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Carvalho N, Barreira AL, Henriques S, Ferreira M, Cardoso C, Luz C, Costa PM. Compilation of Evidence Supporting the Role of a T Helper 2 Reaction in the Pathogenesis of Acute Appendicitis. Int J Mol Sci 2024; 25:4216. [PMID: 38673802 PMCID: PMC11050072 DOI: 10.3390/ijms25084216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/27/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024] Open
Abstract
Despite being the most common abdominal surgical emergency, the cause of acute appendicitis (AA) remains unclear, since in recent decades little progress has been made regarding its etiology. Obstruction of the appendicular lumen has been traditionally presented as the initial event of AA; however, this is often the exception rather than the rule, as experimental data suggest that obstruction is not an important causal factor in AA, despite possibly occurring as a consequence of the inflammatory process. Type I hypersensitivity reaction has been extensively studied, involving Th2 lymphocytes, and cytokines such as IL-4, IL-5, IL-9 and IL-13, which have well-defined functions, such as a positive-feedback effect on Th0 for differentiating into Th2 cells, recruitment of eosinophils and the release of eosinophilic proteins and the production of IgE with the activation of mast cells, with the release of proteins from their granules. Cytotoxic activity and tissue damage will be responsible for the clinical manifestation of the allergy. AA histological features are similar to those found in allergic reactions like asthma. The intestine has all the components for an allergic immune response. It has contact with hundreds of antigens daily, most of them harmless, but some can potentially induce an allergic response. In recent years, researchers have been trying to assess if allergy is a component of AA, with their latest advances in the understanding of AA as a Th2 reaction shown by the authors of this article.
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Affiliation(s)
- Nuno Carvalho
- Serviço Cirurgia Geral, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (A.L.B.); (S.H.); (M.F.); (C.L.); (P.M.C.)
- Faculdade Medicina, Universidade Lisboa, 1649-028 Lisboa, Portugal
| | - Ana Lúcia Barreira
- Serviço Cirurgia Geral, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (A.L.B.); (S.H.); (M.F.); (C.L.); (P.M.C.)
| | - Susana Henriques
- Serviço Cirurgia Geral, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (A.L.B.); (S.H.); (M.F.); (C.L.); (P.M.C.)
| | - Margarida Ferreira
- Serviço Cirurgia Geral, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (A.L.B.); (S.H.); (M.F.); (C.L.); (P.M.C.)
- Faculdade Medicina, Universidade Lisboa, 1649-028 Lisboa, Portugal
| | - Carlos Cardoso
- Dr. Joaquim Chaves, Laboratório de Análises Clínicas, 1495-068 Algés, Portugal;
| | - Carlos Luz
- Serviço Cirurgia Geral, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (A.L.B.); (S.H.); (M.F.); (C.L.); (P.M.C.)
- Faculdade Medicina, Universidade Lisboa, 1649-028 Lisboa, Portugal
| | - Paulo Matos Costa
- Serviço Cirurgia Geral, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (A.L.B.); (S.H.); (M.F.); (C.L.); (P.M.C.)
- Faculdade Medicina, Universidade Lisboa, 1649-028 Lisboa, Portugal
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Mlika M, Ben Ismail I, Zoghlami A. A "fruitful" cause of acute appendicitis. LA TUNISIE MEDICALE 2023; 101:585-587. [PMID: 38372548 PMCID: PMC11217960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/02/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Acute appendicitis is a common health problem mainly due to a lumen obstruction. The obstruction is mainly due to fecal material, lymphoid hyperplasia or parasites. Foreign bodies and especially seeds have been rarely reported as causes of acute appendicitis and account for less than 1% of the different causes. CASE REPORT The authors described a rare case of acute appendicitis caused by seed and causing diagnostic challenge with the most frequent parasites observed in the appendix lumen. Different arguments were gathered to rule out enterobius vermicularis, taenia species, ascaris infection or schistosomiasis. CONCLUSION Seed-caused-appendicitis has to be known and identified by pathologists in order to avoid the diagnosis of parasites infection which may induce an overuse of antibiotics after the appendectomy.
