Lumen Of Appendix Research Articles

FP7.17 - Appendiceal Foreign Bodies in Adults: A Systematic Review of Case Reports

Abstract Adults can accidentally swallow foreign bodies (FBs) with food. In rare occasions, these can lodge in the appendix lumen causing inflammation. This is known as foreign body appendicitis. We conducted this study to review different types and management of appendiceal FBs. A comprehensive search on PubMed, MEDLINE, Embase, Cochrane Library and Google Scholar was performed to detect appropriate case reports for this review. Case reports eligible for this review included patients above 18 years of age with all types of FB ingestion causing appendicitis. A total of 64 case reports were deemed to be eligible for inclusion in this systematic review. The patient mean age was 44.3 ± 16.7 years (range, 18-77). Twenty-four foreign bodies were identified in the adult appendix. They were mainly lead shot pellet, fishbone, dental crown or filling, toothpick, and others. Forty-two percent of the included patients presented with classic appendicitis pain, while 17% were asymptomatic. Moreover, the appendix was perforated in 11 patients. Regarding modalities used for diagnosis, computed tomography (CT) scans confirmed the presence of FBs in 59% of cases while X-ray only managed to detect 30%. Almost all of the cases (91%) were treated surgically with appendicectomy and only six were managed conservatively. Overall, lead shot pellets were the most common foreign body found. Fishbone and toothpick accounted for most of the perforated appendix cases. This study concludes that prophylactic appendicectomy is recommended for the management of foreign bodies detected in the appendix, even if the patient is asymptomatic.

Culture-based bacterial evaluation of the appendix lumen and antibiotic susceptibility of acute appendicitis in Japan: A single-center retrospective analysis.

The question of whether to perform an appendectomy or conservative treatment for acute appendicitis can differ depending on the facility or surgeon, but antibiotic treatment is administered regardless of whether an appendectomy or conservative treatment is selected. We investigated the contemporary bacteriology for acute appendicitis and evaluated the antibiotic sensitivity of the bacteria that are currently associated with appendicitis. We retrospectively analyzed the bacterial culture results and antibiotic susceptibility of 141 patients who underwent appendicitis surgery, including the identification and antimicrobial susceptibility of the cultured bacteria within the excised appendices. Bacterial cultures were positive in 131 cases (92.9%). The most commonly isolated bacteria were Escherichia coli (90 isolates, 66.7%), followed by Enterococcus species (n = 19, 14.5%), Pseudomonas aeruginosa (n = 18, 13.7%), Streptococcus species (n = 15, 11.5%), and Klebsiella species (n = 8, 6.1%). Eight strains (8.8%) of E coli were extended-spectrum β-lactamase producers, and ten strains (11.1%) were fluoroquinolone-resistant. Tazobactam/piperacillin and meropenem inhibited the growth of 100% of the major identified bacteria. The patients with appendicoliths had a significantly higher bacterial culture rate. Enterococcus species were frequently isolated from the patients with complicated appendicitis. For the antibiotic treatment of appendicitis, it is essential to understand the patient's microbiological profile and antibiotic susceptibilities. Research from Asian countries such as Japan can enhance our knowledge of regional antibiotic resistance patterns and inform effective treatment strategies.

A magnet foreign body in the vermiform process in a child aged two years and eight months

BACKGROUND: Foreign bodies in the gastrointestinal tract is a fairly common pathology in pediatric surgery. The proportion of all cases is about 80%; in 20% of cases, foreign bodies can stuck in the physiological colon narrowings and in 0.005% — in the appendix. It is thought that magnetic foreign bodies pose a danger, if they are two or more because they can be attracted to each other at different parts of the gastrointestinal tract. A foreign body can get into the vermiform process, if its mass exceeds the mass of caecum content. Under the gravity mechanism, the foreign body penetrates into the dilated appendix lumen, but lumen peristalsis may not be strong enough to push it back into the large intestine. Swallowed foreign bodies may be asymptomatic in the vermiform process, and can manifest clinically as the inflammation either after few hours or after many years. CLINICAL CASE DESCRIPTION: In patient X., aged 2 years and 8 months, a magnet foreign body (a piece of magnetic pen) got into the vermiform process. The independent discharge of this object was under control, but no results. Patient's general state was satisfactory. No pathologies were observed in organs and systems. After a series of X-ray examinations of the abdominal organs, suspicion appeared that this foreign body was in the appendix. Diagnostic laparoscopy with intraoperative radiography and then laparoscopic appendectomy were performed. Macropreparation: unchanged vermiform process 6 cm long. The appendix lumen was opened, a foreign body was found — a magnetic rod with size 0.5 cm x 0.2 cm. CONCLUSION: The postoperative period was uneventful. The child was discharged from the hospital in the recovering state after the performed surgical intervention — an elective laparoscopic appendectomy.

