Farideh Esfandiari
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of
Medical Sciences, Shiraz, Iran
| | - Hamid Reza Heidarian
- Department of Parasitology and Mycology, Fasa University of Medical Sciences, Fasa,
Iran
| | - Fatemeh Khajeh
- Department of Pathology, Fasa University of Medical Sciences, Fasa, Iran
| | - Zahra Sharafi
- Department of Parasitology and Mycology, Fasa University of Medical Sciences, Fasa,
Iran
| | - Ehsan Masoudi
- Department of Anatomy, School of Medicine, Shiraz University of Medical Sciences,
Shiraz, Iran
| | - Mohammad Rayani
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical
Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
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Núñez-Rocha RE, Girón F, Rodríguez L, Camargo-Gómez D, Restrepo-Bonilla C, Panqueva RDPL, Cadena M, Nassar R, Herrera-Almario GE, Hernández-Restrepo JD. Incidence of appendiceal neoplasms in appendectomy patients. BMC Surg 2023; 23:287. [PMID: 37735406 PMCID: PMC10512515 DOI: 10.1186/s12893-023-02183-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Non-operative management has been suggested as a therapy for uncomplicated appendicitis. Notwithstanding, the risk of missing an appendiceal tumor must be considered, being the surgical piece crucial to rule out neoplasms. Therefore, we aim to determine the incidence of appendiceal neoplasms in patients with acute appendicitis, tumor types and the importance of the anatomopathological study of the surgical piece. STUDY DESIGN Retrospective study in which we described patients who underwent emergent appendectomy with histopathological findings of appendiceal neoplasms from January 2012 to September 2018. Descriptive analysis included demographic variables, diagnostic methods, and surgical techniques. RESULTS 2993 patients diagnosed with acute appendicitis who underwent an emergency appendectomy. 64 neoplasms of the appendix were found with an incidence of 2,14%. 67.2% were women, the mean age was 46,4 years (± 19.5). The most frequent appendiceal neoplasms were neuroendocrine tumors (42,2%), followed by appendiceal mucinous neoplasms (35,9%), sessile serrated adenomas (18,8%), and adenocarcinomas (3,1%). In 89,1% of the cases, acute appendicitis was determined by imaging, and 14% of cases were suspected intraoperatively. Appendectomy was performed in 78,1% without additional procedures. CONCLUSIONS Appendiceal tumors are rare and must be ruled out in patients with suspected acute appendicitis. The incidence of incidental neoplasms is higher in this study than in the previously reported series. This information must be included in decision-making when considering treatment options for acute appendicitis.
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Affiliation(s)
- Ricardo E Núñez-Rocha
- Hospital Universitario Fundación Santa Fe de Bogotá, Calle 119 No. 7-14, Bogotá, DC, Colombia
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia
| | - Felipe Girón
- Hospital Universitario Fundación Santa Fe de Bogotá, Calle 119 No. 7-14, Bogotá, DC, Colombia.
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia.
| | - Lina Rodríguez
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia
| | | | | | - Rocío Del Pilar López Panqueva
- Hospital Universitario Fundación Santa Fe de Bogotá, Calle 119 No. 7-14, Bogotá, DC, Colombia
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia
| | - Manuel Cadena
- Hospital Universitario Fundación Santa Fe de Bogotá, Calle 119 No. 7-14, Bogotá, DC, Colombia
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia
| | - Ricardo Nassar
- Hospital Universitario Fundación Santa Fe de Bogotá, Calle 119 No. 7-14, Bogotá, DC, Colombia
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia
| | - Gabriel E Herrera-Almario
- Hospital Universitario Fundación Santa Fe de Bogotá, Calle 119 No. 7-14, Bogotá, DC, Colombia
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia
| | - Juan David Hernández-Restrepo
- Hospital Universitario Fundación Santa Fe de Bogotá, Calle 119 No. 7-14, Bogotá, DC, Colombia
- School of Medicine, Universidad de los Andes, Cundinamarca, Colombia
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Köhler F, Matthes N, Rosenfeldt M, Kunzmann V, Germer CT, Wiegering A. Neoplasms of the Appendix. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:519-525. [PMID: 37282595 PMCID: PMC10534129 DOI: 10.3238/arztebl.m2023.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Neoplasms of the vermiform appendix are rare. They comprise a heterogeneous group of entities requiring differentkinds of treatment. METHODS This review is based on publications retrieved by a selective literature search in the PubMed, Embase, and Cochranedatabases. RESULTS 0.5% of all tumors of the gastrointestinal tract arise in the appendix. Their treatment depends on their histopathologicalclassification and tumor stage. The mucosal epithelium gives rise to adenomas, sessile serrated lesions, adenocarcinomas,goblet-cell adenocarcinomas, and mucinous neoplasms. Neuroendocrine neoplasms originate in neuroectodermal tissue. Adenomasof the appendix can usually be definitively treated by appendectomy. Mucinous neoplasms, depending on their tumorstage, may require additional cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC). Adeno -carcinomas and goblet-cell adenocarcinomas can metastasize via the lymphatic vessels and the bloodstream and should thereforebe treated by oncological right hemicolectomy. Approximately 80% of neuroendocrine tumors are less than 1 cm in diameterwhen diagnosed and can therefore be adequately treated by appendectomy; right hemicolectomy is recommended if the patienthas risk factors for metastasis via the lymphatic vessels. Systemic chemotherapy has not been shown to be beneficial forappendiceal neoplasms in prospective, randomized trials; it is recommended for adenocarcinomas and goblet-cell adenocarcinomasof stage III or higher, in analogy to the treatment of colorectal carcinoma.
