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Cohen R, McKean K, Chetrit S. Enterocutaneous fistula resulting from the drainage of a contained appendiceal perforation secondary to a partially obstructing low-grade appendiceal mucinous neoplasm. BMJ Case Rep 2021; 14:e244546. [PMID: 34446520 PMCID: PMC8395359 DOI: 10.1136/bcr-2021-244546] [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] [Accepted: 08/10/2021] [Indexed: 11/03/2022] Open
Abstract
We report a case of an enterocutaneous fistula resulting from drainage of a contained appendiceal perforation secondary to an obstructing appendiceal mucinous neoplasm. A 66-year-old otherwise healthy female patient proceeded to laparoscopic appendicectomy with resection of the fistula tract. Histopathology demonstrated a mid-appendiceal mucinous neoplasm, with a benign enterocutaneous fistula tract communicating with the distal, non-malignant portion of the appendix. We provide an overview of the literature and highlight the need to consider appendiceal mucinous neoplasm as a differential in the management of spontaneous right iliac fossa collections and fistulae.
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Affiliation(s)
- Ryan Cohen
- School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia
- Colorectal Surgery, St John of God Health Care Inc, Perth, Western Australia, Australia
| | - Katie McKean
- Colorectal Surgery, St John of God Health Care Inc, Perth, Western Australia, Australia
| | - Stephanie Chetrit
- Colorectal Surgery, St John of God Health Care Inc, Perth, Western Australia, Australia
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2
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Badhe PV, Ravi Kiran D, Seshadri H. Pseudomyxoma retroperitonei masquerading as a psoas abscess. BMJ Case Rep 2021; 14:14/6/e240299. [PMID: 34083186 DOI: 10.1136/bcr-2020-240299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 52-year-old woman was referred to our department with multiple discharging sinuses and swelling in the right flank and iliac region for the past year. Ultrasound revealed a large collection in the right psoas muscle with the sinus tract reaching up to the skin in the right iliac region. Despite repeated attempts at drainage, the collection continued to increase in size. CT was requested and revealed a large heterogeneous irregular collection in the right psoas with fistulous communication with the cecum and skin with the erosion of the overlying ilium. Because of lack of vertebral involvement, enhancing internal septations, non-visualisation of the appendix and feculent material admixed with mucinous discharge from the sinus, pseudomyxoma retroperitonei secondary to ruptured mucinous neoplasm of the appendix was suspected. Mucoid material at the local site was sent for histopathology, which confirmed our suspicion. Our treatment plan after ileostomy was cytoreductive surgery along with adjuvant radiotherapy (40 Gy in 20 fractions) with chemotherapy (5-fluorouracil and folinic acid given for 30 weeks, once a week). However, after ileostomy, the patient refused further treatment, citing financial reasons.
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Affiliation(s)
- Padma Vikram Badhe
- Radiodiagnosis, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Dasari Ravi Kiran
- Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Harini Seshadri
- Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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3
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McDonald SJ, Lee F, Dean N, Ridley LJ, Stewart P. Fistulae involving the appendix: a systematic review of the literature. ANZ J Surg 2021; 90:1878-1887. [PMID: 33710738 DOI: 10.1111/ans.15805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/19/2020] [Accepted: 02/23/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND The appendix has a unique place in surgical history. Although the first ever appendicectomy involved a fistula to the skin, fistulae involving the appendix remain uncommon and can lead to unique surgical considerations. METHODS A systematic review of the literature was performed for case reports of appendiceal fistulae. We excluded cases in which the patient had a history of appendicectomy. Cases were categorized by site and aetiology, with information regarding relative frequency and demographics obtained. RESULTS A total of 301 case reports of fistula involving the appendix were found. The most common sites of these fistulae were to the bladder (148 cases), skin (40 cases), vasculature (19 cases), umbilicus (16 cases) and to the gastrointestinal tract. The most common aetiology in sub-analysis was appendicitis alone (150 cases), with less common causes including appendiceal adenocarcinoma (32 cases) and congenital abnormalities (18 cases). There were significantly more appendiceal fistulae in males than in females, with a ratio of 1.7:1. In patients with appendiceal adenocarcinoma as a cause for fistula, there were significantly more females than males with a ratio of 2.3:1. CONCLUSION In conducting a systematic review of case reports of fistulae involving the appendix, we identified 301 unique case reports, with a range of different sites and aetiologies.