The microbiome of the appendix differs in patients with and without appendicitis: A prospective cohort study

BackgroundAppendicitis seems to be a disease of infectious origin, but the detailed pathogenesis is unknown. We aimed to investigate the microbiome of the appendix lumen in patients with and without appendicitis, including a comparison of the subgroups of complicated versus uncomplicated appendicitis. MethodsThis prospective observational cohort study included adult patients undergoing laparoscopic appendectomy for suspected appendicitis. According to histopathologic findings, the investigated groups consisted of patients with and without appendicitis, including subgroups of complicated versus uncomplicated appendicitis based on the surgical report. A swab of the appendix lumen was analyzed for genetic material from bacteria with shotgun metagenomics, and outcomes included analyses of microbiome diversity and differential abundance of bacteria. ResultsA total of 53 swabs from patients with suspected appendicitis were analyzed: 42 with appendicitis (16 complicated) and 11 without appendicitis. When comparing patients with and without appendicitis, they were equally rich in bacteria (alpha diversity), but the microbiome composition was dissimilar between these groups (beta diversity) (P < .01). No consistent bacterial species were detected in all patients with appendicitis, but a least 3 genera (Blautia, Faecalibacterium, and Fusicatenibacter) and 2 species, Blautia faecis and Blautia wexlerae, were more abundant in patients without appendicitis. For the subgroups complicated versus uncomplicated appendicitis, both measures for microbiome diversity were similar. ConclusionThe appendix microbiome composition of genetic material from bacteria in adult patients with and without appendicitis differed, but the microbiome was similar for patients with complicated versus uncomplicated appendicitis. Trial registration NCT03349814

APPENDICITIS INFLAMMATORY RESPONSE SCORE FOR DIAGNOSIS OF ACUTE APPENDICITIS AS COMPARED TO ALVARADO SCORE

Background: Acute appendicitis was first described by Reginald. H. Fitz in 1886. It is the most frequent cause of acute abdominal pain requiring surgical intervention. Annually appendectomy is the most common abdominal operation performed on emergency basis. Lifetime risk for developing acute appendicitis is 8.6% in men and 6.7% in women. Acute Appendicitis inciting event in most instances is obstruction of the appendix lumen. Acute Appendicitis is classified as catarrhal phlegmonus, gangrenous and perforated. This classification describes the evolutionary stage of disease. Acute appendicitis is more of a clinical diagnosis present as pain abdomen with classical migration from peri-umbilical region to right iliac fossa in 75% of patient nausea and anorexia. Clinical signs are mostly pyrexia, localized tenderness in the right iliac fossa, muscle guarding and rebound tenderness. Laboratory and radiological investigation are also important tool for the diagnosis. Scoring system have been designed to aid in the clinical assessment of patient with acute appendicitis. The most used scoring is the Alvarado score is best performing in validation studies. Alvarado score doesnt incorporate C reactive protein as a variable, many studies shows the importance of C reactive protein in assessment of patient with appendicitis. Objective: Appendicitis Inflammatory Response score as a diagnostic tool for acute appendicitis in our hospital setting. Study design: A Prospective Study. Study period: October 2016 – September 2018. Study setting: Department of General Surgery, Justice K. S. Hegde charitable hospital. Study population: Patients admitted with signs and symptoms of acute appendicitis at Justice K.S. Hegde charitable Hospital, Mangalore. Sample size: 123 patients using epiinfo software for diagnostic test with PPV 64% with article reference (12) confidence interval of 95% and power of study at 80%. Study group: Patients clinically diagnosed with acute appendicitis and giving consent for the study. Methodology: The present study was conducted in the Department of General surgery, Justice K.S. Hegde charitable Hospital Mangalore, in 123 patients, of any age, who were admitted with complaint of acute appendicitis. Patients included in the study were finally correlate with the histopathological report. Result: The maximum patients were in the age group of 11-20 year compromising around 30.9%. Most of the patients were female around 56.1%. Histopathological report showed around 82.1% as Acute appendicitis, 6.5% acute on chronic, recurrent appendicitis 8.9%, chronic appendicitis, granulomatous appendicitis &amp; lymphoid hyperplasia of appendix were .8% each. AIR classified around 46.3% in low probability, 48% indeterminate and 5.7% in high probability group. Alvarado classified around 3.3% in unlikely, 51.2% in possible diagnosis, 37.4% acute and 8.1% in definite group. On spearman correlation coefficient there was found to be a strong positive correlation between both the scoring system and statistically significant p value of 0.0001. AIR score showed a sensitivity of 56.44% and specificity of 59.09% at score &gt;4. Alvarado had a sensitivity of 98.02 % and specificity of 9.09% at score &gt;4. Alvarado and AIR showed 9.90% and 6.93% at score &gt;8 respectively. The specificity of Alvarado and AIR was 100% respectively. The AIR at a low and higher score had a high PPV and NPV, that may help in correctly diagnosing the patient with acute appendicitis and ruling out from non- appendicitis patient. Conclusion: 1. Alvarado score is better diagnostic tool for acute appendicitis as compared to the AIR score. 2. Alvarado score has higher sensitivity in score of &gt;4 as compared to AIR. 3. AIR score with low sensitivity has low discriminatory power in ruling out patient with acute appendicitis.

