Cause Of Appendicitis Research Articles

ACUTE EOSINOPHILIC APPENDICITIS IN A CHILD WITH NORMAL TOTAL LEUKOCYTE COUNT AND ABSOLUTE EOSINOPHILIC COUNT

Abstract Introduction/Objective Eosinophilic appendicitis is a rare condition with a reported incidence of 0.03% to 1.2%, and often presents with clinical manifestations indistinguishable from acute appendicitis. Eosinophilic appendicitis may be associated with a localized allergic phenomenon. Methods/Case Report We present a 13-year-old male with ~24-hour history of constipation who was brought to the emergency department because of right lower quadrant abdominal pain, nausea, and vomiting. He was afebrile and had no antecedent of atopy or parasitic infestation. Laboratory investigation revealed an elevated C-reactive protein: 0.7 mg/dL [0.0-0.3]; mildly decreased hemoglobin: 12.2 g/dL [12.6 -16.8]; normal white blood cell count: 9.7 x10 3/mcL [3.2-10.6]; eosinophil count:1.7% [<5] and mildly elevated monocyte count: 0.9 x103/mcL [0.2-0.7]. Ultrasound examination revealed a non-compressible 7mm in diameter hyperemic appendix. The laparoscopic appendectomy specimen measured 9.5 cm long by 0.8 cm in diameter. The serosa was focally congested and there was mild mural thickening but no obvious sign of active appendicitis. Microscopic examination showed focally abundant mucosal eosinophils and a considerable sprinkling of eosinophils throughout the muscularis propria. No intraluminal parasite or neutrophilic associated mucosal damage was seen. The final diagnosis was: Acute Eosinophilic Appendicitis. Results (if a Case Study enter NA) N/A Conclusion Among the many and still intriguing causes of appendicitis is acute eosinophilic appendicitis. Eosinophils exert homeostatic roles in the normal host and pathological eosinophil-mediated processes over different tissues and their varied milieu. While this patient did not have any evidence of allergy, parasitic infestation, or elevated eosinophilic count in his work up, the presentation of acute appendicitis without an increase in total leukocytic count may alert for the possibility of an eosinophilic appendicitis. Conceivably, eosinophil mediators, such as IL-5, IL-33, granulocyte–macrophage colony-stimulating factor, thymic stromal lymphopoietin, and eotaxin-1 determine eosinophil behavior in a rarified appendix microenvironment.

Actinomyces as a rare cause of appendicitis: a case report

Abstract Actinomycosis remains a rare and often underdiagnosed cause of appendicitis with only 10% of cases diagnosed prior to surgery. It is an important cause to consider particularly in the setting of an indolent infection with nonspecific symptoms. We present a 22 years old male who presented with 3 weeks history of lower abdominal pain who underwent laboratory investigations and imaging studies suggestive of acute appendicitis. He underwent an emergency laparoscopic caecectomy with histopathology of the specimen suggestive of actinomycosis. He recovered well postoperatively and was discharged home with a prolonged course of oral penicillins. Preoperative diagnosis of actinomycosis is uncommon and accounts for ~10% of cases. Definitive diagnosis is usually through histopathology or tissue/fluid culture. Treatment usually involves a combination of surgical resection and antibiotic therapy with a success rate of >90%.

Enterobius vermicularis infection at time of appendicectomy: is it a neglected risk factor?

Obstruction of the appendiceal orifice is well established as a potential cause of appendicitis. However, it remains debated as to if appendiceal orifice obstruction secondary to Enterobius vermicularis is considered a risk factor for appendicitis or appendiceal colic. Enterobius vermicularis maintains an increased prevalence within lower socioeconomic and human development index regions. Whilst Australia has an overall high human development index it has significant variability in health literacy and socioeconomics. The purpose of this literature review is to evaluate the relationship between Enterobius vermicularis and appendicitis, to review the prevalence of Enterobius vermicularis appendicectomies in lower human development index and socioeconomic status communities, and to review the Australian based Enterobius vermicularis literature available. A comprehensive review of the literature was performed to review the prevalence of Enterobius vermicularis at time of appendicectomy. PubMed, Scopus, and Google Scholar databases were investigated for applicable studies published until December 2023. Enterobius vermicularis within the appendiceal lumen may cause irritation and lymphoid hyperplasia resulting in appendiceal colic with a similar clinical presentation to that of acute appendicitis. An increased association between Enterobius vermicularis, low human development index, and socioeconomic status is suggested. Public health interventions reduce Enterobius prevalence. A single Australian based study from 1994 was identified. Enterobius vermicularis infection is a neglected risk factor for appendiceal colic. A high index of suspicion for Enterobius vermicularis infection should be taken for clinically stable patients with normal inflammatory biochemistry and low human development index. Further research is required to assess if there is a disparity in Enterobius vermicularis in relation to human development index, socioeconomic status, and remoteness within Australian communities.