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Affiliation(s)
- Franziska Köhler
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Germany
| | - Niels Matthes
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Germany
| | - Mathias Rosenfeldt
- Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Germany
- Institute of Pathology, University of Würzburg, Germany
| | - Volker Kunzmann
- Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Germany
- Medical Clinic and Polyclinic II, University Hospital of Würzburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Germany
- Department of Biochemistry and Molecular Biology, University of Würzburg, Germany
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Allahqoli L, Mazidimoradi A, Momenimovahed Z, Günther V, Ackermann J, Salehiniya H, Alkatout I. Appendiceal Endometriosis: A Comprehensive Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13111827. [PMID: 37296678 DOI: 10.3390/diagnostics13111827] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
Objective: the purpose of this review was to evaluate the prevalence of appendiceal endometriosis and the safety of concomitant appendectomy in women with endometriosis or pelvic pain. Materials and Methods: We searched the electronic databases Medline (PubMed), Scopus, Embase, and Web of Science (WOS). The search was not subject to any limitation in terms of time or method. The primary research question was: what is the prevalence of appendiceal endometriosis? The secondary research question was: is it safe to perform appendectomy during surgery for endometriosis? Publications that reported data about appendiceal endometriosis or appendectomy in women with endometriosis were reviewed regarding the inclusion criteria. Results: We found 1418 records. After review and screening, we included 75 studies published between 1975 and 2021. With regard to the first question of the review, we found 65 eligible studies and divided these into the following two categories: (a) endometriosis of the appendix presenting as acute appendicitis, and (b) endometriosis of the appendix as an incidental finding in gynecological surgery. Forty-four case reports described appendiceal endometriosis in women who were admitted for the treatment of pain in the right-sided lower abdomen. Endometriosis of the appendix was observed in 2.67% (range, 0.36-23%) of women who were admitted due to acute appendicitis. In addition, appendiceal endometriosis was an incidental finding during gynecological surgery in 7.23% of cases (range, 1-44.3%). With regard to the second question of the review, which was the safety of appendectomy in women with endometriosis or pelvic pain, we found 11 eligible studies. Reviewed cases had no significant intraoperative or follow-up complications during the 12 weeks. Conclusion: Based on the reviewed studies, coincidental appendectomy appears reasonably safe and was associated with no complications in the cases reviewed for the present report.
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Affiliation(s)
- Leila Allahqoli
- Ministry of Health and Medical Education, Tehran 1467664961, Iran
| | - Afrooz Mazidimoradi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
| | - Zohre Momenimovahed
- Department of Midwifery and Reproductive Health, Qom University of Medical Sciences, Qom 3716993456, Iran
| | - Veronika Günther
- University Hospitals Schleswig-Holstein, Kiel School of Gynaecological Endoscopy, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
| | - Johannes Ackermann
- University Hospitals Schleswig-Holstein, Kiel School of Gynaecological Endoscopy, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Ibrahim Alkatout
- University Hospitals Schleswig-Holstein, Kiel School of Gynaecological Endoscopy, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
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Axentiev A, Shehzad B, Bernescu I. Appendiceal Inversion Presenting as a Cecal Polypoid Mass on Screening Colonoscopy: A Case Report and Review of Available Diagnostic Adjuncts to Differentiate Benign From Malignant Colorectal Pathology. Cureus 2023; 15:e35645. [PMID: 37009345 PMCID: PMC10065354 DOI: 10.7759/cureus.35645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/05/2023] Open
Abstract
Appendiceal inversion is uncommon. It may be a benign finding or seen in association with malignant pathology. When detected, it masquerades as a cecal polyp which poses a diagnostic dilemma with malignancy in the differential. In this report, we highlight a case of a 51-year-old patient with an extensive surgical history as a newborn in the setting of omphalocele and intestinal malrotation, who was found to have a 4 cm cecal polypoid growth on screening colonoscopy. He underwent a cecectomy for tissue diagnosis. Ultimately, the polyp was found to be an inverted appendix without evidence of malignancy. Currently, suspicious colorectal lesions which cannot be removed by polypectomy are primarily addressed with surgical excision. We reviewed the literature for available diagnostic adjuncts to better differentiate benign from malignant colorectal pathology. The application of advanced imaging and molecular technology will allow for improved diagnostic accuracy and subsequent operative planning.