The development and application of pediatric complicated appendicitis prediction model.

Acute appendicitis in children refers to the acute inflammation of the appendix, which accounts for 20% ∼ 30% of cases of acute abdomen in pediatric surgery. This study aimed to establish a decision tree model of complicated appendicitis in children using appendiceal ultrasound combined with an inflammatory index and evaluated its clinical efficacy in pediatric patients. A total of 395 children admitted to the Emergency Department of the Shanghai Children's Hospital from January 2018 to December 2021 and diagnosed with appendicitis by postoperative pathology were retrospectively analyzed. According to the postoperative pathology, the children were divided into a complicated and non-complicated appendicitis group, respectively. Routine laboratory inflammatory indicators, including white blood cell count, N(%), neutrophil (Neu) count, Neu/lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin were collected from the two groups. Collecting data on ultrasound examination of the appendix includes whether the appendix diameter is thickened, whether the echogenicity of the mesenteric rim surrounding the appendix is enhanced, whether there is rich blood supply in the appendix, and whether there are fecaliths in the appendix lumen. The risk factors for complicated appendicitis were screened out by univariate and multivariate logistic regression analyses, the binary logistic regression prediction and decision tree models were established, respectively, and the receiver operating characteristic (ROC) curve was used to verify the accuracy of the two prediction models. Binary logistic regression analysis showed that CRP, NLR, the presence of an appendicolith, and peripheral retina echo enhancement were independent risk factors for complicated appendicitis in children (P< 0.05). The decision tree model had an overall accuracy of 79%, an area under the ROC curve (AUC) of 0.809 (95% confidence interval [CI] 0.780-0.865), and sensitivity and specificity of 71.3% and 77.7%, respectively. The logistic regression model had an overall accuracy of 74.9%, an AUC value of 0.823 (95% CI, 0.765-0.853), a sensitivity value of 80.3%, and a specificity of 71.8%. This predictive model, based on ultrasound of the appendix combined with inflammatory markers, provides a useful method to assist pediatric emergency physicians in diagnosing childhood appendicitis. The decision tree model reflected the interaction of various indexes, and the model was simple, intuitive, and effective.

