Acute Gangrenous Appendicitis Research Articles

Acute Gangrenous Appendicitis in A 70-Year-Old Patient with Multiple Myeloma

Acute Gangrenous Appendicitis in A 70-Year-Old Patient with Multiple Myeloma

Intra-abdominal hemorrhage from an ileocolic vessel as a complication of acute appendicitis perforation

This is an extremely rare complicated presentation of acute appendicitis perforation, which was accompanied by an intra-abdominal hemorrhage from an ileocolic vessel. A 61-year-old man visited an emergency department complaining of abdominal pain. Tenderness & rebound tenderness at the right lower quadrant and muscle guarding were noticed. Computed tomography showed perforated appendicitis with peritonitis. Also, an intra-abdominal hemorrhage of the ileocolic vessel was suggested. An emergent laparoscopic exploration was performed and found a gangrenous retrocecal appendix, peri-lesional adhesion, and substantial hematoma. Finally, a partial cecectomy was performed. A pathologic test confirmed the acute gangrenous appendicitis. Physicians should be aware that appendicitis could complicate an intra-abdominal hemorrhage even though it is extremely rare.ackground.

Comparison of Clinical, Pathological, and Procedural Characteristics of Adult and Pediatric Acute Appendicitis before and during the COVID-19 Pandemic

Aims: This study aims to examine the impact of the COVID-19 pandemic on the clinical, pathological, and surgical features of acute appendicitis (AA) in a tertiary referral center - Clinical Hospital Centre Zagreb, through a patient data comparison before and during the pandemic. Methods: Demographic (age, gender), clinical (duration of hospitalization), pathological (gangrenous AA, perforated AA, complications), and surgical data (type of appendectomy, negative appendectomy, conversion, revision) were retrospectively collected from an electronic database for all consecutive patients admitted for AA before and during the COVID-19 pandemic. Results: Demographic data were comparable between groups. There was statistically no significant difference in the type of appendectomy (p=0.331). The median hospital length of stay was 3 (2-5) days (p=0.078). There was an increase in the conversion rate (4.2% to 7.7%, p=0.031). The negative appendectomy rate did not differ significantly (5.6% vs. 4.2%, p=0.338). There was no significant difference in the incidence of perforated AA (13.3% vs. 15.7%, p=0.339). Conclusion: We did not observe a significant increase in the rate of AA complications during the COVID-19 pandemic at the Clinical Hospital Centre Zagreb. This could be because AA is typically diagnosed and treated in emergency care, which remained available during the pandemic. Additionally, diagnostic and therapeutic protocols remained unchanged despite the pandemic.

Endoscopic clip-induced acute appendicitis in a patient on chronic hemodialysis: a case report with literature review

BackgroundForeign body-induced acute appendicitis is rare but could most often be caused by fish bones; those caused by endoscopic clips are highly rare. Herein, we report a case of acute appendicitis caused by endoscopic clips that developed 2 years after the endoscopic procedure.Case presentationA 68-year-old man with a 2-year history of hemodialysis (HD) for diabetic nephropathy visited our hospital with pain in the right lower quadrant. He had undergone endoscopic submucosal dissection (ESD) for gastric adenoma 2 years earlier. Abdominal computed tomography revealed acute gangrenous appendicitis and a high-density structure lodged in the appendix. This structure was determined to be an endoscopic clip that was lodged in the patient’s appendix for 2 years. The patient underwent an emergency laparoscopic appendectomy, and an endoscopic clip covered by a fecalith was found in the appendix.ConclusionEndoscopic clips usually fall off spontaneously in approximately a week and pass through stool. However, in this case, appendicitis developed 2 years after the ESD. An emergency surgical appendectomy may be recommended for appendicitis caused by foreign bodies. Prophylactic appendectomy or removal of foreign bodies should be considered for HD patients, even in the absence of symptoms owing to the potential severity of appendicitis in such patients.

Eosinophil Granule Proteins Involvement in Acute Appendicitis-An Allergic Disease?