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Clinicopathologic parameters and outcomes of mucinous neoplasms confined to the appendix: a benign entity with excellent prognosis. Mod Pathol 2022; 35:1732-1739. [PMID: 35676331 DOI: 10.1038/s41379-022-01114-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
Abstract
Appendiceal mucinous neoplasms (AMNs), characterized by expansile or "pushing" growth of neoplastic epithelium through the appendix wall, are sometimes accompanied by peritoneal involvement, the extent and grade of which largely determine clinical presentation and long-term outcomes. However, the prognosis of tumors entirely confined to the appendix is still debated and confusion remains regarding their biologic behavior and, consequently, their clinical management and even diagnostic nomenclature. We evaluated AMNs limited to the appendix from 337 patients (median age: 58 years, interquartile range (IQR): 47-67), 194 (57.6%) of whom were women and 143 (42.4%) men. The most common clinical indication for surgery was mass or mucocele, in 163 (48.4%) cases. Most cases (N = 322, 95.5%) comprised low-grade epithelium, but there were also 15 (4.5%) cases with high-grade dysplasia. Lymph nodes had been harvested in 102 (30.3%) cases with a median 6.5 lymph nodes (IQR: 2-14) per specimen for a total of 910 lymph nodes examined, all of which were negative for metastatic disease. Histologic slide review in 279 cases revealed 77 (27.6%) tumors extending to the mucosa, 101 (36.2%) to submucosa, 33 (11.8%) to muscularis propria, and 68 (24.4%) to subserosal tissues. In multivariate analysis, deeper tumor extension was associated with older age (p = 0.032; odds ratio (OR): 1.02, 95% confidence intervals (CI): 1.00-1.03), indication of mass/mucocele (p < 0.001; OR: 2.09, CI: 1.41-3.11), and wider appendiceal diameter, grossly (p < 0.001; OR: 1.61, CI: 1.28-2.02). Importantly, among 194 cases with at least 6 months of follow-up (median: 56.1 months, IQR: 24.4-98.5), including 9 high-grade, there was no disease recurrence/progression, peritoneal involvement (pseudomyxoma peritonei), or disease-specific mortality. These data reinforce the conclusion that AMNs confined to the appendix are characterized by benign biologic behavior and excellent clinical prognosis and accordingly suggest that revisions to their nomenclature and staging would be appropriate, including reverting to the diagnostic term mucinous adenoma in order to accurately describe a subset of them.
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Kadi M, Nasr A, Shabkah AA, Alnahari R, Alhawi A, Alyamani R, Saleem AM. Histopathological examination of cases with acute appendicitis, A retrospective study at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Ann Med Surg (Lond) 2022; 81:104401. [PMID: 36147057 PMCID: PMC9486616 DOI: 10.1016/j.amsu.2022.104401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022] Open
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Iqbal A, Fujimura T, Shinjoh M, Furuichi M, Iimori T, Umeyama T, Ishida T, Morinaga S, Kamimaki I, Ohkusu K, Takahashi T. The first case report of pediatric acute appendicitis caused by "Candidatus Actinobaculum timonae". J Infect Chemother 2021; 28:451-454. [PMID: 34887179 DOI: 10.1016/j.jiac.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
A 14-year-old boy presented to the hospital with pain in the right lower abdomen. His condition was diagnosed as acute appendicitis. An emergency operation was performed, and histopathological examination revealed an actinomycete-related organism in the excised appendicitis specimen. On 16S rRNA gene sequence analysis, "Candidatus Actinobaculum timonae" was identified, which is the first known case in a pediatric patient.