Ascaris lumbricoides, an uncommon cause of appendicitis

Appendicitis is the first cause of acute abdomen. There are many causes of appendicitis, one of them is parasites, and, Ascaris is the most common helminth infection in tropical countries (Asia, Africa, South America). Ascaris, once it is ingested, lives at the digestive tract and it can end up in the appendix lumen and lead to appendicitis by luminal obstruction, in fact this presentation is rare and is still debatable in the literature. Diagnostic most of times is made retrospectively by the demonstrations of ascaris eggs on the pathological examination of the appendix. We present the case of 7 years old male that arrives to emergency room presenting clinically acute appendicitis with 24 hours from beginning with fever 38ºC, intense mesogastrium abdominal pain with migration to right lower quadrant, anorexy, without nausea or vomiting, normal vital signs at physical examination intense abdominal pain, rebound, positive McBurney and psoas sign, leukocytosis with sift left. He underwent to emergency operation because suspect of appendicitis, we found a cecal appendix with Ascaris lumbricoides parasite in its lumen.

A case report of perforated appendicitis with pyoperitoneum in a tertiary care center

Acute appendicitis remains one of the most frequent reasons for emergency hospital admissions and the most common cause of an 'acute abdomen' in young adults. The risk of appendicitis is 8.6% for men and 6.7% for women throughout a lifetime, with the frequency peaking in the second decade of life. In 19% of acute appendicitis cases, there is perforation, and it has a bimodal distribution. Appendiceal gangrene and perforation appear to be caused by the appendiceal lumen being blocked. Gangrenous appendicitis and free bacterial contamination of the peritoneal cavity result from ischaemic necrosis of the appendix wall. Extreme ages, diabetes mellitus, immunosuppressive diseases, and obstruction of the appendix lumen are risk factors for appendix perforation. Advances in radiographic imaging have increased diagnostic accuracy, although the diagnosis of acute appendicitis remains primarily clinical. Ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans are the imaging modalities presently in use. Early appendectomy continues to be the best option and the least contentious treatment for acute appendicitis. The accepted standard of care for perforated appendicitis includes both open and laparoscopic procedures. Antibiotic prophylaxis responds effectively to complicated appendicitis.

Challenge for the Surgeon: Acute Appendicitis and Hostile Abdomen

Introduction: Urgent medical care and specific therapy are needed for illnesses like acute appendicitis and hostile abdomen. A frequent condition that affects people of all ages, acute appendicitis is more prevalent in young people of European descent. The major factor causing acute appendix inflammation is obstruction of the appendix's lumen. Abdominal infection, acute appendicitis, acute pancreatitis, and peritonitis are just a few of the dangerous conditions that might be indicated by a hostile abdomen. Theoretically, acute appendicitis is an immediate inflammation of the appendix that causes abdominal discomfort and, if untreated, can lead to significant consequences. Acute appendicitis is often treated with surgery to remove the appendix. Abdominal discomfort, nausea, vomiting, fever, and chills are among the symptoms. Although it can afflict persons of various ages, acute appendicitis is most frequently experienced by young people of European descent. With a frequency of about 7% worldwide, acute appendicitis epidemiology is a subject of much research. A hostile abdomen is a condition that can be a symptom of a number of dangerous illnesses, including abdominal sepsis, acute appendicitis, acute pancreatitis, and peritonitis. Abdominal discomfort, stiffness, bloating, and inflammation-related symptoms are some of the symptoms. It takes a thorough analysis, including physical exams and imaging tests, to diagnose a hostile abdomen. Depending on the underlying reason, the hostile abdomen may be treated with surgery, antibiotics, or other medical procedures. Discussion: If left untreated, illnesses like acute appendicitis and hostile abdomen can lead to major problems. In order to appropriately detect and diagnose their patients, clinicians must be knowledgeable about these disorders. Although acute appendicitis cannot be prevented, major complications can be avoided with early management. For optimal care of the hostile abdomen and diagnosis of the underlying etiology, a multidisciplinary approach is also required. Abdominal hostility and acute appendicitis are two significant illnesses that need prompt medical care, a precise diagnosis, and effective treatment. A frequent condition that affects people of all ages, acute appendicitis is more prevalent in young people of European descent. An hostile abdomen is a symptom indicating a wide range of dangerous illnesses.

