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Hernandez Cervantes BY, Martinez Lopez D, Almaguer Acevedo FM, Betamcourt Benjamin M, Guzman Lambert R, Rodriguez Gonzalez M. Adult with concurrent mesenteric cyst and acute appendicitis: a case report. J Surg Case Rep 2023; 2023:rjad275. [PMID: 37220593 PMCID: PMC10200360 DOI: 10.1093/jscr/rjad275] [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] [Received: 03/21/2023] [Accepted: 04/25/2023] [Indexed: 05/25/2023] Open
Abstract
Mesenteric cysts are uncommon intra-abdominal lesions that account for only one in every 100 000 adult hospitalizations. Their diagnosis is based on a comprehensive clinical examination as well as radiological modalities such as ultrasonography and computed tomography (CT) scans, and it is usually a clinical challenge because of non-specific symptoms. We present our first case of a 51-year-old man with a simple mesenteric cyst accompanying acute appendicitis diagnosed by CT scan of the abdomen and treated by exploratory laparotomy, complete enucleation of the cyst and appendectomy with a 10 month follow-up without complications or recurrence. This type of presentation has not been thoroughly investigated, with only two children reported during our literature review. Even if there is a high level of suspicion, a CT scan is required for confirmation.
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Affiliation(s)
- Barbara Y Hernandez Cervantes
- Correspondence address. Department of Surgery, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana. Tel: +233 549344585; E-mail: and
| | - Duniesky Martinez Lopez
- Department of Internal Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | | | | | - Radisnay Guzman Lambert
- Department of Surgery, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
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Intraoperative Appearance of Endosalpingiosis: A Single-Center Experience of Laparoscopic Findings and Systematic Review of Literature. J Clin Med 2022; 11:jcm11237006. [PMID: 36498581 PMCID: PMC9738105 DOI: 10.3390/jcm11237006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Endosalpingiosis is assumed to be the second most common benign peritoneal pathology after endometriosis in women. Although recent studies indicate a significant association with gynecologic malignancies, many underlying principles remain unclear. This work aimed to systematically describe the intraoperative appearance of endosalpingiosis. Methods: Data and intraoperative videos of patients with histologically verified endosalpingiosis were retrospectively reviewed. The main outcome measures were macroscopic phenotype and anatomical distribution. Additionally, a systematic review searching PubMed (Medline) and Embase was conducted. Results: In the study population (n = 77, mean age 40.2 years (SD 16.4)), the mean size of lesions was 3.6 mm and the main visual pattern was vesicular (62%). The most frequent localization was the sacrouterine ligaments (24.7%). In the systematic review population (n = 1174 (210 included studies overall), mean age 45.7 years (SD 14.4)), there were 99 patients in 90 different studies with adequate data to assess the appearance of the lesions. The mean size of the lesions was 48.5 mm, mainly with a cystic visual pattern (49.5%). The majority of the lesions affected the ovaries (23.2%), fallopian tubes (20.4%), or lymph nodes (18.5%). Comparing this study to the literature population, the main differences concerned the size (p < 0.001) and main visual patterns (p < 0.001) of lesions. Conclusions: The usual intraoperative findings of endosalpingiosis appeared less impressive than described in the literature. In our study population, lesions of a few millimeters in size with a vesicular appearance were mostly seen, most frequently in the sacrouterine ligament area. Intraoperative recognition by the gynecologic surgeon and histologic diagnosis should play an important role in further understanding this entity, scientifically and clinically.
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Nayak A, Karpes J, Stewart K. Appendiceal endosalpingiosis: a case report of a rare finding from appendicectomy. J Surg Case Rep 2022; 2022:rjac402. [PMID: 36072651 PMCID: PMC9439693 DOI: 10.1093/jscr/rjac402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 08/18/2022] [Indexed: 11/14/2022] Open
Abstract
Endosalpingiosis is occasionally incidentally found on histopathologic examination of gynecologic or gastrointestinal specimen, most commonly in the ovary, fallopian tube, omentum and uterus. Recently an association between endosalpingiosis and, ovarian and uterine cancer has been described. Here, we describe a rare case of appendiceal endosalpingiosis mimicking appendicitis. Further prospective studies are required to elucidate the clinical significance of appendiceal endosalpingiosis, the potential association with gynecologic malignancy and implications for management.