Atypical perforated appendicitis secondary to schistosomiasis: a rare case report

Introduction: Schistosomiasis is the second most common parasite disease after malaria and a rare cause of appendicitis. It has been well-documented in the literature that schistosomiasis infection can have several multisystem effects. The unusual condition known as schistosomal appendicitis was initially described by Turner. Case presentation: We present a 48-year-old man with perforated appendicitis and schistosomiasis-like radiological findings. An appendectomy was performed, and schistosomiasis was confirmed by a histological study of the excised appendix. Praziquantel was administered in a single dosage. Conclusion: Although schistosomiasis is a rare cause of appendicitis and is very prevalent in developing nations, it should be considered when managing the condition. Anti-shistosoma drugs, which are not frequently used in post-appendectomy cases, should also be considered in the management.

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.

Mucocele of the Appendix Discovered Golestan Hospital of Ahwaz: A Case Report

Introduction: One rare cause of appendicitis is mucocele, which may have a neoplastic or non-neoplastic source. Simple appendectomy or right hemicolectomy may be necessary; sometimes, medication may be prescribed to manage symptoms. In this study, we reported a rare case with mucocele of the appendix managed by antibiotic therapy and a simple appendectomy. Case Presentation: A 60-year-old female with a seven-month history of right lower quadrant pain. A physical exam showed tenderness and rebound tenderness in the McBurney’s point. Her CT-scan tubular mass, measured 105 * 37 mm in RLQ, is suggested for mucocele appendicitis. Appendectomy was performed through a McBurney incision, and the pathology was a mucocele of the appendix with mucin-secreting mucosal hyperplasia. Conclusions: Malignancy of the appendix is extremely rare. Appendiceal tumors have a low prevalence, but due to the nature of these tumors, which can also be malignant, they should be given importance, and careful follow-up is mandatory. Patients must remain informed and proactive as the surgical community continues to learn more about this condition. The mucocele appendix can be successfully managed and treated with timely diagnosis and treatment.

The Histopathological Findings in Appendectomy Specimens in an Iranian Population.

Appendicitis is one of the most common causes of acute abdominal surgeries. The importance of parasitic etiologies in the pathogenesis of appendicitis is not well known in appendectomy specimens on a large scale in southwestern Iran. The current study aimed to retrospectively assess the demographic data and histopathological records of appendicitis in a 28-year period in Fars province, southwestern Iran. Histopathological records of 13,013 patients who had undergone surgeries for appendicitis at Dr. Ali Shariati Hospital, affiliated with the Fasa University of Medical Sciences from December 1993 to January 2021 were reviewed and data concerning the patients' demographic data and histopathological records were retrieved from each record. More than 6800 archived microscopic glass slides were also reviewed. From a total of 13,013 histopathological records of surgical excisions of appendicitis that were reviewed over a 28-year period, 8,189 (62.9%) were male and 4,842 (37.1%) were female. Patients' age ranged from 2 to 98 years, with a mean age of 24.68±19.87 years. The most common inflammatory changes were 5,687 (43.7%), 1,228 (9.4%), 670 (5.1%), 522 (4%), and 363 (2.8%) cases of acute appendicitis, suppurative appendicitis, early acute appendicitis, gangrenous appendicitis, and perforated appendicitis respectively. Microscopically, no viral inclusions, fungal elements, and histopathologic findings of bacterial causes were found. Parasitic infections such as helminthiasis were detected in 74 (0.6%) cases aged from 6 to 63. Enterobiasis (Syn. oxyuriasis, pinworm infection) accounted for 73 (98.6%) of the 74 helminthiases, while ascariasis accounted for 1 (1.4%). Out of 74 cases, 29 (39.2%) showed evidence of appendicitis. The results suggest that although parasitic agents are minor causes of appendicitis, these agents should be kept in mind during differential diagnosis. However, whether every parasitic infection leads to appendicitis is controversial.