Pendampingan Asuhan Keperawatan Medikal Bedah pada Pasien dengan Gangguan Sistem Pencernaan: Apendisitis

Introduction: Appendicitis is a disease of the respiratory system where inflammation is due to infection of the appendix or appendix, this infection will cause several complications if surgery is not immediately taken for treatment, usually an appendectomy is performed to reduce the risk of perforation. Appendicitis can be caused by predisposing factors such as obstruction of the lumen, infection with bacteria from the colon (E. Coli, Streptococcus), and male sex in adolescents-adults. As well as precipitating factors such as blockage of the appendix lumen, erosion of the appendix mucosa, and an unhealthy lifestyle, such as eating habits that are low in fiber. Objective: This assistance aims to provide nursing care to the patient Mr. A with a medical diagnosis of appendicitis in the Anggrek room at RSUD Kota Banjar in 2022. Method: Assistance activities are carried out by providing nursing care through 5 stages of the nursing process, including Assessment, Diagnosis, Nursing Intervention, Nursing Implementation, and Evaluation. Result: The results showed that the patient's main complaint was pain in the post-operative appendectomy wound in the right lower quadrant of the abdomen, the diagnosis that appeared in the patient was acute pain and sleep disturbances, after being given nursing actions from January 4-6, the results showed that the patient said the pain he felt has decreased, the patient does not look grimacing, the patient's expression looks relaxed, the pain scale has decreased from the initial scale of 6 to a scale of 3. Conclusion: After the process of providing nursing care was carried out on 04-January-2022, it was found that the nursing problem in Mr. A with a medical diagnosis of appendicitis could be resolved.

Comparison of MRI appendix biometrics in children with and without acute appendicitis.

The goal of this study is to improve MRI-specific diagnostic criteria for pediatric appendicitis through comparison of normal and abnormal appendix-related imaging features. A retrospective multireader-multicase design was used, including non-contrast MRI performed for suspected pediatric appendicitis following non-diagnostic US from January 2014 to December 2017. Positive diagnosis was defined by surgical pathology or symptom resolution after antibiotics. Four pediatric radiologists independently graded study biometrics while blinded to clinical data. Balanced complete block design was used to determine performance characteristics. Global diagnosis of appendicitis (208 studies) had sensitivity 90.6% and specificity 97.7%. Median appendix diameter was 10.4mm among positive cases and 5.8mm among negative cases (p < 0.001) with an optimal diagnostic cutoff of 7.5mm (sensitivity 89.4%, specificity 86.5%). Median appendix wall thickness was 2.6mm among positive cases and 1.7mm among negative cases (p < 0.001) with an optimal diagnostic cutoff of 2.3mm (sensitivity 63.1%, specificity 82.9%). Performance characteristics for qualitative appendix features included distinguishable appendix luminal signal (sensitivity 89.6%, specificity 83.7%), intraluminal fluid-signal intensity (sensitivity 63.6%; specificity 52.3%), intraluminal signal intermediate between fluid and bowel wall (sensitivity 91.0%; specificity 37.1%), appendicolith (sensitivity 34.9%; specificity 100.0%), intraluminal layering (sensitivity 25.9%; specificity 100.0%), hyperintense appendix wall signal (sensitivity 31.7%; specificity 100.0%), periappendiceal fluid (sensitivity 66.8%; specificity 72.5%), periappendiceal fatty edema (sensitivity 91.3%; specificity 94.5%), and free pelvic fluid (sensitivity 88.5%; specificity 26.0). This study provides MRI-specific performance of pediatric appendicitis quantitative and qualitative biometrics with peri-appendiceal fatty edema, appendix diameter > 7.5mm, and distinguishable appendix luminal signal demonstrating the highest overall accuracy. • This retrospective multireader-multicase study characterized magnetic resonance imaging-specific diagnostic accuracy of quantitative and qualitative biometrics for pediatric appendicitis. • The optimal quantitative diagnostic thresholds for an abnormal pediatric appendix at MRI included diameter and wall thickness of 7.5mm and 2.3mm, respectively. • Qualitative imaging biometrics with high specificity for pediatric appendicitis on MRI included the presence of distinguishable appendix lumen signal from wall signal, appendicolith, intraluminal fluid-fluid layer, appendix wall hyperintensity, and peri-appendiceal fatty edema.

The Investigation of 14 Appendiceal Mucocele Cases Encountered in 4850 Appendectomy Patients.

