Appendiceal Mass Research Articles

Primary infertility associated with neuroendocrine tumor (Carcinoid) of the appendix

Abstract Neuroendocrine tumors of the appendix (NET-A), formerly called appendiceal carcinoids, are rare tumors of the gastrointestinal tract. Appendiceal tumors have also been associated with infertility. However, in many of these cases, significant abdominal pathology, specifically pseudomyxoma peritonei, was identified during definitive surgical intervention. A 34-year-old nulligravid woman undergoing infertility evaluation presented to an academic tertiary care fertility center. An abnormal mass was identified on hysterosalpingogram and CT confirmed appendiceal mass. Surgical removal of the mass was performed and histopathology was consistent with an NET-A with negative margins extending to the serosa. Two months after surgical intervention, the patient spontaneously conceived pregnancy and subsequently delivered a normal infant. This case exemplifies the importance of careful inspection of radiologic films by the gynecologic physician. Of added interest, this case describes an asymptomatic NET-A associated with primary infertility. To our knowledge, this is the first report of an incidentally indentified NET-A that resulted in primary infertility.

【急性虫垂炎の治療方針の変遷と現状】 Interval appendectomyの適応と至適手術時期についての検討

【急性虫垂炎の治療方針の変遷と現状】 Interval appendectomyの適応と至適手術時期についての検討

A rare case of an appendiceal mass masquerading as a pelvic tumour and causing bilateral hydronephrosis.

Diagnosing acute appendicitis in children can be difficult due to atypical presenting symptoms. While there are reported cases of acute appendicitis or appendiceal masses causing unilateral hydronephrosis, bilateral hydronephrosis as a complication of appendiceal mass is very rare. We report a case of a child who presented with cardinal symptomatology associated with the urogenital tract. Ultrasound (US) investigation showed a pelvic mass causing bilateral hydronephrosis. An initial diagnosis of a pelvic teratoma was made based on the US and computed tomography (CT) scan findings. The final diagnosis of an appendiceal mass causing bilateral hydronephrosis was established intraoperatively.

Pseudomyxoma Peritonei Presenting as Acute Appendicitis: Clinical and Imaging Findings

A 30-year old man presented with symptoms and signs of acute appendicitis. Abdominal imaging via ultrasound and computed tomography detected a mass in the right iliac fossa. Exploratory laparotomy revealed an appendiceal mass and gelatinous peritoneal fluid, while histopathology confirmed the diagnosis of pseudomyxoma peritonei arising from a mucocele of the appendix and attributed to an appendiceal cystadenocarcinoma. The clinical and imaging findings of this rare case are herein presented.

Immediate appendectomy for appendiceal mass.

The aim of this retrospective study was to evaluate the safety and effectiveness of immediate appendectomy in patients presenting with appendicular mass. Forty-seven patients with appendicular mass were operated within 24 hours after admission to Vakif Gureba Training and Research Hospital, General Surgery Department, from January 2004 to April 2010. The appendiceal mass was diagnosed with physical examination, abdominal ultrasonography, and computed tomography, or during surgical exploration. Age and sex, duration of symptoms, physical examination findings at admission, operation details, intraoperative and postoperative complications, and length of hospital stay were analyzed for each patient. There were 25 males (53.2%) and 22 females (46.8%), with a mean age of 37.23±15.60 (range: 14-75) years. The mean time from the onset of the symptoms to operation was 4.06±2.50 (range: 1-15) days. A simple appendectomy was performed in 38 (80.9%) patients. Twenty-nine (61.8%) patients were discharged and followed up without any complication after surgery. Wound infection was detected in 13 (27.7%) patients. Immediate appendectomy in appendicular mass is a safe and effective alternative to conservative management.

What is the optimal treatment for appendiceal mass formed after acute perforated appendicitis?

We read with great interest the editorial article by Meshikhes AWN published in issue 25 of World J Gastroenterol 2011. The article described the advantages of emergency laparoscopic appendectomy compared with interval appendectomy as a new safe treatment modality for the appendiceal mass. The author concluded that the emergency laparoscopic appendectomy was a safe treatment modality for the appendiceal mass, and might prove to be more cost-effective than conservative treatment, with no need for interval appendectomy. However, we would like to highlight certain issues regarding the possibility of percutaneous catheter drainage to successfully treat the appendiceal mass, with no need for appendectomy, too.