Several pieces of evidence point to an allergic component as a trigger of acute appendicitis. As the Th2 immune response is characterized by eosinophil mobilization to the target organ and release of their cationic granule proteins, it is reasonable to investigate if the degranulation of eosinophils could be associated with the local injury. The primary aim of this study is to evaluate the participation of eosinophils granules proteins in acute appendicitis, both at local and systemic levels and the secondary aim is to evaluate the diagnostic accuracy of eosinophils granules proteins for the detection of acute appendicitis, as well as for distinguishing between complicated and uncomplicated acute appendicitis. Eosinophil-derived neurotoxin (EDN), eosinophil cationic protein (ECP) and eosinophil peroxidase (EP) are the most well-known eosinophil granule proteins. From August 2021 to April 2022, we present a prospective single-center study to evaluate the EDN, ECP, and EP concentrations simultaneously in appendicular lavage fluid (ALF) and the serum of 22 patients with acute phlegmonous appendicitis (APA), 24 with acute gangrenous appendicitis (AGA), and 14 normal controls. Concerning EDN, no differences were found between groups. ECP concentrations in ALF and serum were significantly higher in the histologically confirmed acute appendicitis compared to the control groups (p < 0.0001 and p < 0.0001, respectively). In ALF, no differences were found between ECP levels in APA: 38.85 ng/mL (IQR 26.50-51.77) and AGA 51.55 ng/mL (IQR 39.55-70.09) groups (p = 0.176). In the serum, no difference was found between ECP levels at APA: 39 ng/mL (IQR 21.30-56.90) and AGA: 51.30 ng/mL (IQR 20.25-62.59) (p = 0.100). For EP, the concentrations in ALF (p < 0.001) and serum (p < 0.001) were both higher in acute appendicitis compared to the control. In ALF, no difference was found between APA: 240.28 ng/mL (IQR 191.2-341.3) and AGA: 302.5 (IQR 227.7-535.85) (p = 0.236). In the serum, no differences were found between APA: 158.4 ng/mL (IQR 111.09-222.1) and AGA: 235.27 (IQR 192.33-262.51) (p = 0.179). Globally, the ALF concentrations were higher than serum concentrations, reflecting an intense inflammatory local reaction in AA. The optimal ECP cut-off for discriminating between acute appendicitis and the controls was >11.41 ng/mL, with a sensitivity of 93.5%, but with a specificity for identifying appendicitis of 21.4%, good discriminative power (AUC = 0.880). For EP, the optimal cut-off was >93.20 ng/mL, with a sensitivity of 87%, but with a specificity of 14.3% (AUC = 0.901), excellent discriminative power. For the diagnosis of perforated AA, the discriminative power of ECP and EP serum concentrations are weak (AUC = 0.562 and AUC = 0.664, respectively). Concerning the presence of peritonitis, the discriminative power of ECP and EP serum concentrations is acceptable, respectively: AUC = 0.724 and AUC = 0.735. Serum levels of EDN (p = 0.119), ECP (p = 0.586) and EP (p = 0.08) in complicated appendicitis were similar to uncomplicated appendicitis. Serum concentrations of ECP and EP can be added to decision-making AA diagnosis. A Th2-type immune response is present in AA. These data bring forward the role of an allergic reaction in the pathogenesis of acute appendicitis.

Metastasis of small cell lung carcinoma to the appendix: A case report and literature review

Small cell lung cancer (SCLC) is an aggressive tumor with rapid growth and metastasis. Common sites of metastasis include lymph nodes, adrenal glands, liver, bone, and brain, while gastrointestinal metastasis is less and appendicular metastasis is much rarer. Here, we reported a rare case of appendiceal metastasis from small cell lung cancer presented with acute gangrenous perforated appendicitis, periappendiceal abscess and retroperitoneal abscess. The patient, a 63-year-old male, was diagnosed as small-cell lung cancer due to cough, expectoration and blood in sputum. After chemotherapy, local radiotherapy and whole brain prophylactic radiotherapy, the disease progressed continuously and recurred 1 year later, then presented with acute gangrenous perforated appendicitis combined with periappendiceal abscess and retroperitoneal abscess 2 years later. Histopathological and immunohistochemical findings after appendectomy suggested malignant metastasis of small cell lung cancer. Therefore, in the diagnosis and treatment of SCLC cases, SCLC metastasis occurs not only in the common lymph nodes, kidney, adrenal gland, brain, liver, etc., but also in the appendix. This report is expected to provide new guidance for the diagnosis and treatment of such cases.