Appendiceal mucocele is a rarely seen disease which occurs when the appendix lumen is filled and obstructed by mucous. In our study, we aimed to reveal the surgical approach of our clinic, features of tumors, and clinical presentations in line with literature in cases of appendix mucocele. Fourteen appendix mucocele patients who were admitted in our hospital between 2012 and 2019 were examined retrospectively in the electronic recording medium. Our patients were evaluated in terms of age, gender, clinical status, operation, imaging results, and pathology results. Of the fourteen patients, 12 applied to the emergency department and 2 to the general surgery clinic. All of our patients had abdominal pain at the time of admission. In the physical examination, 5 (35%) patients had defenses, 10 (71%) patients had rebound tenderness, and 12 (85%) patients had tenderness. In preoperative imaging studies, 11 patients were interpreted as having acute appendicitis and 3 patients were evaluated as having appendix mucocele. The pathological results were reported as 6 patients had appendiceal mucocele and 8 patients had appendiceal mucocele together with acute appendicitis. Appendiceal mucocele is a disease which generally causes similar clinical findings of acute appendicitis. Ultrasound and CT may be useful in preoperative diagnosis. Surgical treatment options of mucocele are open or laparoscopic appendectomy, cecum resection, and right hemicolectomy. Although its incidence is low, due to pseudomyxoma peritonei, it is a pathology that requires careful surgery.

The Role of Vascular Endothelial Growth Factor as a Predictor of Complicated Appendicitis in Animal Model Oryctolagus cuniculus

BACKGROUND: Appendicitis is the most common abdominal disease that requires surgery in children. The mortality rate in appendicitis is greatly affected by rupture or leakage of the appendix. In establishing the diagnosis of appendicitis, several modalities are needed, namely, with a pediatric appendicitis score and ultrasound. In addition to operative measures, non-operative therapeutic research is also developing, especially for cases of appendicitis without complications. Pathologically, the occurrence of complications in appendicitis is influenced by good vascularization for tissue healing through the process of angiogenesis by vascular endothelial growth factor (VEGF).&#x0D; AIM: We aimed to see the effect of VEGF and folic acid levels on the occurrence of complicated appendicitis.&#x0D; METHODS: This research method is laboratory experimental design. A total of 32 rabbits used were male rabbits weighing 2500–3000 g that met the inclusion and exclusion criteria. Samples were examined for VEGF levels and then the appendix lumen was obstructed with Silk No.-O thread. Thirteen hours later, blood samples are taken back to check VEGF and folic acid (FA) levels and an appendectomy is performed for histopathological examination.&#x0D; RESULTS: There is a decrease of basal VEGF levels regarding histopathological results. In complicated appendicitis, the basal VEGF level was lower than acute appendicitis and normal; 8.61 (±4.87), 7.66 (±3.47), and 5.75 (±4.88), respectively. Similar trend was found in basal FA levels. In complicated appendicitis, it has a lower level than both acute appendicitis and normal; 2.00 (±2.08), 1.14 (±1.00), and 0.44 (±0.22) in order. However, there is no statistical significance in both trends (p = 0.775 and p = 0.058).&#x0D; CONCLUSION: There was a trend showing low value of VEGF and FA that were a predictor of appendicitis and complicated appendicitis. Unfortunately, no statistical significance was shown in this study.

Can peritoneal thickening and enhancement be used to determine perforation in patients with acute appendicitis?