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Affiliation(s)
- Stephen J McDonald
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Felix Lee
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Nicholas Dean
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Lloyd J Ridley
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Discipline of Medical Imaging, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Stewart
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Division of Colorectal Surgery, Department of Surgery, Concord Hospital, Sydney, New South Wales, Australia
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4
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Brenner AS, Baldin A, Molteni R, Lima RFRD, Freitas LH, Sartor MC, Neves EL. Appendico-cutaneous fistula following hysterectomy: first case report. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AbstractAppendico-cutaneous fistulas not related to acute appendicitis or cancer are rare and show spontaneous resolution after conservative treatment, mainly when they show low output, absence of obstruction or sepsis and in patients with good nutritional status. We found no report in the literature on appendico-cutaneous fistula after hysterectomy. The evolution of this case shows that this type of fistula can have low, but persistent debt, requiring definitive surgery.
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Affiliation(s)
| | - Antonio Baldin
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Curitiba, PR, Brazil
| | - Rafaela Molteni
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Curitiba, PR, Brazil
| | | | | | | | - Emerson Luis Neves
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Curitiba, PR, Brazil
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5
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Yokode M, Ikeda E, Matsui Y, Iwamura S, Mikami S, Kobayashi H, Imai Y, Kaihara S, Yamashita Y. Fistula Formation Secondary to Mucinous Appendiceal Adenocarcinoma May Be Related to a Favorable Prognosis: A Case Report and Literature Review. Intern Med 2018; 57:2945-2949. [PMID: 29877276 PMCID: PMC6232025 DOI: 10.2169/internalmedicine.0694-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A 90-year-old man was referred to our hospital because of a positive fecal occult blood test. Colonoscopy revealed a lesion with multiple nodules covered with abundant mucus at the hepatic flexure. Computed tomography showed a dilated appendix attached distally to the hepatic flexure. Right hemicolectomy was performed, and the pathological examination revealed a mucinous appendiceal adenocarcinoma infiltrating the hepatic flexure without pseudomyxoma peritonei. The patient is doing well without recurrence 12 months postoperatively. Extraperitoneal drainage of the malignant ascites caused by the fistula may allow for an early diagnosis, while also making it possible to successfully resect the lesion, thus resulting in a favorable outcome.
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Affiliation(s)
- Masataka Yokode
- Department of Gastroenterology and Hepatology, Kobe City Medical Center West Hospital, Japan
| | - Eiji Ikeda
- Department of Gastroenterology and Hepatology, Kobe City Medical Center West Hospital, Japan
| | - Yugo Matsui
- Department of Surgery, Kobe City Medical Center West Hospital, Japan
| | - Sena Iwamura
- Department of Surgery, Kobe City Medical Center General Hospital, Japan
| | - Sakae Mikami
- Department of Gastroenterology and Hepatology, Kobe City Medical Center West Hospital, Japan
| | | | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, Japan
| | - Satoshi Kaihara
- Department of Surgery, Kobe City Medical Center General Hospital, Japan
| | - Yukimasa Yamashita
- Department of Gastroenterology and Hepatology, Kobe City Medical Center West Hospital, Japan
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6
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A case of low-grade appendiceal mucinous neoplasm with invagination resected laparoscopically. Int Cancer Conf J 2017; 6:109-113. [PMID: 31149482 DOI: 10.1007/s13691-017-0285-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/12/2017] [Indexed: 12/15/2022] Open
Abstract
Low-grade appendiceal mucinous neoplasm (LAMN) is rare disease, and the absence of characteristic clinical symptoms makes preoperative diagnosis difficult. The strategy of treatment for LAMN has not been established. Surgical approach and lymph node (LN) dissection are still controversial. We herein present a case of LAMN with difficulties in making the preoperative diagnosis, which exhibited invagination and was treated by laparoscopy-assisted ileocecal resection with LN dissection. When cystic mass is detected in the bowel, LAMN or mucinous adenocarcinoma should be considered as a different diagnosis. And the laparoscopy-assisted ileocecal resection is a feasible operation for LAMN with careful procedure.