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Affiliation(s)
- Asef Iqbal
- Department of Pediatrics, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Takumi Fujimura
- Department of Pediatric Surgery, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Masayoshi Shinjoh
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan.
| | - Munehiro Furuichi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan
| | - Takashi Iimori
- Department of Pediatrics, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Tomoshige Umeyama
- Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan
| | - Tsuyoshi Ishida
- Department of Diagnostic Pathology, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Shojiro Morinaga
- Department of Diagnostic Pathology, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Isamu Kamimaki
- Department of Pediatrics, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Kiyofumi Ohkusu
- Department of Microbiology, Tokyo Medical University, 6-1-1 Shinjuku Shinjuku-ku, Tokyo, Japan
| | - Takao Takahashi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan
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Bonjour TJ. The ambiguous abdomen in a basic military trainee. JAAPA 2021; 34:54-56. [PMID: 34582388 DOI: 10.1097/01.jaa.0000791496.19639.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Timothy J Bonjour
- Timothy J. Bonjour is associate dean of graduate allied health education at the San Antonio Uniformed Services Health Education Consortium and practices emergency medicine at Brooke Army Medical Center, Fort Sam Houston and Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, in San Antonio, Tex. The author has disclosed no potential conflicts of interest, financial or otherwise
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13
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Skendelas JP, Alemany VS, Au V, Rao D, McNelis J, Kim PK. Appendiceal adenocarcinoma found by surgery for acute appendicitis is associated with older age. BMC Surg 2021; 21:228. [PMID: 33934697 PMCID: PMC8088755 DOI: 10.1186/s12893-021-01224-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/21/2021] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Appendectomy for acute appendicitis is the most common procedure performed emergently by general surgeons in the United States. The current management of acute appendicitis is increasingly controversial as non-operative management gains favor. Although rare, appendiceal neoplasms are often found as an incidental finding in the setting of appendectomy. Criteria and screening for appendiceal neoplasms are not standardized among surgical societies. METHODS The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients who underwent appendectomy over a 9-year period (2010-2018). Over the same time period, patients who underwent appendectomy in two municipal hospitals in The Bronx, New York City, USA were reviewed. RESULTS We found a 1.7% incidence of appendiceal neoplasms locally and a 0.53% incidence of appendiceal tumors in a national population sample. Both groups demonstrated an increased incidence of appendiceal carcinoma by age. This finding was most pronounced after the age of 40 in both local and national populations. In our study, the incidence of appendiceal tumors increased with each decade interval up to the age of 80 and peaked at 2.1% in patients between 70 and 79 years. CONCLUSIONS Appendiceal adenocarcinomas were identified in patients with acute appendicitis that seem to be associated with increasing age. The presence of an appendiceal malignancy should be considered in the management of older patients with acute appendicitis before a decision to embark on non-operative therapy.
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Affiliation(s)
- John P Skendelas
- Jacobi Medical Center, Bronx, NY, USA
- North Central Bronx Hospital, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Vincent Au
- Jacobi Medical Center, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
| | - Devika Rao
- Jacobi Medical Center, Bronx, NY, USA
- North Central Bronx Hospital, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - John McNelis
- Jacobi Medical Center, Bronx, NY, USA
- North Central Bronx Hospital, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Peter K Kim
- Jacobi Medical Center, Bronx, NY, USA.
- North Central Bronx Hospital, Bronx, NY, USA.
- Albert Einstein College of Medicine, Bronx, NY, USA.
- Jacobi Medical Center, 1400 Pelham Parkway, Building 1, Room 510, Bronx, NY, 10461, USA.
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Shahmoradi MK, Zarei F, Beiranvand M, Hosseinnia Z. A retrospective descriptive study based on etiology of appendicitis among patients undergoing appendectomy. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Coratti F, Vannuccini S, Foppa C, Staderini F, Coratti A, Cianchi F, Petraglia F. Emergency surgery for appendectomy and incidental diagnosis of superficial peritoneal endometriosis in fertile age women. Reprod Biomed Online 2020; 41:729-733. [PMID: 32807657 DOI: 10.1016/j.rbmo.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/19/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023]
Abstract
RESEARCH QUESTION This study aimed to evaluate the presence of superficial peritoneal endometriosis (SUP) in women referred to emergency surgery for right iliac fossa (RIF) pain and undergoing an appendectomy, considering which factors may be useful to suspect and identify endometriosis. DESIGN An observational case-control study was conducted on a group (n = 149) of fertile age women. After surgery, Group A was selected upon the diagnosis of endometriosis (n = 34); Group B (n = 115) represented the controls. Demographics, comorbidities and clinical findings were registered and analysed. RESULTS Appendicitis of various grades of severity was diagnosed in all patients, but SUP was also identified in 23%, of which 14.7% also presented with endometriosis of the appendix. Women in Group A reported chronic pelvic pain, dysmenorrhoea, dyspareunia and oral contraceptive use more frequently. At multivariate analysis, factors associated with endometriosis were: age <40 years, autoimmune disorders, multiple allergies, abdominal chronic pain, associated gynaecological pain symptoms, Alvarado score ≤6, and inconclusive ultrasound findings. CONCLUSIONS The incidental finding of SUP in fertile age women presenting with an acute RIF pain and undergoing emergency surgery is a relevant observation. Clinical history and symptoms should guide surgeons in performing a correct diagnosis and in referring the patient to the gynaecology specialist.