Appendiceal intussusception to the cecum caused by mucocele of the appendix: Laparoscopic approach

INTRODUCTIONAppendiceal intussusception is a very rare disease that is found in only 0.01% of patients who have undergone an appendectomy. Clinical symptoms vary and some patients are asymptomatic. Laparoscopic surgery for appendiceal tumors is still controversial. We present a case of intussusception of the appendix with a mucinous cystadenoma treated by laparoscopic surgery. PRESENTATION OF CASEWe report a case of 47 year-old-women patient who presented with a six month history of intermittent right lower abdominal pain. Abdominal computer tomography CT showed appendiceal mass with intussusception. A laparoscopic right hemicolectomy was performed because the tumor involved the entire appendix. Histopathological examination revealed mucocele due to mucinous cystadenoma of appendix. DISCUSSIONAppendiceal intussusception to the cecum caused by mucocele of the appendix is extremely rare. It is very difficult to diagnose the presence of an intussuscepted appendix pre-operatively and investigations will usually include colonoscopy and CT scan. An appendicular intussusception should not be reduced by colonoscopy. Laparoscopic surgery for appendiceal tumors is still controversial; the main concerns to be addressed are the adequacy of resection and intraperitoneal rupture of the tumor. Our patient successfully underwent laparoscopic surgery without any complications. CONCLUSIONAppendiceal intussusception to the cecum caused by mucocele of the appendix is a rare cause of abdominal pain and difficult to diagnose. The laparoscopic surgery for appendiceal tumors is safe, feasible, and even may be beneficial.

Interval appendectomy in adults: A necessary evil?

The management of appendiceal mass remains a matter of major controversy in the current literature. Currently, initial nonoperative management followed by interval appendectomy is favored over immediate appendicectomy. However, the necessity of doing an interval appendectomy has been questioned – is it a necessary evil? The present review revisits the above controversy, evaluates the current literature, assesses the need for interval appendectomy in adults, and provides recommendations.

A Retrospective Study on Mucocele of the Appendix Presented with Acute Abdomen or Acute Appendicitis

Objective We reported the demographic, clinical, radiologic, preoperative and postoperative characteristics and outcomes on patients of appendix mucocele that presented with or operated for acute appendicitis or acute abdomen. Methods A retrospective study. Patients who were presented or operated for acute appendicitis or acute abdomen and had an operative histopathological diagnosis as appendix mucocele (simple mucocele, mucinous cystadenoma, mucinous cystadenocarcinoma) were included. Demographic, clinical, radiologic, preoperative and postoperative data of eligible cases were evaluated. Results From January 2003 to February 2010, a total of 2120 patients with the pre-operative diagnosis of acute appendicitis were treated in our center, and nine (0.42%) patients were diagnosed to have mucocele of the appendix. Seven patients (78%) were female. Average age of the patients was 59.5 (range=25-74). Major complaint was right lower quadrant pain in eight (89%) patients. In preoperative ultrasonographic examination of the patients, appendiceal cystic masses (mucocele) were diagnosed in four (44.5%) patients. In histopathologic examination, the number of patients diagnosed to have simple mucocele was two (22%), mucinous cystadenoma was four (45%), and mucinous cystadenocarcinoma was three (33%). No postoperative morbidity or mortality was noted. Conclusion Appendix mucocele is a rare disease and it is usually diagnosed histopathologicaly in appendectomy specimens. When a cystic mass in appendix is seen during operation, appendiceal mucocele should be kept in mind to avoid iatrogenic perforation causing pseudomyxoma peritonei and possible concomitant malignancies should be searched.

A retrospective clinicopathological analysis of appendiceal tumors from 3,744 appendectomies: a single-institution study

This study was conducted to describe the clinicopathological characteristics of appendiceal tumors and to evaluate their appropriate management. Between September 2000 and September 2005, 28 appendiceal tumors were identified by a retrospective review of 3,744 appendectomies. Twenty-eight patients were found to have appendiceal tumors (incidence, 0.7%).The largest single group of tumors were benign mucinous cystadenomas (50%); carcinoids (32.1%) were next, and they were followed by malignant tumors (17.9%). Four out of five patients who had malignant appendiceal tumors presented with periappendiceal abscess. None of the patients was correctly diagnosed preoperatively. One-stage curative resection was possible in more than 76% of the patients, and the rate of making the correct preoperative diagnosis was 35%. Most appendiceal tumors presented with appendicitis and periappendiceal abscess. Appendiceal tumors should be included in the differential diagnosis when an unexpected appendiceal mass is encountered during appendectomy.

Appendiceal mass: Is interval appendicectomy “something of the past”?