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Affiliation(s)
- Mona Mlika
- Department of Pathology-Trauma and Major Burn Center. Ben Arous. Tunis, Faculty of Medicine of Tunis-University of Tunis El Manar, Tunis- Tunisia
| | - Imen Ben Ismail
- Department of Surgery, Trauma and Major Burn Center Ben Arous - Tunis/Faculty of Medicine of Tunis-University of Tunis El Manar ,Tunis Tunisia
| | - Ayoub Zoghlami
- Department of Surgery, Trauma and Major Burn Center Ben Arous - Tunis/Faculty of Medicine of Tunis-University of Tunis El Manar ,Tunis Tunisia
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Issın G, Demır F, Simsek HA, Cagatay DV, Tayfur M, Kandemır A, Balcı MG. Seeds or Parasites? Clinical and Histopathological Features of Seeds and Parasites in the Appendix. Turk Patoloji Derg 2023; 39:42-54. [PMID: 36647674 PMCID: PMC10518133 DOI: 10.5146/tjpath.2022.01586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 09/05/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Parasites and plant seeds may both be found in appendectomy specimens. Each plant seed has a different appearance and can thus exhibit wide variations under the microscope. Fragmented seeds may histologically mimic parasites. The differential diagnosis between seeds and parasites can be challenging in such cases. This study aimed to determine the incidence of parasites, seeds, and foreign bodies in appendectomy materials and highlight the most characteristic histopathological features associated with these structures. MATERIAL AND METHOD In this study, pathology slides of 9,480 patients, who underwent appendectomy between 2010 and 2021, were reviewed, and cases that contained parasites, seeds, or foreign bodies were identified. We reviewed the literature on seeds and parasites in appendectomy specimens. RESULTS Parasites were observed in 56 (0.6%) cases. Of these cases, 45 had Enterobius vermicularis (80%), and 11 had Taenia subspecies (20%). Plant seeds were observed in 47 cases (0.5%), and were macroscopically recognizable in 5 of them as olive, lemon, and cherry seeds. Parasites and seeds were usually observed in the lumen of appendix vermiformis, filled with abundant fecal materials. CONCLUSION Seeds are seen in approximately 0.5% of the appendectomy specimens. Though rarely seen, the fragmented seed appearance may cause diagnostic difficulties. In this context, the key morphological features of parasites and plant seeds outlined in this study may be helpful in their differential diagnosis.
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Affiliation(s)
- Gizem Issın
- Department of Pathology, Erzincan Binali Yildirim University, Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Fatih Demır
- Department of Pathology, Erzincan Binali Yildirim University, Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | | | - Diren Vuslat Cagatay
- Department of Pathology, Erzincan Binali Yildirim University, Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Mahir Tayfur
- Department of Pathology, Erzincan Binali Yildirim University, Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Ali Kandemır
- Department of Biology, Erzincan Binali Yildirim University, Faculty of Science and Art, Erzincan, Turkey
| | - Mecdi Gürhan Balcı
- Department of Pathology, Erzincan Binali Yildirim University, Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
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A Th2 Cytokine Profile in Appendicular Lavage Fluid Suggests Allergy as a Possible Etiology for Acute Appendicitis. Mediators Inflamm 2019; 2019:8146257. [PMID: 31772507 PMCID: PMC6854935 DOI: 10.1155/2019/8146257] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/19/2019] [Accepted: 09/26/2019] [Indexed: 11/23/2022] Open
Abstract
Acute appendicitis is the most frequent surgical abdominal emergency, but its etiology remains poorly understood. Histological examination of the appendix, following its removal due to acute appendicitis, consistently shows features in common with bronchial asthma, suggesting an allergic reaction as a candidate etiologic factor. Here, we propose the concept of appendicular lavage and use it to study the levels of the Th2 cytokines IL-4, IL-5, and IL-9 in patients with a clinical diagnosis of acute appendicitis. The study group included 20 patients with a histological diagnosis of phlegmonous appendicitis, 13 patients with gangrenous appendicitis, and a control group of 8 patients with a clinical diagnosis of appendicitis but with normal histology. Cytokine levels were higher in acute appendicitis. The difference was more pronounced when comparing phlegmonous appendicitis with nonpathological appendicitis (p = 0.01) for IL-4 (48.3 vs. 21.3 pg/mL), IL-5 (29.2 vs. 8.0 pg/mL), and IL-9 (34.1 vs. 16.6 pg/mL). This Th2 cytokine profile is compatible with the hypothesis of allergy as an etiologic factor for acute appendicitis and may have important implications for the diagnosis, prevention, and treatment of this condition.