Arterial Thrombosis of Vermiform Appendix Resulting in Gangrenous Appendicitis

Acute appendicitis is still the most common surgical disease in the experience of surgeon and it requires operative treatment in hospital. There are several suggestions on the causes of acute appendicitis: infectious or neurovascular conditions, obturation of the orifice of vermiform appendix with a fecal bolus, and other versions. One of the rare causes of acute appendicitis is ischemia of vermiform appendix, which results in the development of primary gangrenous appendicitis. The clinical manifestation of this pathology may be atypical. We present a case report of a 65-year-old patient with acute gangrenous appendicitis complicated by localized purulent peritonitis. When admitted to the hospital, the patient was suspected of mesenteric thrombosis. MSCT angiography was performed about that, which diagnosed thrombosis of a. appendicularis and acute appendicitis. Treatment included laparotomy, appendectomy, sanitation, and abdominal drainage. In the paper, we discuss the incidence and results of treatment of acute appendicitis.

Acute Gangrenous Appendicitis with Superior Mesenteric Venous Thrombosis

Acute Gangrenous Appendicitis with Superior Mesenteric Venous Thrombosis

СЛУЧАЙ ОСТРОГО ГАНГРЕНОЗНОГО ПЕРФОРАТИВНОГО АППЕНДИЦИТА В НЕВПРАВИМОЙ ПАХОВОЙ ГРЫЖЕ

Acute appendicitis is one of the most frequent abdominal diseases requiring surgical treatment. The variability of its location is characterized by the variability of clinical manifestations, which complicates the diagnosis of the disease. An extremely rare clinical case of acute gangrenous perforated appendicitis in the sac of an oblique inguinal hernia is presented. Surgical treatment was successful: herniolaparotomy, appendectomy, Postempsky hernoplasty were performed.

Acute appendicitis as the first manifestation of HenochSchönlein purpura

Henoch-Schönlein purpura (HSP) is a small vessel systemic vasculitis. Typical symptoms include palpable purpura, joint pain, and abdominal pain. Most cases improve after a few weeks, not requiring any treatments other than symptom control. Acute abdomen resulting from vasculitis is very rare and should be treated as a surgical emergency. We report the case of a 9-year-old boy with acute gangrenous appendicitis as the first manifestation of HSP.

Preoperatively predicting the pathological types of acute appendicitis using machine learning based on peripheral blood biomarkers and clinical features: a retrospective study.

BackgroundThis study aimed to establish machine learning models for preoperative prediction of the pathological types of acute appendicitis.MethodsBased on histopathology, 136 patients with acute appendicitis were included and divided into three types: acute simple appendicitis (SA, n=8), acute purulent appendicitis (PA, n=104), and acute gangrenous or perforated appendicitis (GPA, n=24). Patients with SA/PA and PA/GPA were divided into training (70%) and testing (30%) sets. Statistically significant features (P<0.05) for pathology prediction were selected by univariate analysis. According to clinical and laboratory data, machine learning logistic regression (LR) models were built. Area under receiver operating characteristic curve (AUC) was used for model assessment.ResultsNausea and vomiting, abdominal pain time, neutrophils (NE), CD4+ T cell, helper T cell, B lymphocyte, natural killer (NK) cell counts, and CD4+/CD8+ ratio were selected features for the SA/PA group (P<0.05). Nausea and vomiting, abdominal pain time, the highest temperature, CD8+ T cell, procalcitonin (PCT), and C-reactive protein (CRP) were selected features for the PA/GPA group (P<0.05). By using LR models, the blood markers can distinguish SA and PA (training AUC =0.904, testing AUC =0.910). To introduce additional clinical features, the AUC for the testing set increased to 0.926. In the PA/GPA prediction model, AUC with blood biomarkers was 0.834 for the training and 0.821 for the testing set. Combining with clinical features, the AUC for the testing set increased to 0.854.ConclusionsPeripheral blood biomarkers can predict the pathological type of SA from PA and GPA. Introducing clinical symptoms could further improve the prediction performance.