The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned. Furthermore, emergency appendicectomy for appendiceal mass is increasingly performed with equal success and safety to that performed in non-mass forming acute appendicitis. There is an increasing volume of evidence -although mostly retrospective- that if traditional conservative management is adopted, there is no need for routine I.A except for a small number of patients who continue to develop recurrent symptoms. On the other hand, the routine adoption of emergency laparoscopic appendicectomy (LA) in patients presenting with appendiceal mass obviates the need for a second admission and an operation for I.A with a considerable complication rate. It also abolishes misdiagnoses and deals promptly with any unexpected ileo-cecal pathology. Moreover, it may prove to be more cost-effective than conservative treatment even without I.A due to a much shorter hospital stay and a shorter period of intravenous antibiotic administration. If emergency LA is to become the standard of care for appendiceal mass, I.A will certainly become 'something' of the past.

Osteomyelitis of the body of the iliac bone as a late complication of perforated appendicitis with abscess formation

BACKGROUND: Osteomyelitis adjacent to an abscess is difficult to diagnose because both disorders can present with the same symptoms. Early recognition and start of treatment are essential because osteomyelitis can have severe consequences. We present a man with osteomyelitis by direct contamination of an adjacent abscess after a perforated appendicitis. METHODS: Case report. RESULTS: A 66-year-old man was treated conservatively for appendicitis with a large appendiceal mass. After perforation for which a resection of the affected coecum was performed, treatment was complicated by abscess formation. A small abscess deep in the pelvic cavity could not be reached for percutaneous drainage. After several weeks the patient's recovery stroked and he developed complaints of pain with weight-bearing and movement of the hip. Computed Tomography showed an osteolytic lesion of the body of the iliac bone adjacent to the former abscess. After long-term antibiotic treatment the patient recovered completely. RESULTS AND CONCLUSIONS: Osteomyelitis due to direct contamination from an adjacent abscess after a perforated appendicitis is rare. Diagnosis can be difficult because both disorders can present with the same complaints.

Colonoscopic Findings in Appendiceal Intussusception in Cystic Fibrosis: A Tubular Cecal Structure Containing Impacted Luminal Secretions

Colonoscopic diagnosis of appendiceal intussusception with cystic fibrosis is important to avoid colonoscopic “polypectomy” of an inverted appendix causing inadvertent cecal perforation.1Fazio R.A. Wickremesinghe P.C. Arsura E.L. et al.Endoscopic removal of an intussuscepted appendix mimicking a polyp: an endoscopic hazard.Am J Gastroenterol. 1982; 77: 556-558PubMed Google Scholar Yet little is known about the colonoscopic findings.2Bradly D.P. Gallegos M. Jakate S. Appendiceal mass in an adolescent with cystic fibrosis.Clin Gastroenterol Hepatol. 2009; (A24): 7Google Scholar We report a striking colonoscopic appearance of this intussusception. A 19-year-old woman with cystic fibrosis, complicated by pulmonary bronchiectasis, chronic pancreatic insufficiency, and 2 admissions for right lower quadrant (RLQ) pain attributed to distal intestinal obstruction syndrome (DIOS), presented with increasingly severe RLQ pain and vomiting for 2 weeks. The abdomen was soft, but was mildly tender in the RLQ. Routine blood test results and esophagogastroduodenoscopy were within normal limits. Abdominopelvic computed tomography revealed a tubular structure (extracolonic appendix, black arrows) extending 8 cm outside cecum, penetrating through the cecal wall (white arrow), to become a multiwalled structure within the cecum (intracecal, inverted appendix), and containing a 1.3-cm–wide lumen, findings consistent with appendiceal intussusception (Figure A, sagittal view). Colonoscopy, performed to exclude cecal cancer, revealed a 5-cm long, smooth, tubular structure covered by normal-appearing mucosa, arising perpendicularly from cecal caput, and containing a central 1.3-cm–wide lumen filled beyond the brim with impacted, inspissated secretions (Figure B, colonoscopic videophotograph at ileocecal valve level). This structure was identified as a partly inverted appendix by its attachment to cecal caput and absence of an alternative appendiceal orifice. Cautious colonoscopic irrigation with water, serial luminal biopsies, and suctioning removed only 10% of impacted secretions, in an unsuccessful attempt at disimpaction to reduce the intussusception. Colonoscopic biopsies of intussuscepted appendiceal mucosa were safely performed, revealing nonneoplastic, colonic-type mucosa with infiltration of eosinophils, findings associated with chronic appendicitis/appendiceal intussusception. The patient underwent laparoscopic appendectomy. Gross examination of resected specimen revealed a distended appendix with a dilated, 1.3-cm–wide lumen, filled with inspissated mucous. Microscopic examination in cross-section revealed thinned appendiceal mucosa from compression by a greatly expanded central lumen, filled with impacted, inspissated, eosinophilic secretions (Figure C, low-power photomicrograph, H&E, 20×). High-power photomicrograph revealed inspissated secretions arising from a crypt (arrows) and flowing, similar to lava, into the appendiceal lumen, which are characteristic appendiceal findings with cystic fibrosis (Figure C, inset, 400×). Patients with cystic fibrosis can develop appendiceal intussusception from impacted appendiceal secretions that provide a lead point for intussusception.3Chaar C.I.O. Wexelman B. Zuckerman K. et al.Intussusception of the appendix: comprehensive review of the literature.Am J Surg. 2009; 198: 122-128Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar They also develop other obstructed ducts/lumens from inspissated secretions, including DIOS, pancreatic obstruction with pancreatic insufficiency, and biliary obstruction. The following, currently reported, colonoscopic and colonoscopic biopsy findings may be diagnostic of appendiceal intussusception with cystic fibrosis: a tubular structure within cecum, containing impacted, inspissated secretions within its lumen, arising from the cecal caput, and without an alternative appendiceal orifice, with colonoscopic biopsies showing an eosinophilic mucosal inflammatory infiltrate without neoplasia. Endoscopic therapy to relieve obstruction currently is performed for esophageal food impaction. As a speculation, gentle colonoscopic appendiceal luminal irrigation, perhaps using N-acetylcysteine, might disimpact and potentially reduce the intussusception, just as colonic irrigation at colonoscopy with N-acetylcysteine may relieve DIOS.4Shah U. Shafiq Y. Khan M.A. Gastrograffin use in distal intestinal obstruction syndrome of cystic fibrosis.J Ayub Med Coll Abbottabad. 2007; 19: 58-60PubMed Google Scholar