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Affiliation(s)
- Francesco Coratti
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Silvia Vannuccini
- Department of Molecular and Developmental Medicine, University of Siena Siena, Italy; Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital Florence, Italy
| | - Caterina Foppa
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Fabio Staderini
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Andrea Coratti
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Fabio Cianchi
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital Florence, Italy.
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Naar L, Kim P, Byerly S, Vasileiou G, Zhang H, Yeh DD, Kaafarani HMA. Increased risk of malignancy for patients older than 40 years with appendicitis and an appendix wider than 10 mm on computed tomography scan: A post hoc analysis of an EAST multicenter study. Surgery 2020; 168:701-706. [PMID: 32739139 DOI: 10.1016/j.surg.2020.05.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of underlying malignancy in appendicitis ranges between 0.5% and 1.7%. We sought to identify the subset of patients with appendicitis who are at increased risk of appendiceal malignancy. METHODS Using the Eastern Association for the Surgery of Trauma Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous database, we included all patients from 28 centers undergoing immediate, delayed, or interval appendectomy between 2017 and 2018. Univariate then multivariable analyses were performed to compare patients with and without malignancy and to identify independent demographic, clinical, laboratory, and/or radiological predictors of malignancy. Akaike information criteria for regression models were used to evaluate goodness of fit. RESULTS A total of 3,293 patients were included. The median age was 38 (27-53) years, and 46.5% were female patients. On pathology, 48 (1.5%) had an underlying malignancy (adenocarcinoma [60.4%], neuroendocrine [37.5%], and lymphoma [2.1%]). Patients with malignancy were older (56 [34.5-67] vs 37 [27-52] years, P < .001), had longer duration of symptoms before presentation (36-41 vs 18-23 hours, P = .03), and were more likely to have a phlegmon on imaging (6.3% vs 1.3%, P = .03). Multivariable analyses showed that an enlarged appendiceal diameter was independently associated with malignancy (odds ratio = 1.06, 95% confidence interval = 1.01-1.12; P = .01). The incidence of malignancy in patients >40 years with an appendiceal diameter >10 mm on computed tomography was 2.95% compared with 0.97% in patients ≤40 years old with appendiceal diameter ≤10 mm. The corresponding risk ratio for that population was 3.03 (95% confidence interval: 1.24-7.42; P = .02). CONCLUSION The combination of age >40 and an appendiceal diameter >10 mm is associated with a greater than 3-fold increased risk of malignancy in patients presenting with appendicitis.
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Affiliation(s)
- Leon Naar
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Peter Kim
- Department of General Surgery, Jacobi Medical Center and North Central Bronx Hospital, New York, NY
| | - Saskya Byerly
- Division of Surgical Critical Care, Trauma Surgery, Department of Surgery, Ryder Trauma Center/Jackson Memorial Hospital, University of Miami, FL
| | - Georgia Vasileiou
- Division of Surgical Critical Care, Trauma Surgery, Department of Surgery, Ryder Trauma Center/Jackson Memorial Hospital, University of Miami, FL
| | - Hang Zhang
- Division of Biostatistics, Department of Public Health Sciences, University of Miami, FL
| | - D Dante Yeh
- Division of Surgical Critical Care, Trauma Surgery, Department of Surgery, Ryder Trauma Center/Jackson Memorial Hospital, University of Miami, FL
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA.