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Affiliation(s)
- Agnish Nayak
- Department of General Surgery, Campbelltown Hospital , Sydney , Australia
- Central Clinical School, University of Sydney , Sydney, NSW , Australia
| | - Josh Karpes
- Department of General Surgery, Campbelltown Hospital , Sydney , Australia
- St George Hospital Clinical School, University of New South Wales , Kogarah, NSW , Australia
| | - Kathryn Stewart
- Department of General Surgery, Campbelltown Hospital , Sydney , Australia
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Alfaraj AS, Almohamad AA, Alqabbani NS, Alghazwi MH, Alharbi AM, Ahmed AA, Aljumah MK, Aljumaah NY, Kadhem HE, Al Jalooud HH, AlMohsen ZS, Alharbi KM, Al Abbas HE, Al Khalifah FB, Al-Hawaj F. Colonic Angiolipoma: An Extremely Rare Tumor Clinically Masquerading as Acute Appendicitis. Cureus 2021; 13:e20659. [PMID: 35028238 PMCID: PMC8743046 DOI: 10.7759/cureus.20659] [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] [Accepted: 12/24/2021] [Indexed: 11/05/2022] Open
Abstract
The clinical presentation of right iliac fossa pain, anorexia, and vomiting are the classic clinical features of acute appendicitis. However, a broad spectrum of manifestations may result in a similar clinical picture, including gastrointestinal, genitourinary, and gynecologic pathologies. Imaging studies are crucial to establishing the diagnosis. Here, we report the case of a 58-year-old man who presented to the emergency department with a one-week history of right lower quadrant abdominal pain. The pain was associated with nausea, vomiting, and frequent bowel motions. There was no history of fever or weight loss. The examination of the abdomen showed localized tenderness and guarding in the right iliac fossa. The basic laboratory investigation was within the reference range. The computed tomography scan demonstrated a well-circumscribed intraluminal mass lesion in the ascending colon with no evidence of complete obstruction. The mass was slightly heterogeneous but had fat attenuation. There was no evidence of invasion. There was no stranding of the adjacent fat. The radiological findings were consistent with colonic lipoma. The patient underwent laparoscopic surgery and had a segmental resection of the tumor with primary anastomosis. The appendix was also resected. Histopathological examination showed mature adipose cells along with thin-walled, capillary-sized vessels representing a benign angiolipoma. Further, the resected appendix was completely normal and showed no evidence of acute inflammation. Colonic angiolipoma is an extremely rare tumor. This case demonstrated that a large angiolipoma of the ascending colon may show a presenting clinical picture similar to that of acute appendicitis. Complete resection of the tumor is associated with an excellent outcome.
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Affiliation(s)
| | - Asma A Almohamad
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | | | | | | | - Amina A Ahmed
- College of Medicine, Xi'an Jiaotong University, Xi'an, CHN
| | | | | | - Hawra E Kadhem
- College of Medicine, Xi'an Jiaotong University, Xi'an, CHN
| | | | | | - Kawkab M Alharbi
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Hassan E Al Abbas
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | - Faisal Al-Hawaj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Reyes JVM, Syed SB, Seen T, Sheth N, Kowalczyk C. Typhlitis: A Rare Appendicitis Mimic in a Young Healthy Female. Cureus 2021; 13:e15839. [PMID: 34322332 PMCID: PMC8298106 DOI: 10.7759/cureus.15839] [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] [Accepted: 06/22/2021] [Indexed: 11/05/2022] Open
Abstract
Typhlitis, also known as neutropenic enterocolitis, is a rare but serious condition characterized by inflammation of the cecum causing right lower quadrant (RLQ) pain and fever. It typically affects immunocompromised patients with neutropenia, hematologic malignancies, AIDS, or those on immunosuppressive therapy. This is an entity that should be considered in any differential for a patient with febrile RLQ pain, not just those with obvious immunosuppression.