Hip Injury - Football

HISTORY - A 21 year old college football player presents with increasing lower abdominal, right groin, and scrotal pain for 1 ½ years duration. He notes no initial trauma or sentinel event for the pain. Over the course of the next several months, the pain steadily increases and became more localized to his right hip/groin area. Patient noticed that the pain was exacerbated by running and sexual activity and radiated all over his pelvis and lower abdomen. PHYSICAL EXAMINATION: Examination revealed a soft, non-tender and non-distended abdomen without visible hernias, palpable masses, or hepatosplenomegaly. The musculoskeletal exam revealed no asymmetry and full flexion and extension of hips. However, decreased adduction and external rotation of the right hip with a negative Patricks test noted. Pt also had pain to palpation over pubic symphysis. Genital exam revealed normal genitalia, without hernia, testicular mass, lesion, or discharge. DIFFERENTIAL DIAGNOSIS Sports Hernia Varicocele/Hydrocele of Testis Sexually Transmitted Infection with Prostatitis/Epididymitis Labral tear of the hip Osteitis Pubis TEST AND RESULTS -U/S of groin/testes - revealed no visible hernias, nephrolithiasis, testicular or appendiceal torsion, varicocele, hydrocele, or mass of testis; however did show right spermatic cord swelling. -MRI Pelvis with and without contrast - 22mm right paralabral cyst and right superior labral tear. No hernia noted. -STI testing performed for Gonorrhea, Chlamydia, Syphilis, HIV, and Hepatitis panel negative on two separate occasions spaced out by 8 months in duration. FINAL/WORKING DIAGNOSIS - Right Labral cyst and Right acetabular labral tear. - Spermatic Cord Swelling. TREATMENT AND OUTCOMES -A series of steroid injections into the right hip using CT guidance to bridge to future hip arthroscopy for labral tear/cyst removal after football season has been completed. -Continue to be followed by athletic trainer for muscle strengthening exercises and stretches. -Scrotal support for spermatic cord swelling. -Returned to full workout routine and collegiate football within 4 weeks of steroid injection, muscle strengthening and stretching with full, painless range of motion, and able to meet the demands of his sport.