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Bastiaenen VP, Allema WM, Klaver CEL, van Dieren S, Koens L, Tanis PJ, Bemelman WA. Routine histopathologic examination of the appendix after appendectomy for presumed appendicitis: Is it really necessary? A systematic review and meta-analysis. Surgery 2020; 168:305-312. [PMID: 32471653 DOI: 10.1016/j.surg.2020.03.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 03/31/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Owing to substantial costs and increasing interest in the nonoperative management of appendicitis, the necessity of routine histopathologic examination of appendectomy specimens is being questioned. The aim of this study was to determine whether routine histopathologic examination after appendectomy for suspected appendicitis should still be performed. METHODS PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies listing the histopathologic diagnoses after appendectomy for suspected appendicitis. Main outcomes were the incidence of histopathologically proven aberrant findings, the ability of surgeons to recognize unexpected appendiceal pathology intraoperatively, and the percentage of aberrant findings resulting in a change of postoperative management. A meta-analysis was performed using a random-effects model. RESULTS Twenty-five studies with 57,357 patients were included. The pooled percentage of aberrant findings was 2.52% (95% confidence interval 1.81-3.51). Neoplasms were found in 0.71% (95% confidence interval 0.54-0.94). Findings of the intraoperative assessment by the surgeon were reported for 82 of the 2,718 (3.0%) unexpected diagnoses, with great variation between studies. The impact on postoperative management was described for 237 of 2,718 (8.7%) aberrant findings. Of these, 166 (70.0%) resulted in a change of postoperative management. CONCLUSION Based on current evidence, it remains unclear how many of the unexpected appendiceal pathologies with clinical consequences can be identified intraoperatively by the surgeon. Until reliable data on the safety and potential cost savings of a selective policy becomes available, we advise sending appendectomy specimens routinely for histopathologic examination.
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Affiliation(s)
- Vivian P Bastiaenen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Wies M Allema
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Charlotte E L Klaver
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Susan van Dieren
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Lianne Koens
- Department of Pathology, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Pieter J Tanis
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Willem A Bemelman
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
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The neglected role of Enterobius vermicularis in appendicitis: A systematic review and meta-analysis. PLoS One 2020; 15:e0232143. [PMID: 32324817 PMCID: PMC7179856 DOI: 10.1371/journal.pone.0232143] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/07/2020] [Indexed: 01/13/2023] Open
Abstract
Although the main cause of appendicitis is unclear, infection with Enterobius vermicularis is suggested as a neglected risk factor. Since, there is no comprehensive analysis to estimate the prevalence of E. vermicularis in appendicitis; therefore, we conducted a global-scale systematic review and meta-analysis study to estimate the prevalence of E. vermicularis infection in appendicitis cases. PubMed, Scopus, Web of Science and Google Scholar databases were systematically searched for relevant studies published until 15 August 2019. Pooled prevalence of E. vermicularis infection was estimated using the random effects model. Data were classified based on the continents and countries. Moreover, subgroup analyses regarding the gender, the human development index (HDI), and income level of countries were also performed. Fifty-nine studies involving 103195 appendix tissue samples belonging to the individuals of appendicitis were included. The pooled prevalence of E. vermicularis infection was (4%, 95%CI, 2–6%), with the highest prevalence (8%, 95% CI: 0–36%) and lowest prevalence (2%, 95% CI: 1–4%) in Africa and Americas continents, respectively. With respect to countries, the lowest and highest prevalence rates were reported from Venezuela (<1%, 95% CI: 0–1%) and Nigeria (33%, 95% CI: 17–52%), respectively. Indeed, a higher prevalence was observed in females, as well as in countries with lower levels of income and HDI. Our findings indicate the relatively high burden of E. vermicularis infection in appendicitis cases. However, our findings suggest the great need for more epidemiological studies to depth understand overlaps between E. vermicularis infection and appendicitis in countries with lower HDI and income levels.
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Lim CSH, Cheah SYL, Kwok AMF, Ravindran P, Chan DL. Systematic review and meta-analysis of the association between diverticulosis of the appendix and neoplasia. ANZ J Surg 2020; 90:1871-1877. [PMID: 32207873 DOI: 10.1111/ans.15811] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diverticula of the appendix (DA) are infrequent and their clinical implications are often overlooked. Several studies have found a significantly increased prevalence of neoplasms in appendiceal specimens with diverticula. Despite the potential clinical implications, there is a paucity of literature. A systematic review and meta-analysis was performed to evaluate the prevalence of DA and its association with neoplasia. METHODS A systematic search of literature (Cochrane, EMBASE, PubMed and Medline) reporting the prevalence of DA and association with neoplasia was performed in November 2019. Relevant articles were assessed in accordance with the PRISMA guidelines. Risk of bias assessment was carried out using modified Newcastle-Ottawa scale. Meta-analysis with risk ratio and random-effects model was performed using RevMan. RESULTS The initial search identified 1122 potential articles of which 11 were appropriate for quantitative analysis. The prevalence rate of DA was 1.74%. The mean age of patients with DA and those without DA was 41.2 and 33.9 years, respectively. The ratio of male to female was 1.8:1. The prevalence of neoplasia in specimens without DA versus those with DA was 1.28% and 26.94%, respectively. Only four studies addressed the prevalence of locoregional neoplasia in the setting of DA compared to control. Meta-analysis with random-effects model demonstrated that pooled risk ratio was 25.46 (95% confidence interval 12.77-50.75, P < 0.00001). CONCLUSION The strong association with neoplasia in this meta-analysis reinforces the clinical significance of DA. Surgeons, pathologists and radiologists should be mindful of this uncommon pathology and consider individualized patient management, until further evidence can direct clinical guidelines for the management of patients with DA.