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7
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Diarrhea Concealing a Duodenal-Cecal Fistula Secondary to Appendiceal Mucinous Neoplasm. ACG Case Rep J 2017; 4:e3. [PMID: 28138447 PMCID: PMC5244891 DOI: 10.14309/crj.2017.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/09/2016] [Indexed: 11/17/2022] Open
Abstract
Primary mucinous adenocarcinoma of the appendix is a rare gastrointestinal malignancy. Fistulous tract formation is a complication that is cited in literature. An 85-year-old man with multiple comorbidities presented with several weeks of persistent non-bloody diarrhea. Laboratory work-up was non-diagnostic. Abdominal imaging with barium contrast showed an enterocolonic fistulous tract extending from the duodenum to the cecum involving an enlarged appendiceal mass. Subsequent biopsy confirmed mucinous appendiceal neoplasm with peritoneal spread to the liver and mesentery. This is the first report describing an enterocolonic fistula formation resulting from this malignancy.
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8
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Abstract
A woman aged 64 years presented as an emergency with a mass in the right iliac fossa, clinically within the abdominal wall, but an otherwise soft abdomen. Systemically, she was quite well with normal vital signs. Blood tests revealed raised inflammatory markers, and an abdominal CT scan demonstrated a perforated appendix with associated large subcutaneous abscess. This represents a rare presentation of a common condition, demonstrating how appendicitis can still be a challenging problem for the clinician. The patient underwent incision and drainage of the abscess, resulting in the formation of an enterocutaneous fistula (ECF). This was managed with enteral nutritional support, wound dressings and antibiotics. Following normal CT imaging, an ileocaecal resection was planned in the expectation that the ECF would persist. The operation was postponed due to intercurrent illness, during which time her symptoms and the ECF fully resolved.
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Affiliation(s)
- Oliver Beaumont
- John Radcliffe Hospital, Oxford, UK.,Oxford University Clinical Academic Graduate School, Oxford, UK
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9
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Hasan R, Kumar S, Rao AC, Kadavigere R. Rare Presentation of Pseudomyxoma Retroperitonei: Stretching the Limits. Malays J Med Sci 2016; 23:79-85. [PMID: 27660549 PMCID: PMC5025067 DOI: 10.21315/mjms2016.23.4.11] [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: 03/05/2016] [Accepted: 06/13/2016] [Indexed: 10/20/2022] Open
Abstract
A 55-year-old woman presented with a mucopurulent sinusal discharge from the right supragluteal region, with symptoms over the previous five months. This abscess began as a slowly swelling growth, which eventually turned into a discharging sinus, and she was diagnosed with a gluteal abscess. The patient underwent incisional drainage, and intra-operatively, the sinus tract could be seen extending to the retroperitoneum. A subsequent CT scan and an MRI of the abdomen revealed a large heterogeneous retroperitoneal cystic mass on the right side of midline, extending inferiorly into the anterior thigh along the iliopsoas. Superiorly, a tubular projection extended from the lesion, indenting the ileocaecal junction, while a fluid filled cutaneous fistulous tract was seen, extending to the right flank. A diagnosis of pseudomyxoma retroperitonei, likely of retrocaecal appendicular origin, was proposed. An explorative laparotomy with an appendectomy, and the evacuation of the retroperitoneal collection were completed. The subsequent histopathology confirmed the diagnosis of appendicular mucinous cystadenoma, with pseudomyxoma retroperitonei.