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Walker C, Moosavi A, Young K, Fluck M, Torres D, Widom K, Wild J. Factors Associated with Failure of Nonoperative Management for Complicated Appendicitis. Am Surg 2019. [DOI: 10.1177/000313481908500840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In recent years, nonoperative management of complicated appendicitis has become more common. Patients managed nonoperatively do well, but there is a paucity of literature on patients who fail nonoperative management. The purpose of this study was to examine the overall failure rate, morbidity associated with failure, and potential predictors of failure in nonop management of appendicitis. This is a descriptive retrospective review of patients from a single hospital system who were diagnosed with advanced appendicitis and underwent nonop management between January 1, 2007, and November of 2017. The data were obtained through review of patient charts from the electronic medical record. Failure was defined as requirement of an operation due to ongoing infection secondary to appendicitis. There were 183 patients initially managed non-operatively, with 70 patients failing nonoperative management. Patients failing nonoperative management experienced longer hospitalization (6.2 vs 2.9 days, P < 0.0001), and more patients in the failure group required admission to the ICU (10.0% vs 1.8%, P = 0.028). Multivariate analysis revealed that longer duration of symptoms reduced the likelihood of failure (odds ratio: 0.77 [0.64–0.92]). In this retrospective review, 38 per cent of patients failed nonop management of appendicitis. Symptom duration could provide insight for clinicians in assessing the role of non-operative management because increasing symptom duration reduced the likelihood of failure.
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Affiliation(s)
- Charles Walker
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Ali Moosavi
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Katelyn Young
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Marcus Fluck
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Denise Torres
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Kenneth Widom
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Jeffrey Wild
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
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Campora M, Trambaiolo Antonelli C, Grillo F, Bragoni A, Cornara L, Migliora P, Pigozzi S, Mastracci L. Seeds in the appendix: a ‘fruitful’ exploration. Histopathology 2017; 71:322-325. [PMID: 28295494 DOI: 10.1111/his.13211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michela Campora
- Pathology Unit, Department of Surgical and Diagnostic Sciences (DISC); University of Genoa; Genoa Italy
| | | | - Federica Grillo
- Pathology Unit, Department of Surgical and Diagnostic Sciences (DISC); University of Genoa; Genoa Italy
- IRCCS AOU S. Martino-IST; Genoa Italy
| | - Alberto Bragoni
- Pathology Unit, Department of Surgical and Diagnostic Sciences (DISC); University of Genoa; Genoa Italy
| | - Laura Cornara
- Department for the Earth, Environment and Life Sciences (DiSTAV); University of Genoa; Genoa Italy
| | | | - Simona Pigozzi
- Pathology Unit, Department of Surgical and Diagnostic Sciences (DISC); University of Genoa; Genoa Italy
- IRCCS AOU S. Martino-IST; Genoa Italy
| | - Luca Mastracci
- Pathology Unit, Department of Surgical and Diagnostic Sciences (DISC); University of Genoa; Genoa Italy
- IRCCS AOU S. Martino-IST; Genoa Italy
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Chou ASB, Hsu YH, Wu BG. Appendicular foreign body presenting with appendicular mass. Tzu Chi Med J 2016; 28:136-137. [PMID: 28757743 PMCID: PMC5442914 DOI: 10.1016/j.tcmj.2016.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 01/28/2016] [Accepted: 02/23/2016] [Indexed: 10/29/2022] Open
Affiliation(s)
- Andy Shau-Bin Chou
- Department of Medical Imaging, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Medical Imaging and Radiologic Sciences, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Yung-Hsiang Hsu