Metastatic gastric adenocarcinoma with appendiceal phlegmon: a case report

BackgroundGastric carcinoma is one of the most frequent malignancies worldwide. Gastric cancer metastasis to the appendix is uncommon in incidence, and has been rarely described in acute-appendicitis-related literature reviews. In this presented case, we have reported a rare case of appendiceal phlegmon, due to a diagnosis of metastatic gastric adenocarcinoma with uncommon symptoms.Case presentationA 79-year-old Caucasian male presented to the emergency department with history of weakness, anorexia, lethargy, and mood changes for 2 months. Abdominopelvic computed tomography showed an abscess in right iliac muscle. After percutaneous drainage of the abscess and 6 weeks antibiotic therapy, an appendectomy was done for the patient. Histopathologic findings revealed the involvement of the appendiceal wall by adenocarcinoma, most probably with gastrointestinal origin. Gastric cancer was confirmed later by upper endoscopy and pathologic report.ConclusionsAlthough the presence of tumor in appendectomy specimens is rare, and metastasis to appendix is even rarer, it should be considered as a cause of appendicitis, especially in elderly patients.

A Focal Submucosal Lipomatosis

Gastrointestinal lipomatosis is less frequent condition and it differs from lipoma due to the lack of capsule. The most common location of gastrointestinal lipomatosis is colon, followed by the ileum and jejunum. Isolated lipomatosis of the appendix is rare. It can be diffuse, asymmetric, or focal. In the localized form, only few patients present with symptoms. Obstruction of the lumen of the appendix is thought to be the primary pathology of appendicitis. Various pathologies such as hard fecal mass, stones, lymphoid hyperplasia, and neoplasia have been implicated. Obstruction of the appendiceal lumen due to isolated submucosal lipomatosis of the appendix is extremely rare. It can be one of the causes of appendicitis. Although radiological modalities such as ultrasonography, computed tomography scan, and magnetic resonance imaging are used for diagnostic workups, definitive diagnosis requires histopathological examination.

Unusual Cause of Acute Appendicitis: Bone Fragment

Foreign bodies are a rare cause of appendicitis, because in most cases these ingested foreign bodies cross the digestive tract asymptomatically [1] [2] [3]. However, some penetrate the lumen of the appendix causing its inflammation. We report an unusual observation of acute appendicitis induced by a foreign body namely a bone fragment in the visceral surgery department of the Centre Hospitalier Intercommunal de Villeneuve Saint-Georges.

The Simultaneous Occurrence of Acute Appendicitis and Bowel Perforation in Taenia Infection: A Case Report

Background: Appendicitis is most likely due to obstruction of the appendiceal lumen. Parasitosis is an unusual cause of obstruction and in specific, Taenia Saginata is a very rare cause of appendicitis, even more so of small bowel perforation. Teiniosis is usually an asymptomatic process but a greater load or migration of the adult form may complicate some cases. The simultaneous occurrence of acute appendicitis and ileal perforation in the same setting has not been reported in the literature. Case Presentation: A 60-year-old Lebanese female patient presented to the emergency department with right lower quadrant pain radiating to the left lower abdomen. The patient reported associated fever, chills, and anorexia prior to presentation. On physical examination, she was afebrile and normotensive, abdominal examination revealed diffuse lower abdominal tenderness. A blood workup revealed an elevated c-reactive protein (CRP) value with a normal white blood count (WBC). Computed tomography (CT) scan done with intravenous (IV) and per os (PO) contrast disclosed a leak of PO contrast in the absence of pneumoperitoneum implying a contained perforated appendicitis or colitis. The patient underwent urgent laparoscopic exploration. Intraoperatively patient had gangrenous appendicitis and an inflamed right fallopian tube, as well as small bowel perforation and the presence of a tapeworm. The tapeworm was removed and the patient ended up having an appendectomy, right salpingectomy, and oophorectomy, with the closure of ileal perforation. Her hospital stay was uneventful and she was discharged on ciprofloxacin, mebendazole, and metronidazole. Soon after her discharge from the hospital, the patient resumed her normal daily activities. Histopathological studies revealed mixed inflammatory infiltrates and the worm to be Taenia Saginata. Conclusion: Patients with teniosis are mostly asymptomatic. In symptomatic patients, the course is usually mild except for some rare occasions including appendicitis or bowel perforation. The diagnosis of Taenia Saginata infection in such cases should be considered in endemic areas such as the Middle East and North Africa (MENA) region where eating raw meat is habitual.