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Affiliation(s)
- Roumina Hasan
- Department of Pathology, Melaka Manipal Medical College, Manipal University, Manipal 576104, India
| | - Sandeep Kumar
- Department of Radiology, Kasturba Medical College, Manipal University, Manipal 576104, India
| | - Anuradha ck Rao
- Department of Pathology, Kasturba Medical College, Manipal University, Manipal 576104, India
| | - Rajagopal Kadavigere
- Department of Pathology, Melaka Manipal Medical College, Manipal University, Manipal 576104, India
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10
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Balint IB, Nad M, Kiraly A, Bali O, Rashed A, Vizsy L. Giant appendix or an appendiceal mucocele? Case report of an 11-year-old child. Interv Med Appl Sci 2014; 6:187-90. [PMID: 25598994 DOI: 10.1556/imas.6.2014.4.8] [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: 08/21/2014] [Revised: 09/09/2014] [Accepted: 09/11/2014] [Indexed: 11/19/2022] Open
Abstract
We present an 11-year-old male child with an enormous appendix that was regarded as an appendiceal mucocele. The disorder is very rare and usually appears in middle aged patients. It is a clinical diagnosis. It could cause a variety of symptoms, especially, acute appendicitis and unidentified lesion in the right iliac fossa. According to the reasons, it could be just a curiosity without any relevancy or the sign of a malignant lesion with bad prognostic factors. The histopathological findings prove the origin.
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11
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Herrod PJJ, Cirolli R. Appendix viriliformis: an intra-abdominal testis and an appendicoileal fistula. Ann R Coll Surg Engl 2013; 95:e107-9. [PMID: 24112479 PMCID: PMC5827268 DOI: 10.1308/003588413x13511609957614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2012] [Indexed: 10/03/2023] Open
Abstract
When a patient is taken to theatre for a laparotomy, surprises can still be found despite modern investigative techniques. We present the case of two rare abdominal pathologies (an appendicoileal fistula and an intra-abdominal testis adherent to the vermiform appendix) being found simultaneously and review the literature on these topics.
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12
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Adenocarcinoma of Appendix Presenting as Flank Fistula. Indian J Surg Oncol 2013; 4:220-1. [DOI: 10.1007/s13193-012-0208-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022] Open
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13
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Sayles M, Courtney E, Younis F, O'Donovan M, Ibrahim A, Fearnhead NS. Appendiceal mucinous adenocarcinoma presenting as an enterocutaneous fistula in an incisional hernia. BMJ Case Rep 2010; 2010:bcr.11.2009.2472. [PMID: 22789695 DOI: 10.1136/bcr.11.2009.2472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 68-year-old woman with a history of bone-graft harvesting from the right iliac crest presented with an incisional hernia and abscess at the graft donor site. Following incision and drainage of the abscess, CT demonstrated an enterocutaneous fistula between the appendix and bone-graft incision with appendicitis assumed to be the original cause of the abscess. At laparoscopy, the appendix was adherent to the hernia sac with mucinous material at the superficial orifice of the fistula site but not in the peritoneal cavity. Laparoscopic appendicectomy with fistula track excision was performed. Histological evaluation confirmed a well-to-moderately differentiated mucinous adenocarcinoma arising on a background of dysplastic villous adenoma. Tumour extended along the fistula track to involve the surface skin. A laparoscopic right hemicolectomy, lymph node dissection and wide local excision of the fistula track were carried out at a second procedure. Final histology confirmed pT4N1 tumour with clear resection margins.
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Appendiceal Mucinous Cystadenocarcinoma with Implantation Metastasis to the Incision Scar and Cutaneous Fistula. J Gastrointest Cancer 2010; 43:349-53. [DOI: 10.1007/s12029-010-9181-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Hadj-Taieb I, Masmoudi A, Ayadi L, Meziou TJ, Khabir A, Charfeddine A, Boujelbène S, Beyrouti MI, Tahri N, Boudawara T, Turki H, Zahaf A. [Appendicular cystadenocarcinoma with cutaneous fistula]. Ann Dermatol Venereol 2010; 137:198-202. [PMID: 20227562 DOI: 10.1016/j.annder.2009.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cutaneous metastasis of colorectal cancer is rare. We report a case of fistular lesions of the buttocks revealing a mixed tumour of the appendix involving mucinous cystadenocarcinoma and carcinoid tumour. CASE REPORT A 67-year-old woman was admitted for four skin fistulae of the right buttock present for 6 years. Histological examination of skin biopsy specimens identified infiltration of the dermis by metastatic mucinous adenocarcinoma while colonoscopy showed a caecal tumour measuring 4 cm. Surgical excision was performed involving right hemicolectomy, evacuation of retroperitoneal mucin collection and excision of fistulae. Histopathological examination of surgical specimen confirmed mixed tumour consisting of perforated mucinous cystadenocarcinoma and carcinoid tumour of the appendix. Recurrence of the fistular lesions was seen. The patient was hospitalized several times for surgical drainage of mucin. She died one year later. DISCUSSION Cutaneous metastasis of colorectal cancer is an uncommon event that usually occurs after identification of the primary tumour and generally indicates advanced-stage disease and an ominous prognosis. This case is particular and underlines the need to rule out a metastatic origin of cutaneous fistulae, even in patients otherwise apparently in good health.