Acute appendicitis (AA) is a common cause of abdominal pain in developed countries. In patients with suspected AA, computed tomography (CT) is considered as the gold standard with the highest sensitivity and specificity, and it is also an im-portant modality, especially in patients with complicated AA. In this study, we aimed to evaluate age and laboratory findings, as well as specific CT findings in differentiating between perforated and non-perforated appendicitis. We retrospectively analyzed 252 patients diagnosed with AA and underwent appendectomy between November 2015 and December 2019 in Somalia Mogadishu Recep Tayyip Erdogan Education and Research Hospital. Patients under 18 years of age and those with no pre-operative CT scans were excluded from the study. The demographic, laboratory, CT findings, and pathological data of all patients were evaluated. This study included 80 patients, 32 (40%) classified as perforated appendicitis (Group-1) and 48 (60%) as non-perforated appendicitis (Group-2). The C-reactive protein value was found to be statistically higher in Group-1 than in Group-2 (177.5±118.9 and 100.2±87.3 mg / L, respectively; p=0.001). The appendix lumen diameter (p=0.002), appendix wall defect (p<0.001), peritoneal thickening and enhancement (p<0.001), ascites (p=0.031), intra-abdominal abscess (p=0.003), jejunal thickening (p=0.019), ileal thick-ening (p=0.008), and ileus (p=0.035) values were significantly higher in Group-1. In the binominal logistic regression analysis performed with statistically significant data, an appendiceal wall defect (OR: 0.069, 95% CI=0.014-0.327, p=0.001) and peritoneal thickening and enhancement (OR: 0.131, 95% CI=0.024-0.714, p=0.019) were identified as independent variables for perforated appendicitis. Among CT findings, appendix wall defects and peritoneal thickening and enhancement play an important role in detecting perforation.

Curative Medical Treatment for Acute Appendicitis without Surgical Appendectomy (Jaber Maneuver)

Clinical and Pathological evaluation Acute abdomen with a mixture of modern radiographic images, diagnostic laboratory investigations and clinical observation such as (McBurney’s triangle manifestations with rebound tenderness) [1]. All these signs suggest firmly acute appendicitis with mucosal viral or bacterial infection within the narrow lumen of appendix leading to luminal obstruction, this leads to increase the mucosal secretions, and inflammatory exudates, which increase the intraluminal pressure, obstructed lymphatic drainage. Edema and mucosal ulceration develop with bacterial transudation to the submucosa. Resolution may occur at this point either spontaneously or in response to antibiotics.

Demographics of paediatric patients presenting with acute appendicitis: A 5-year retrospective review of hospitals served by the Department of Paediatric Surgery at the University of the Witwatersrand

Background. There are no recently published data on the incidence and demographics or perforation rates of paediatric patients from our local population presenting with acute appendicitis. Objective. To show the age and gender distribution of paediatric patients presenting with acute appendicitis within our communities, as well as demonstrating the incidence of perforated acute appendicitis in our paediatric population. Method. The study is a retrospective record review of all paediatric patients who presented with acute appendicitis to the Department of Paediatric Surgery at both Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), and Chris Hani Baragwanath Academic Hospital (CHBAH) from June 2010 to September 2015. Data collected included all demographic data as well as histology results of patients who underwent appendectomies. Results. The total numbers of patients included in the study were 544; 234 at CHBAH, and 311 at CMJAH. The male-to-female ratio was 1.58:1. The mean age for presentation at both hospitals combined was 8.76 years. We found that 13.41% of paediatric patients with acute appendicitis in this cohort were under the age of 6 years. A histological review showed that 50.1% of patients in our cohort presented with complicated appendicitis, and we had a negative appendectomy rate of 8.4%. Histological results of patients under the age of 6 years revealed a higher negative appendicectomy rate of 11.4%. However, the incidence of complicated appendicitis in this age group was only 45.7%, which is lower than that reported in the literature. Three patients were found to have Enterobius vermicularis in the lumen of the appendix, and Ascaris ova were identified in one patient. Histology revealed a low-grade mucinous neoplasm in one patient. Conclusion. Acute appendicitis occurred at a median age of 8.76 years in our study population, with a male-to-female ratio of 1.58:1. We found that acute appendicitis occurred relatively more frequently in our patients under the age of 6 years compared with the incidence of acute appendicitis in this age group published elsewhere. Complicated appendicitis occurred in 50.1% of our patient population, with an increased frequency of perforated appendicitis occurring in our male population. However, complicated appendicitis occurred in only 44.7% of our patients below the age of 6 years, which is in stark contrast to published literature. Helminthic infections were rare associated pathogens in our study, and an unlikely underlying pathogen of acute appendicitis in our population.