Ingested Foreign Bodies Can Cause Appendicitis and Perforation: A Multi-Institutional Case Series.

Appendicular foreign bodies are a rare, under-described cause of appendicitis. We performed this study to determine the varied causes and consequences of foreign-body appendicitis. On retrospective review of the pathology archives of seven institutions, we identified 56 appendix specimens containing a foreign body (defined as ingested, non-digestible material). We recorded the type of foreign body, patient age and sex, and other findings, as available. Mean patient age was 7.7 years (range: 1 day-18 years). The foreign bodies included hair, plant material, magnets, other metallic material, BB pellets, foreign material not otherwise specified, and other miscellaneous objects. Of 48 cases with available clinical information, 31 patients presented with abdominal pain, and 22 were preoperatively diagnosed as having appendicitis/appendicular inflammation. Seven patients had appendiceal perforation (13%). The foreign body was grossly identified in 34/47 cases with available gross descriptions. Twenty-seven cases had an identifiable foreign body microscopically; 10 were associated with giant cell reaction. Hair and plant materials were the most common foreign objects found in the appendix; they often cause mucosal damage and giant cell reaction. Metallic objects were less common. Although appendicular foreign bodies in children are rare and sometimes asymptomatic, they may lead to perforation.

The appendix-mucosal immunity and tolerance in the gut: consequences for the syndromes of appendicitis and its epidemiology.

The cause of appendicitis is unknown. A review is presented across diverse sources relating to the biology of the appendix and its perturbations. A mechanistic model of the function of the appendix is presented, and its application to the syndromes and consequences of appendicitis is described.

Diamonds in the appendix

BackgroundAn uncommon cause of appendicitis is the entrapment of ingested foreign objects in the appendix. Although a rare event, it could remain asymptomatic for a prolonged time. The presence of foreign bodies in the gastrointestinal tract has a high potential for complications, in particular if sharp or large enough in size to cause obstruction. However, most often an ingested foreign object would be eliminated in the stool. Rarely, it may reside in the appendix depending on various factors such as the nature of the ingested body and the appendiceal peristaltic movements.Case presentationWe report a case of abdominal pain due to a diamond earring trapped in the appendix for 2 years. A plain X-ray of the abdomen confirmed the diagnosis which prompted a laparoscopic appendectomy resulting in resolution of symptoms.ConclusionThe initial presentation of an ingested foreign object can be similar to signs of symptoms of acute appendicitis and the patient must be monitored for several days to follow the trajectory of the foreign body in order to prevent complications. Even though the incidence is more common among the pediatric population, vigilance among adults should also be undertaken with a history of ingesting a foreign object, as this case demonstrates the importance of keeping a high index of suspicion when encountering such cases.

Crohn's disease with pathological findings of a granulomatous lesion in the appendix

Crohn's disease is a rare cause of appendicitis. In this report, we describe a case of Crohn's disease that was diagnosed 4 months after surgery for acute appendicitis in a 15-year-old boy. He was followed carefully after surgery, because the pathological findings showed the presence of a granuloma, which may imply Crohn's disease. At four months after surgery, he visited our hospital with a chief complaint of diarrhea. Lower gastrointestinal endoscopy revealed longitudinal ulcerative lesions in the entire colon. Taken together with the pathological findings of the appendix, the patient was diagnosed with Crohn's disease. The patient is currently on a continuous infliximab regimen. In the present case, although there were no symptoms at the time of surgery, we informed the patient and his parents of the pathology results in advance, and told them to return to our clinic as soon as symptoms appeared. The pathological diagnosis led to an early diagnosis of CD. Although rare, Crohn's disease should be kept in mind as a cause of appendicitis.

Population preference for treatment of uncomplicated appendicitis.