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Affiliation(s)
| | - Sarah Yi-Lin Cheah
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Allan Mun Fai Kwok
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Praveen Ravindran
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Daniel Leonard Chan
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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20
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Son J, Park YJ, Lee SR, Kim HO, Jung KU. Increased Risk of Neoplasms in Adult Patients Undergoing Interval Appendectomy. Ann Coloproctol 2020; 36:311-315. [PMID: 32054244 PMCID: PMC7714372 DOI: 10.3393/ac.2019.10.15.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/15/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The low rate of recurrent appendicitis after initial nonsurgical management of complicated appendicitis supports the recently implemented strategy of omitting routine interval appendectomy. However, several reports have suggested an increased incidence rate of neoplasms in these patients. We aimed to identify the risk of neoplasms in the population undergoing interval appendectomy. METHODS This study retrospectively analyzed consecutive cases of appendicitis that were treated surgically between January 2014 and December 2018 at a single tertiary referral center. Patients were divided into 2 groups depending on whether they underwent immediate or interval appendectomy. Demographics and perioperative clinical and pathologic parameters were analyzed. RESULTS All 2,013 adults included in the study underwent surgical treatment because of an initial diagnosis of acute appendicitis. Of these, 5.5% (111 of 2,013) underwent interval appendectomy. Appendiceal neoplasm was identified on pathologic analysis in 36 cases (1.8%). The incidence of neoplasm in the interval group was 12.6% (14 of 111), which was significantly higher than that of the immediate group (1.2% [22 of 1,902], P < 0.001). CONCLUSION The incidence rate of neoplasms was significantly higher in patients undergoing interval appendectomy. These findings should be considered when choosing treatment options after successful nonsurgical management of complicated appendicitis.
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Affiliation(s)
- Jungtak Son
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Jun Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Ryol Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Ook Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Unusual Histopathological Findings in Appendectomy Specimens Obtained from 1683 Pediatric Patients with Suspected Acute Appendicitis. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1814-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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The role of appendectomy at the time of laparoscopic surgery for benign gynecologic conditions. Curr Opin Obstet Gynecol 2019; 30:237-242. [PMID: 29889113 DOI: 10.1097/gco.0000000000000466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The risk-benefit ratio of concurrent appendectomy at the time of gynecologic surgery has long been debated and remains controversial. However, emerging data on the appendix's role in chronic pain syndromes point to a previously unrecognized link between gynecologic disorders and appendicular pathology. In this article, we review the indications for appendectomy at the time of laparoscopic gynecologic surgery for the treatment of endometriosis and chronic pelvic pain. RECENT FINDINGS The incidence of appendiceal endometriosis is highly variable depending on the patient population selected. Although rare in patients undergoing appendectomy for acute appendicitis, women with endometriosis may experience rates as high as 9.3-39.0%, especially when suffering from deep infiltrative endometriosis. Appendectomy may also significantly reduce pain in women with unexplained chronic pelvic pain. SUMMARY Despite lack of prospective data, retrospective studies suggest that appendectomy during gynecologic procedures for chronic pelvic pain and severe endometriosis may be beneficial and necessary to fully address the treatment of these complex gynecologic conditions. In these clinical scenarios, the benefits of laparoscopic appendectomy at the time of the primary gynecologic procedure may outweigh the risks and cost, and should be discussed with patients preoperatively.
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Abstract
Neuroendocrine tumours (NETs) are a heterogenous group of tumours arising from neuroendocrine cells in several sites around the body. They include tumours of the gastroenteropancreatic system, phaeochromocytoma and paraganglioma and medullary thyroid cancer. In recent years, it has become increasingly apparent that a number of these tumours arise as a result of germline genetic mutations and are inherited in an autosomal dominant pattern. The number of genes implicated is increasing rapidly. Identifying which patients are likely to have a germline mutation enables clinicians to counsel patients adequately about their future disease risk, and allows for earlier detection of at-risk patients through family screening. The institution of screening and surveillance programmes may in turn lead to a major shift in presentation patterns for some of these tumours. In this review, we examine the features which may lead a clinician to suspect that a patient may have an inherited cause of a NET and we outline which underlying conditions should be suspected. We also discuss what type of screening may be appropriate in a variety of situations.