Culture-based bacterial evaluation of the appendix lumen in patients with and without acute appendicitis

PurposeControversy exists over whether bacterial flora within the appendix differs between patients with and without appendicitis. To examine these potential differences, we cultured the appendiceal luminal microbiota of patients with and without acute appendicitis, and identified the bacterial species therein. MethodsFifty-seven patients with acute appendicitis and 37 patients without acute appendicitis who underwent curative resection of colorectal cancer and prophylactic appendectomies (control group) were included. Appendicitis patients were classified into the phlegmonous group or the gangrenous appendicitis group histopathologically. There was no patient with perforated appendicitis. Aerobic isolates were identified using standard identification schemata, and anaerobic isolates were identified according to the Japanese guidelines. ResultsThere were no significant differences among the three groups in the median number aerobe species present per patient. However, the median number anaerobe species in the gangrenous appendicitis group was significantly higher than that of the control group and the phlegmonous appendicitis group. In addition, the incidence of patients with Bacillus species, Fusobacterium nucleatum, and Bilophila wadsworthia increased as the disease progressed from phlegmonous to gangrenous appendicitis. ConclusionThe present results suggest that increased diversity of anaerobes and the translocation of Bacillus species, F. nucleatum, and B. wadsworthia are associated with the progression of acute appendicitis.

Mucinous cystadenoma of the appendix

Mucocele is a rare condition caused by the collection of mucus with in the lumen of the appendix. It accounts for 0.2%–0.3% of patients undergoing appendectomy procedure. In this article, we describe the case of a 53-year-old female patient who presented with pain in the right lower quadrant of the abdomen and a clinical pattern likely to a appendicitis. The patient was treated with appendectomy while avoiding perforation of the cyst. The histological specimen revealed mucinous cystadenoma with clear resection lines. The patient was discharged on the second day after surgery without any complications.

How Frequent does Bow and Arrow Sign Locate Ileocecal Valve during Colonoscopy?

Abstract Aim: Two major ways to locate the ileocecal valve (ICV) are to look for a thickening or bulge on the ileocecal fold, and the other is the “bow and arrow” method or the “appendix trick”. The aim of this study was to determine the accuracy of “bow and arrow” method to locate the ICV during colonoscopy. Patients and Methods: Colonoscopy was performed with the patients in the left lateral position. After cecal intubation had been confirmed, the appendiceal opening was identified, with the curve serving as the bow, an imaginary arrow was placed across the curve toward the appendix lumen. The tip of the imaginary arrow was then followed to confirm if it correlated to the location of the ICV. Results: The “bow and arrow” accurately located the ICV in 105 (76.6%) patients, but failed in 32 (23.4%) patients. The mean age (56.2 ± 13.1 years) of the patients in whom the “bow and arrow” located the ICV was lower than that (62.7 ± 0.9 years) of the patients in whom it failed to locate the ICV. Males, 58 (71.6%) had positive “bow and arrow”, while this was observed in 47 (83.9%) females. It correctly located the ICV in 73 (53.3%) of those with thin‑lip ICV, 20 (14.6%) of those with volcanic type, and 12 (8.8%) of those with double bulge ICV. Conclusion: The bow and arrow sign could not locate the ICV in all cases in our practice and so where it failed, alternative method should be employed to locate the ICV.

Mucocele of the appendix: A case report and review of literature

Mucocele represents mucinous dilation of the lumen of vermiform appendix resulting from obstruction or increase secretion. It is a rare disease with an incidence of 0.2–0.7% of all appendectomies and 8–10% of all appendiceal tumours. The clinical presentation is atypical with most cases usually asymptomatic. Mucocele of the appendix indicates dilation of the appendix lumen irrespective of the aetiology. Four types of appendiceal mucocele are defined by the cause of obstruction: retention cysts, epithelial hyperplasia, mucinous cystadenoma and mucinous cystadenocarcinoma. Mucocele of the appendix is a rare condition of the appendix that requires high index of suspicion for a definitive preoperative diagnosis. The treatment for appendiceal mucocele is typically surgical resection. We report a case of a 37-year-old woman with recurrent right iliac fossa pain of 20 years duration. Abdomen was full, moved with respiration with a positive pointing sign. There was marked right iliac fossa tenderness with rebound tenderness and guarding. She had an abdominopelvic ultrasonography that revealed features of acute appendicitis. She had surgery with intraoperative finding of marked distension of the appendix from the tip to the base with necrosis at the base, a right hemicolectomy was done.