Acute gangrenous appendicitis and acute gangrenous cholecystitis in a pregnant patient, a difficult diagnosis: a case report

Abdominal pain is a common complaint in pregnancy, especially given the physiological and anatomical changes that occur as the pregnancy progresses. The diagnosis and treatment of common surgical pathologies can therefore be difficult and limited by the special considerations for the fetus. While uncommon in the general population, concurrent or subsequent disease processes should be considered in the pregnant patient. We present the case of a 36 year old, 13 weeks pregnant female who presented with both acute appendicitis and acute cholecystitis.

Evaluation of preoperative clinical and serological determinations in complicated acute appendicitis: A score for predicting complicated appendicitis

BackgroundTo analyze whether clinical and analytical parameters differ according to histopathology in cases of acute appendicitis (AA). MethodsThis is a retrospective, observational study including patients (>14 years of age) admitted for suspicion of AA from 1 April 2014 to 31 July 2016. Histopathology was divided into complicated (including perforated and gangrenous AA) and uncomplicated appendicitis (phlegmonous). Sex, age, temperature of patients on admission to the Emergency Department, symptom duration, preoperative white blood cell (WBC) count, neutrophil percentage, mean platelet volume (MPV), platelet distribution width (PDW), C-reactive protein (CRP) and hospital stay were compared in the two groups. ResultsThree hundred and thirty-five patients were analyzed, and 284 were included. Appendicitis was uncomplicated in 194 (68.3%) and complicated in 90 (31.7%). Age, symptom duration, neutrophil percentage, CRP and hospital stay were higher in the complicated AA group (P < .05). The mean differences between uncomplicated and complicated AA were: age 13.2 years (95% CI: 8.2–18.2), symptom duration 14.1 h (95% CI: 6.3–21.9), neutrophil percentage 5.0% (95% CI: 3.2–6.8), CRP 73.6 mg/l (95% CI: 50.0–97.2) and hospital stay 2.2 days (95% CI: 1.4–3.0), with p < 0.05 for all these variables. A model based on the preoperative parameters (age, symptom duration, neutrophil percentage and CRP) was calculated to predict the likelihood of complicated AA. The receiver operating characteristic (ROC) of the model had an area under the curve of 0.80 (95% CI 0.75−0.85). ConclusionThis model is able to diagnose complicated AA without the need for imaging techniques, although it must be validated with prospective analysis.

ARROSIVE BLEEDING FROM THE APPENDICULAR ARTERY IN ACUTE DESTRUCTIVE APPENDICITIS

Summary. Objective of the study: to present to the surgical community a rather rare complication of severe destructive appendicitis – arrosive bleeding and the cause of its development.&#x0D; Material and methods. Published a rare clinical case from prac-tice — the development of perforation of the appendix and arrosive bleeding from the appendicular artery in a patient with acute gangrenous appendicitis.&#x0D; Results and its discussion. The atypical course of acute appendicitis of undulating nature under the mask of acute adnexitis and antibacterial therapy has led to a prolonged delay with surgery in the surgical department. Only the appendicular abscess, which spontaneously opened into the abdominal cavity, made it possible to diagnose acute appendicitis and determine indications for emergency surgery, during which arrosive bleeding was diagnosed. The favorable outcome of the disease is due to the local purulent-necrotic process and small hemoperitoneum.&#x0D; Findings. Timely diagnosis of acute appendicitis, with the involvement of additional research methods in unclear cases, and subsequent appendectomy, are the prevention of a rather rare complication — arrosive bleeding from the appendicular artery in the development of severe complicated forms of acute destructive appendicitis.