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Pathology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Bor-Gang Wu
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Abstract
OBJECTIVE The aim of this study was to assess the seasonal variation in emergency general surgery (EGS) admissions. BACKGROUND Seasonal variation in medical conditions is well established; however, its impact on EGS cases remains unclear. METHODS The National Inpatient Sample (NIS) database was queried over an 8-year period (2004-2011) for all patients with diagnosis of acute appendicitis, acute cholecystitis, and diverticulitis. Elective admissions were excluded. The following data for each admission were recorded: age, sex, race, admission month, major operative procedure, hospital region, and mortality. Seasons were defined as follows: Spring (March, April, May), Summer (June, July, August), Fall (September, October, November), and Winter (December, January, February). X11 procedure and spectral analysis were performed to confirm seasonal variation. RESULTS A total of 63,911,033 admission records were evaluated of which 493,569 were appendicitis, 395,838 were cholecystitis, and 412,163 were diverticulitis. Seasonal variation is confirmed in EGS (F = 159.12, P < 0.0001) admissions. In the subanalysis, seasonal variation was found in acute appendicitis (F = 119.62, P < 0.0001), acute cholecystitis (F = 37.13, P < 0.0001), and diverticulitis (F = 69.90, P < 0.0001). The average monthly EGS admission in Winter was 11,322 ± 674. The average monthly EGS admission in Summer was higher than that of Winter by 13.6% (n = 1542; 95% CI: 1180-1904, P < 0.001). CONCLUSIONS Hospitalization due to EGS adheres to a consistent cyclical pattern, with more admissions occurring during the Summer months. Although the reasons for this variability are unknown, this information may be useful for hospital resource reallocation and staffing.
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Rare appendicitis-like syndrome: the case of the obstructing broccoli. Case Rep Med 2014; 2014:764869. [PMID: 24864147 PMCID: PMC4016857 DOI: 10.1155/2014/764869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 03/31/2014] [Indexed: 01/08/2023] Open
Abstract
The diagnosis of acute appendicitis can be somewhat obscure in a patient that presents with right lower quadrant abdominal pain. The advancement and ease of imaging have made CT scanning readily available in the emergency department. Management can be challenging when the patient has a high likelihood of appendicitis based on clinical suspicion and negative CT scan. The purpose of this case report is to demonstrate how an obstructing bezoar caused an appendicitis-like syndrome in a patient with negative CT scan and clinical diagnosis of acute appendicitis. This case report will discuss the appendicitis-like syndrome of an obstructing bezoar and an approach at management.
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Elamurugan TP, Sivashanker M, Kumar SS, Muthukumarassamy R, Kate V. Primary tuberculous appendicitis presented with caecal perforation: a case report. ASIAN PAC J TROP MED 2013; 5:834-6. [PMID: 23043927 DOI: 10.1016/s1995-7645(12)60154-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 03/31/2012] [Accepted: 04/05/2012] [Indexed: 11/19/2022] Open
Abstract
Gastrointestinal tuberculosis accounts for 3% of the extrapulmonary tuberculosis with ileocaecal region being the common site of involvement up to 75%. Primary involvement of appendix is very rare and accounts for only 0.6% to 2.9% of gastrointestinal tuberculosis in the absence tubercular focus elsewhere. The pre-operative investigations usually give non-specific results. The diagnosis in most instances made only after histopathology. Here we report a case of primary appendicular tuberculosis in a patient presented with caecal perforation.
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Affiliation(s)
- T P Elamurugan
- Department and Institution/Department of surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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