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Affiliation(s)
- Jonathan Vincent M Reyes
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, USA
| | - Salman B Syed
- Internal Medicine, University of Illinois College of Medicine, Peoria, USA
| | - Tasur Seen
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, USA
| | - Nirali Sheth
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, USA
| | - Christopher Kowalczyk
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, USA
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Handra-Luca A. Appendix muscle bands, a forgotten entity. Clin Anat 2020; 34:673-677. [PMID: 32990348 DOI: 10.1002/ca.23689] [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: 05/26/2020] [Revised: 08/28/2020] [Accepted: 09/19/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Appendix muscle bands (AMB) develop from the appendix muscle layer into the mesoappendix. There are few recent publications on this forgotten entity. The objectives of this study were to assess the morphological features of AMB as detected at microscopy examination of appendectomy specimens. METHODS Sixty-six cases of AMB as detected on appendectomy specimens were assessed for microscopy features on routine hematoxilin and eosin stained tissue slides. The morphological features were analyzed with regard to the main clinico-pathological parameters. RESULTS AMBs were multiple in 35 cases. Most AMBs were located between the tip and cecal limit, 7 at the tip, and 1 at the cecal limit of the appendectomy specimen. Associated appendix lesions were: acute appendicitis, neuroma, mesoappendix cyst, muscle hiatus, and diverticulae (60,6,2,45, and 1, respectively). In 24 appendices, the AMB developed from the perihiatus muscle. Two microscopy types of AMBs were detected: muscle-AMB and mesoappendix-AMB. CONCLUSION AMB may be detected incidentally at microscopy of appendectomy specimens. Acute appendicitis was associated in most cases, independently on the microscopy type of AMB. Appendix abnormalities as neuroma, mesoappendix cyst, muscle hiatus, and diverticulae can be associated to AMBs.
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Affiliation(s)
- Adriana Handra-Luca
- Service d'Anatomie pathologique, APHP GHU Avicenne, Universite Paris Nord Sorbonne Cite, Bobigny, France
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Kao YK, Chen JH. Adult Jejuno-jejunal intussusception due to inflammatory fibroid polyp: A case report and literature review. Medicine (Baltimore) 2020; 99:e22080. [PMID: 32899081 PMCID: PMC7478680 DOI: 10.1097/md.0000000000022080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RATIONALE Intussusception is defined as the invagination or telescoping of a proximal portion of the intestine into the distal portion of the intestine. Intussusception can occur at any age but is more common among children. Most cases of intussusception in adults have a pathological lead point. Inflammatory fibroid polyp (IFP) is a rare benign tumor-like lesion arising from the submucosa of the gastrointestinal tract that can cause intussusception in adults. Here, we report a case of adult intussusception due to IFP. We also present a literature review of 31 reports including 34 cases between 2012 and December 2019, which shows a mean age of 45.4 ± 14.2 years and female dominance (23/34) of intussusception due to IFP. PATIENT CONCERNS A 47-year-old man presented with a half-day history of epigastric abdominal pain. Physical examination revealed distension and tenderness of the upper abdomen. Computed tomography (CT) of the abdomen and pelvis demonstrated intussusception of the jejunum along with a suspicious jejunal mass associated with mesenteric lymphadenopathies. DIAGNOSIS Intussusception of the jejunum along with a suspicious jejunal mass, and histopathological examination of the resected specimen showed IFP. INTERVENTIONS The patient underwent emergency laparotomy. The intussusception was resected without attempts for reduction. OUTCOMES The postoperative period was uneventful, and the patient was discharged on the fourth postoperative day. LESSONS Intussusception in adults is rare, especially that secondary to IFP. The most commonly used diagnostic tool for adult intussusception is abdominal CT, and the optimal management is resection of the involved bowel segment without reduction if malignancy cannot be ruled out.
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Affiliation(s)
| | - Jian-Han Chen
- Bariatric and Metabolism International Surgery Center
- Division of General Surgery, E-Da Hospital
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
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Tudor J, Williams TR, Myers DT, Umar B. Appendiceal endosalpingiosis: clinical presentation and imaging appearance of a rare condition of the appendix. Abdom Radiol (NY) 2019; 44:3246-3251. [PMID: 30367212 DOI: 10.1007/s00261-018-1813-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Endosalpingiosis rarely affects the appendix but can be mistaken for acute appendicitis or appendiceal tumors. The medical literature regarding appendiceal endosalpingiosis is sparse; consisting of only four case reports which are primarily focused on the histopathology but provide little radiologic correlation. Endosalpingiosis is a rare condition characterized by the presence of benign fallopian tubal-like glandular epithelium derived from Mullerian ducts, usually affecting the serosal surfaces of the pelvis and peritoneum. It is histologically differentiated from endometriosis as endosalpingiosis lacks endometrial stroma. Endosalpingiosis tends to affect older women and has been associated with ovarian serous tumors of low malignant potential. After a retrospective review of a pathology database, we present pathologically proven cases of appendiceal endosalpingiosis with correlative imaging. We discuss the clinical presentation, illustrate the CT and MRI appearance, histologic characteristics, and review the current medical literature of appendiceal endosalpingiosis.