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Affiliation(s)
- I Hadj-Taieb
- Service de dermatologie, hôpital Hédi Chaker, 3029 Sfax, Tunisie
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16
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Spontaneous Skin Fistula of the Lumbar Area - Case Report. POLISH JOURNAL OF SURGERY 2010. [DOI: 10.2478/v10035-010-0032-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Karakaya K, Barut F, Emre AU, Ucan HB, Cakmak GK, Irkorucu O, Tascilar O, Ustundag Y, Comert M. Appendiceal mucocele: Case reports and review of current literature. World J Gastroenterol 2008; 14:2280-3. [PMID: 18407611 PMCID: PMC2703862 DOI: 10.3748/wjg.14.2280] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The mucocele of the appendix is an uncommon disorder which is often asymptomatic but sometimes causes acute appendicitis-like symptoms. Sometimes, patients with mucocele can present with confusing symptoms. Preoperative suspicion and diagnosis of appendiceal mucocele are important. Ultrasonography and computed tomography are useful tools for the diagnosis of appendiceal mucocele. It may be also recognised by colonoscopy as a smooth submucosal lesion of the cecum. Optimal management of the mucocele could be achieved through accurate preoperative diagnosis. Preoperative diagnosis is a major component for minimizing intra-operative and post-operative complications. We herein report five cases and discuss the diagnostic methods and surgical treatment.
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Lakatos PL, Gyori G, Halasz J, Fuszek P, Papp J, Jaray B, Lukovich P, Lakatos L. Mucocele of the appendix: An unusual cause of lower abdominal pain in a patient with ulcerative colitis-. A case report and review of literature. World J Gastroenterol 2005; 11:457-9. [PMID: 15637769 PMCID: PMC4205363 DOI: 10.3748/wjg.v11.i3.457] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [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
The authors report the case of a 60-year-old male patient. In November 2001 he developed intestinal symptoms of bloody diarrhea and abdominal pain. Colonoscopy and biopsy established the diagnosis of ulcerative colitis (proctosigmoiditis). The disease activity was moderate at the beginning. No significant laboratory alterations were found (including CEA, CA19-9), and mesalazine was started orally. He was in remission until November 2003, when he was admitted to our Outpatient Clinic for upper and right lower abdominal pain and bloody diarrhea. Colonoscopy found proctosigmoiditis with a moderate activity, gastroscopy revealed chronic gastritis, laboratory data was normal. Treatment was amended with mesalazine clysma and methylprednisolone (16 mg) orally. Symptoms ameliorated; however, right lower abdominal pain persisted. US and CT examination demonstrated a pericecal cystic mass (11 cm×3.5 cm). At first pericecal abscess was suspected, as the previous US examination (6 mo earlier) had revealed normal findings. Fine needle aspiration was performed. Cytology confirmed the diagnosis of mucocele. The patient underwent partial cecum resection and extirpation of the mucocele. He recovered well and the final histology revealed a cystadenoma of the appendix. Follow up was started. The patient is now free of symptoms. Although primary adenocarcinoma of the appendix is uncommon, the authors emphasize that preoperative diagnosis of an underlying malignancy in a mucocele is important for patient management; however, it is difficult on imaging studies.
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