Functional activity of blood neutrophiles in acute inflammatory diseases of the abdominal organs and abdominal tuberculosis

The diagnosis of various pathomorphological forms of acute appendicitis (AA), acute mesadenitis (AM), and abdominal tuberculosis (AT) remains an urgent problem in medicine. Neutrophilic granulocytes are the first link in the nonspecific immune response to inflammation, which is mediated by phagocytosis and intracellular bactericidal systems. Therefore, the research aimed to establish the features of the functional state of neutrophilic granulocytes in the blood of patients with AA, AM, and AT.Materials and methods. 30 practically healthy, 27 patients with AM, 40 patients with acute phlegmonous appendicitis were examined; 20 patients with acute gangrenous appendicitis, 30 patients with AT. The phagocytic activity of neutrophils in the test with latex granules, redox activity (spontaneous HCT test), cationic lysosomal proteins in the cytochemical test with bromine phenol blue was determined in the blood.Results. Phagocytic activity of neutrophils in patients with destructive forms of AA and AT was lower, and in the group of patients with AM – did not differ from control values. The phagocytic index of neutrophils in patients with destructive forms of AA was 1.5 times lower (p&lt;0.05), and the phagocytic number in patients with gangrenous AA was 1.7 times lower than in healthy individuals (p&lt;0.05). In patients with AM, the percentage of HCT-positive neutrophils was 1.3 times higher, in patients with destructive forms of AA and AT – 2 times higher than in healthy groups (p&lt;0.05). The number of neutrophils containing cationic lysosomal proteins was also higher in destructive forms of AA, and in AM and AT - did not differ from the value in the control group.Conclusions. It has been established that peripheral blood neutrophils in conditions of acute destructive inflammation and abdominal tuberculosis have reduced absorption capacity with simultaneous significant activation of redox processes. Cytochemical tests to detect the phagocytic and metabolic activity of blood neutrophils are available and highly informative for the diagnosis and prediction of inflammation, as well as for the differential diagnosis of bacterial and viral diseases

Accuracy Score on Raja Isteri Pengiran Anak Saleha (RIPASA) and Pediatric Appendicitis (PAS) for Diagnosing Acute Appendicitis in Children

Abstract&#x0D; Introduction. Acute appendicitis is the most common case of acute abdomen. Diagnosis of acute appendicitis is still difficult and is one of the problems in the surgical field. The Clinical Scoring System (CSS) has been developed to help doctors classify risk categories. PAS has been widely evaluated in the pediatric population. In another study it was found that RIPASA had better sensitivity, specificity, and accuracy than PAS in pediatric patients.&#x0D; Methods. This study is a cross sectional study to assess the level of concordance between RIPASA and PAS scores in diagnosing acute appendicitis, with the gold standard of Histopathological examination. Samples were taken by consecutive method, in 30 patients aged &lt;18 years for 1 year.&#x0D; Results. This study had an average age of 10.10 ± 3.745 years. Histopathologically early acute appendicitis 3.3%, acute suppurative appendicitis as much as 20%, acute gangrenous appendicitis 73.3% and others 3.3%. Using a cut-off point value of 9.5 for RIPASA and 7 for PAS, the sensitivity, Specificity, Accuracy of 82.75%, 100%, 80% for RIPASA, and 75.8%, 100%, 73.3% for PAS.&#x0D; Conclusion. The RIPASA score on the cut-off treshold 9.5 has better sensitivity and accuracy than PAS in diagnosing acute appendicitis in pediatric patients and can be used as CSS to assist in making decisions regarding the diagnosis of acute appendicitis in children.

COMPARISON OF SHORT-TERM AND LONG-TERM COURSE OF ANTIBACTERIAL THERAPY FOR INTRA-ABDOMINAL INFECTION CAUSED BY ACUTE GANGRENOUS APPENDICITIS