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Affiliation(s)
- James Tudor
- Department of Radiology, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Todd R Williams
- Department of Radiology, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
| | - Daniel T Myers
- Department of Radiology, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Beena Umar
- Department of Pathology, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA
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Clinicopathologic findings in gynecologic proliferations of the appendix. Hum Pathol 2019; 92:101-106. [PMID: 31430494 DOI: 10.1016/j.humpath.2019.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 12/27/2022]
Abstract
Appendiceal endometriosis, endosalpingiosis, and decidual lesions have received little attention in the pathology literature, meaning their clinicopathologic features remain unclear. We identified 72 cases of appendiceal gynecologic proliferations with available slides. Clinical presentation was recorded when available, and histologic findings were correlated with clinical data. Cases included conventional endometriosis (51), endosalpingiosis (14), and decidual lesions (7). The patients with endosalpingiosis were significantly older (median 45 years) than those with endometriosis (median 34 years, P = .0085) or decidual lesions (median 31 years, P = .0088). Most endometriosis patients presented with known/suspected endometriosis (20/51, 39%), while acute appendicitis was the most common presentation for patients with endosalpingiosis (5/14, 36%) or a decidual lesion (5/7, 71%). Few patients presenting with appendicitis were ever diagnosed with extra-appendiceal disease. All 51 endometriosis cases showed both glands and stroma, and 18 (35%) had hemosiderin. One case progressed to endometrioid adenocarcinoma. Endosalpingiosis was an incidental finding in all cases, confined to the serosa in 4 and extending intramurally in 10. Four of the 7 patients with a decidual lesion were pregnant, and 2 others were taking oral contraceptives. The cases included florid decidualized endometriosis (5) and deciduosis (2). Two cases spread transmurally and effectively obliterated the appendix. Conventional appendiceal endometriosis can have several clinical presentations. Patients with it who present with acute appendicitis rarely develop it elsewhere. Appendiceal endosalpingiosis is rare and effectively incidental. Decidualized endometriosis may overtake the entire appendix.
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Kave M, Parooie F, Salarzaei M. Pregnancy and appendicitis: a systematic review and meta-analysis on the clinical use of MRI in diagnosis of appendicitis in pregnant women. World J Emerg Surg 2019; 14:37. [PMID: 31367227 PMCID: PMC6647167 DOI: 10.1186/s13017-019-0254-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/04/2019] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this systematic review and meta-analysis was to evaluate the clinical use of MRI for the evaluation of acute appendicitis during pregnancy. Methods The searches were conducted by two independent researchers (MK, MS) to find the relevant studies published from 1/1/2009 until end of 30/12/2018. We searched for published literature in the English language in MEDLINE via PubMed, EMBASETM via Ovid, The Cochrane Library, and Trip database. For literature published in other languages, we searched national databases (Magiran and SID), KoreaMed, and LILACS. The keywords used in the search strategy are Pregnancy [MeSH], Pregnant [MeSH] OR-Magnetic resonance imaging [MeSH] OR-Appendicitis [MeSH] OR-Ultrasound, [MeSH] OR, imaging, MRI [MeSH] OR"،" and Right lower quadrant pain [MeSH]. The risk of bias of every article was evaluated by using QUADAS-2. On the basis of the results from the 2 × 2 tables, pooled measures for sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curves (AUC) along with their 95% confidence intervals (CIs) were calculated using the DerSimonian Lair methodology. Results As many as 1164 studies were selected. After analyzing the correspondence of the studies with the required criteria, 19 studies were selected for the final review. For appendicitis in pregnancy, the MRI sensitivity was 91.8% at the 95% confidence interval of (95% CI 87.7-94.9%). At the confidence interval of 95%, the specificity was 97.9% (95% CI 0.97.2-100%). The risk of bias in the studies conducted was measured using the QUADAS-2 tool. Conclusion MRI has high sensitivity and specificity (91.8%, 97.9% respectively) for the diagnosis of acute appendicitis in pregnant patients with clinically suspected appendicitis. It is an excellent imaging technique in many instances, which does not expose a fetus, or the mother, to ionizing radiation, making it an excellent option for pregnant patients with suspected acute appendicitis.
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Affiliation(s)
- Mania Kave
- 1Gynecology and Obstetrics Institution, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Islamic Republic of Iran
| | - Fateme Parooie
- 2Student Research Committee, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Islamic Republic of Iran
| | - Morteza Salarzaei
- 2Student Research Committee, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Islamic Republic of Iran
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