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Affiliation(s)
- Triona O'Shea
- Centre of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Maralyn Druce
- Centre of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
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Hüttenbrink C, Hatiboglu G, Simpfendörfer T, Radtke JP, Becker R, Teber D, Hadaschik B, Pahernik S, Hohenfellner M. Incidental appendectomy during robotic laparoscopic prostatectomy-safe and worth to perform? Langenbecks Arch Surg 2017; 403:265-269. [PMID: 29098385 DOI: 10.1007/s00423-017-1630-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 10/06/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study is to investigate the safety and patients' benefit of incidental appendectomy during robot-assisted laparoscopic radical prostatectomy (RALRP). METHODS Fifty-three patients, who had incidental appendectomy during RALRP between January 2012 and March 2014, were enrolled to this study. To evaluate the safety of the procedure, following parameters were evaluated: patient age, duration of surgery, perioperative complications (classified by Clavien-Dindo), time to bowel movement, and length of hospital stay. Furthermore, intraoperative visual appearance, location, and histopathological evaluation of the appendix were evaluated. Data was analyzed by descriptive statistics. RESULTS Mean age of patients was 61 years, the average hospital stay 5 days. No perioperative complications occurred. The appendix was unsuspicious in 39 patients (73.6%); 14 patients (26.4%) had macroscopically signs of inflammation. Of the 53 resected appendixes, the histopathological evaluation showed 33 (62.2%) inconspicuous appendices, 11 (20.8%) post-inflammatory changes, 4 (7.5%) with chronical signs of inflammation and 3 (5.7%) with signs of acute inflammation. In 2 patients (3.8%), low-grade mucinous neoplasms were found in the specimens. CONCLUSIONS Incidental appendectomy during RALRP is a feasible procedure. With regard to inflammation and neoplastic changes, incidental appendectomy can be considered for patients scheduled for robot-assisted prostate surgery.
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Affiliation(s)
- C Hüttenbrink
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - G Hatiboglu
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - T Simpfendörfer
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - J P Radtke
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - R Becker
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - D Teber
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - B Hadaschik
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - S Pahernik
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - M Hohenfellner
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Gómez-Torres GA, Ortega-Gárcia OS, Gutierrez-López EG, Carballido-Murguía CA, Flores-Rios JA, López-Lizarraga CR, Bautista López CA, Ploneda-Valencia CF. A rare case of subacute appendicitis, actinomycosis as the final pathology reports: A case report and literature review. Int J Surg Case Rep 2017; 36:46-49. [PMID: 28531869 PMCID: PMC5440354 DOI: 10.1016/j.ijscr.2017.04.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/26/2017] [Accepted: 04/30/2017] [Indexed: 12/27/2022] Open
Abstract
Actinomycosis represents only the 0.02% of causes of acute apendicitis. We present the first case of appendiceal actinomycosis reported in México. As to our knowledge, this is the first case in the literature with appendiceal actinomycosis without been perforated.
Introduction Acute appendicitis is the most common indication for an emergency abdominal surgery in the world, with a lifetime incidence of around 10%. Actinomycetes are the etiology of appendicitis in only 0.02%–0.06%, having as the final pathology report a chronic inflammatory response; less than 10% of the cases are diagnosed before surgery. Here, we present the case of a subacute appendicitis secondary to actinomycosis. Case report A 39-year-old male presented with a twelve-day evolution of intermittent abdominal pain in the right lower quadrant, treated at the beginning with ciprofloxacin and urinary analgesic. The day of the admission he referred intense abdominal pain with nausea. An open appendectomy was preformed, finding a tumor-like edematous appendix with a diameter of approximately 2.5 cm. Discussion Actinomyces are part of the typical flora of the oral cavity, gastrointestinal tract and vagina. The predominant form of human disease is A. Israelii, it requires an injury to the normal mucosa to penetrate and cause disease. Abdominal actinomycosis involves the appendix and caecum in 66% of the presentations, of these, perforated appendicitis is the stimulus in 75% of the cases. A combination of antibiotic therapy and operative treatment resolves actinomycosis in 90% of cases. Conclusion Abdominal actinomycosis is an uncommon disease been the common presentation a perforated appendicitis, here we present a less common presentation of it with a non-perforated appendix.
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Affiliation(s)
- G A Gómez-Torres
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México.
| | - O S Ortega-Gárcia
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
| | - E G Gutierrez-López
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
| | | | - J A Flores-Rios
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
| | - C R López-Lizarraga
- Division of Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
| | - C A Bautista López
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
| | - C F Ploneda-Valencia
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
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