Intra-abdominal infection and its complications is still remaining a fairly common and urgent global problem. Currently, there are a large number of publications providing guidelines and recommendations for the treatment of infections caused by a certain type of causative agents. However, the appropriate duration of antibiotic therapy is among the most controversial issues. Majority of clinicians tend to prescribe antibiotic therapy until all signs of inflammation disappear, usually for 7-14 days. But, in 1994, Schein M., and co-authors suggested that with adequate treatment of the focus of intra-abdominal infection, the duration of antibiotic therapy can be reduced to 3-4 days that in turn will reduce the resistance to antibacterial drugs. The aim of this study was to investigate the possibility in reducing antibiotic therapy length for patients with intra-abdominal infection caused by acute gangrenous appendicitis. The study included 32 patients aged 18 - 65 years, who were operated on for acute gangrenous appendicitis at the same day when admitted to the hospital at the surgical department of the 3rd Municipal Clinical Hospital of Poltava. The patients were divided into two groups. The first (study) group included 16 patients who received antibiotic therapy within minimum 3 days until the normalization of the leukocytosis and body temperature. The second (control) group included 16 patients who continued to receive antibiotic therapy for at least 2 days following the normalization of these criteria. Based on the results obtained in studying the effect of the length of antibiotic therapy course on intra-abdominal infection in the patients with acute gangrenous appendicitis during the postoperative period, we revealed the duration of antibiotic therapy for 3 ± 0.25 days showed similar results compared to the results of traditional and longer antibiotic therapy. The comparable values included periods of recovery and discharge following the surgery, the incidence of complications in the early and remote postoperative period. Our data confirm the concept that adequate surgical treatment of the infection focus in the abdominal cavity results in the reduction of antibiotic therapy length for several days after the operation without the risk of developing postoperative complications and recurrence of the infectious process.

Проблемні питання діагностики та лікування гострого апендициту у дітей

Objective: to analyze the results of treatment of children with acute appendicitis and improve the algorithm of care. Materials and methods. The study is based on the results of treatment of 269 children with acute appendicitis and its complications, who were treated in the period 2019-2020; the microbiological part of the work was analyzed on 2334 bacteriological cultures in patients with HA in the period 1997-2019; 239 pathohistological examinations of removed appendages in the period 2019-2020. Results. The groups had different appendectomy techniques: 122 children underwent laparoscopic surgery, 147 children underwent laparotomy. In the group of children who underwent laparoscopic surgery in the structure of diagnoses: acute phlegmonous appendicitis – 51 (41.8%) children; primary peritonitis – 28 (22.9%) children; acute gangrenous-perforated appendicitis, abscess, purulent peritonitis – 24 (19.7%) children, acute gangrenous appendicitis – 16 (13.1%) children, catarrhal – 3 (2.5%) children. In 21 (17.2%) cases there was a conversion: the main reason for which was the lack of visualization of the tailbone, which led the surgeon to switch to laparotomy. Visualization of pathological changes during the ultrasound examination of the abdominal cavity occurred in 27 (31.4%) cases out of 86 performed. Intraoperative diagnosis and histopathological conclusion coincided in 65 (69%) cases. Of these: 74.5% with phlegmonous appendicitis; 68.5% with gangrenous appendicitis; 67% with gangrenous-perforated appendicitis, abscess, purulent peritonitis. In the group of children operated laparotomically in the structure of diagnoses: acute phlegmonous appendicitis – 60 (40.8%) children; acute gangrenous appendicitis – 66 (38%) children; gangrenous-perforative appendicitis, abscess, purulent peritonitis – 26 (17.7%) children. In 35 (44.3%) cases out of 79 in the preoperative ultrasound examination of the abdominal cavity, the tail was not visualized. Intraoperative diagnosis and histopathological conclusion coincided in 115 (78.2%) cases with 147. Comparing the results of treatment of both groups of children, it should be noted that in the group of children operated laparoscopically in 68.4% of cases during the ultrasound examination visualization of the tailbone was impossible. Due to the atypical location of the appendix in 17.2% of cases, which was not visualized during laparoscopy, conversion was performed. In the group of children operated laparotomically in 44.3% of cases, the tail, during the ultrasound examination, was not visualized due to the presence of destructive changes and complications in the abdominal cavity. Conclusions. Diagnosis of acute appendicitis with an atypical location and the presence of anatomical abnormalities can be complicated and affect the choice of treatment, requires a full arsenal of diagnostic capabilities of the clinic. When performing laparoscopic surgery, it is necessary to control its duration, pressure in the abdominal cavity, to conduct visual inspection of the abdominal cavity, to determine the feasibility and timeliness of conversion, which ultimately affects the safety of the patient. According to our studies, in 43% of cases of examined children in the preoperative period, the appendix was not visualized sonographically, during diagnostic laparoscopy in 11.5% (according to our studies) failed to visualize the tailbone, which required the surgeon to convert. According to the research results, the sensitivity of the Alvarado scale was 89.8%, and the specificity was 75.9%, which indicates the expediency and necessity of using the scale when examining children with suspected acute appendicitis. The informed consent of the patient was obtained for conducting the studies. Key words: children, appendicitis, acute appendicitis, laparoscopy, laparotomy.