Appendicitis in Children: Audit of outcome in Kosti-Teaching Hospital

Introduction: Appendicitis is the most common cause of the acute surgical abdomen in children. It accounts for approximately one-third of childhood hospital admissions for abdominal pain. Objectives: To audit the outcome of management of children presenting with abdominal pain suspicious of acute appendicitis. Patients and Methods: This is a retrospective study of 67 children admitted and treated for acute appendicitis in Kosti Teaching Hospital from January 2005 to December 2007. Symptoms, signs, details of management and results of follow up were studied. Results: Boys comprised 45 (67.16%). Age ranged from 4 – 15 years (mean 11.13± 2.59) years. 44(65.67%) of children had acute, 16(23.88%) perforated appendicitis, 3(4.48%) appendiceal mass,appendix single patient (1.49%) had appendiceal abscess and 3(4.48%) normal. Five patients (7.46%) developed postoperative complications but no mortality was encountered.Conclusion: In spite of advances in means of diagnosis appendicitis remains a clinical diagnosis with excellent outcome if diagnosed and treated promptly.Key words: Appendicitis, appendicular abscess, appendicular mass.

Routine or Selective Interval Appendectomy for Non-Surgically Treated Appendiceal Mass

The purpose of this study was to evaluate the need for interval appendectomy after a successful conservative treatment of an appendiceal mass. This retrospective study was conducted on patients admitted with appendiceal mass at King Saud Medical City during between July-2004 to July-2009. Only patients who were successfully treated conservatively (non-surgical) were included in the study. Data on patient demography, clinical presentations, investigations, follow up, relapse of symptoms and/ or recurrent acute appendicitis were collected and analyzed. Seventy-three patients were successfully treated conservatively for appendiceal mass. After discharge from the hospital, all were followed up in an OPD clinic. Seven patients (9.6%) developed recurrent symptoms/ appendicitis and underwent appendectomy. Sixty six patients (90.4%) were discharged from the outpatient clinic as they remained asymptomatic. All were seen in OPD at least twice before discharge. At the time of data collection for this study, all of them were contacted and recalled for assessment in the outpatient department. Five patients (6.8 %) had emergency appendectomy elsewhere after discharge from the OPD clinic. Overall, 12 patients (16.4 %) needed appendectomy after a successful conservative treatment for appendiceal mass. Sixty one patients (83.6 %) have remained asymptomatic since their discharge from the clinic. Routine interval appendectomy is unnecessary after a successful conservative treatment of an appendiceal mass. It should be recommended selectively to those who develop recurrent symptom or recurrent acute appendicitis.

Routine or Selective Interval Appendectomy for Non-Surgically Treated Appendiceal Mass “Arabic abstracts”

Routine or Selective Interval Appendectomy for Non-Surgically Treated Appendiceal Mass “Arabic abstracts”

Is There Still a Benefit to Operate Appendiceal Abscess On Board French Nuclear Submarines?

Appendicular abscess occurred in 14.2% of patients presenting acute appendicitis. Management of these patients remains controversial, ranging from an emergency appendectomy to a nonoperative treatment. On board French nuclear submarines, the usual treatment for all cases of appendiceal masses, including both appendicitis and appendiceal abscess, is an appendectomy. In the past 5 years, the introduction of ultrasonography (US) on board has enabled the diagnosis of appendiceal abscess with a high rate of accuracy, and the latest studies show that nonoperative treatment is an alternative approach. This nonsurgical treatment, based on intravenous administration of antibiotics, is successful in about 93% of the patients. Failure of nonsurgical treatment is a reliable indication of percutaneous drainage. The proportion of adult patients who need percutaneous drainage of abscesses is about 27%. A successful primary nonoperative treatment may or may not be followed by interval appendectomy at the conclusion of the patrol. Nonsurgical treatment is associated with a significantly lower morbidity than surgery. Considering that the on-board surgical facility is limited, nonsurgical treatment appears to be the best approach for treating a sailor with an appendiceal abscess during a submarine patrol mission.

Appendiceal Mass in an Adolescent With Cystic Fibrosis

Appendiceal Mass in an Adolescent With Cystic Fibrosis

Cytology of metastatic appendiceal goblet cell carcinoid in pleural effusion fluid: A case report

Goblet cell appendiceal carcinoid (GCAC) is a rare neoplasm. We described the case of a 72-year-old man who presented with symptoms related to ascites. A computed tomography (CT) scan showed a mass involving the base of the appendix, ascites and concomitant pleural effusion. Thoracentesis of the pleural fluid showed metastatic GCAC. The appendiceal mass was biopsied and diagnosed as a GCAC. We describe the cytologic features of the metastatic GCAC to pleural fluid. To our knowledge this is the first such described case.