Technical success, resection status, and procedural complication rate of colonoscopic full-wall resection: a pooled analysis from 7 hospitals of different care levels

IntroductionEndoscopic full-thickness resection (eFTR) using the full-thickness resection device (FTRD®) is a novel minimally invasive procedure that allows the resection of various lesions in the gastrointestinal tract including the colorectum. Real-world data outside of published studies are limited. The aim of this study was a detailed analysis of the outcomes of colonoscopic eFTR in different hospitals from different care levels in correlation with the number of endoscopists performing eFTR.Material and methodsIn this case series, the data of all patients who underwent eFTR between November 2014 and June 2019 (performed by a total of 22 endoscopists) in 7 hospitals were analyzed retrospectively regarding rates of technical success, R0 resection, and procedure-related complications.ResultsColonoscopic eFTR was performed in 229 patients (64.6% men; average age 69.3 ± 10.3 years) mainly on the basis of the following indication: 69.9% difficult adenomas, 21.0% gastrointestinal adenocarcinomas, and 7.9% subepithelial tumors. The average size of the lesions was 16.3 mm. Technical success rate of eFTR was achieved in 83.8% (binominal confidence interval 78.4–88.4%). Overall, histologically complete resection (R0) was achieved in 77.2% (CI 69.8–83.6%) while histologically proven full-wall excidate was confirmed in 90.0% (CI 85.1–93.7%). Of the resectates obtained (n = 210), 190 were resected en bloc (90.5%). We did not observe a clear improvement of technical success and R0 resection rate over time by the performing endoscopists. Altogether, procedure-related complications were observed in 17.5% (mostly moderate) including 2 cases of acute gangrenous appendicitis requiring operation.DiscussionIn this pooled analysis, eFTR represents a feasible, effective, and safe minimally invasive endoscopic technique.

Study of mast Cells in Appendectomy Specimen

Background: Mast cells play an important role in various inflammatory and immune reaction. Mast cells are constantly present in the appendices, and appendix remains one of the common surgical specimens received at pathology laboratory. Mast cells could be one of the important cell population responsible for nerve proliferation and hypertrophy in cases with clinically and histopathologically diagnosed appendicitis.&#x0D; Material and methods: The study was done on 100 surgically resected specimens of appendix received for routine histopathological evaluation at the Department of Pathology, Government Medical College, Bhavnagar, between June 2018 and May 2019. All appendices surgically resected as a therapeutic measure for clinically suspected appendicitis included. Cases of normal appendix and acute gangrenous appendicitis were excluded from the study. The appendices were assessed for their histological changes and density of mast cell infiltration. The mast cells were counted in 1% toluidine blue stained sections.&#x0D; Results: Out of 100 cases of surgically resected appendices, chronic appendicitis was found in 65% of cases and occurred frequently during the second and third decades of life. Highest mast cell count was seen in acute eosinophilic appendicitis and chronic appendicitis. No significant difference was observed in the mean mast cell counts among the different layers of the appendices studied.&#x0D; Conclusion: Mast cell counts were found to be highest in acute eosinophilic appendicitis and chronic appendicitis. Intermediate mast cell counts were seen in acute appendicitis and acute suppurative appendicitis. Mast cells appear to play roles in accentuation of inflammatory process and fibrosis.