BackgroundNon-operative treatment of uncomplicated appendicitis is safe and increasing in popularity, but has other risks and benefits compared with appendicectomy. This study aimed to explore the preference of the general population regarding operative or antibiotic treatment of uncomplicated appendicitis.MethodsIn this prospective study, a clinical scenario and questionnaire were submitted to a panel comprising a sample of an average adult population. The survey was distributed by an independent, external research bureau, and included a comprehensive explanation of the risks and benefits of both treatment options. The primary outcome was the proportion of participants who would prefer antibiotics over surgery. Secondary outcomes were reasons for this preference and the accepted recurrence rate within 1 year when treated with antibiotics only. All outcomes were weighted for the average Dutch population.ResultsOf 254 participants, 49.2 per cent preferred antibiotic treatment for uncomplicated appendicitis, 44.5 per cent preferred surgery, and 6.3 per cent could not make a decision. About half of the participants preferring antibiotics would accept a recurrence risk of more than 50 per cent within 1 year. Avoiding surgery was their main reason. In participants preferring surgery, many tolerated a recurrence risk of no more than 10 per cent when treated with antibiotics. Removal of the cause of appendicitis was their main reason.ConclusionAround half of the average population sample preferred antibiotics over surgical treatment of uncomplicated appendicitis and were willing to accept a high recurrence risk to avoid surgery initially. Participants who preferred surgery tolerated only a very low recurrence risk with antibiotic treatment.

Schistosomal appendicitis: Case series and systematic literature review.

BackgroundGlobally, schistosomiasis affects at least 240 million people each year with a high proportion of cases in sub-Saharan Africa. The infection presents a wide range of symptoms mainly at the gastrointestinal and urogenital level. Cases of schistosomiasis-related appendicitis are seldom reported. The aim of the present study is to identify the prevalence of schistosomiasis-related appendicitis in Beira, Mozambique and compare to global prevalence.MethodsWe retrospectively reviewed all cases of appendicitis recorded from January 2017 to March 2020 at a single pathology department located in Beira in order to assess the prevalence of schistosomiasis. Moreover, we performed a systematic review on the prevalence of schistosomiasis-related appendicitis in all countries.FindingsA total of 145 appendicitis cases in Beira showed a 13.1% prevalence of schistosomal-related appendicitis. The mean age of patients was 29.1 years, and 14 (73.7%) were male. The systematic review identified 20 studies with 34,790 inpatients with schistosomiasis-related appendicitis with a global prevalence of 1.31% (95% confidence interval (CI): 0.72 to 2.06); a high heterogeneity (I2 = 96.0%) was observed. Studies carried out in Africa reported a significantly higher prevalence of schistosomiasis-related appendicitis (2.75%; 95% CI: 1.28 to 4.68) than those in Middle East (0.49%; 95% CI: 0.18 to 0.95) (p for interaction < 0.0001).ConclusionsSchistosomiasis infection should be considered as possible cause of appendicitis not only in endemic areas but also in developed countries. Considering that prevention is the best way to control the infection, more efforts should be put in place in order to increase the prevention coverage and avoid the cascading implications for health. This is even more so important in this Coronavirus Disease 2019 (COVID-19) era where the majority of attention and funds are used to fight the pandemic.

Unusual cause of appendicitis: Orthodontic wire

Appendicitis is one of the most common childhood diseases requiring surgery and the appendectomy is the most common surgical procedure performed in children. Typical findings on physical exam and imaging points the child toward a surgical consult and, ultimately, removal of the inflamed appendix. Our aim is to present an interesting case and, to our knowledge, never before described cause of appendicitis in the pediatric population. We introduce the case of an 11-year-old female who presented with 3 days of abdominal pain, unremarkable laboratory findings, and a computer tomography (CT) showing a radiopaque object in the terminal ileum adjacent to the appendix. She underwent diagnostic laparoscopy with findings of a metallic wire that perforated the ileal wall and irritated the appendix. The wire was removed without need for intestinal repair and a standard appendectomy was performed. The patient recovered uneventfully. While standard presentation and treatment of appendicitis is at the forefront, occasionally imaging or intra-operative findings can present a surprise. This case of clinical symptoms of appendicitis but discordant imaging, led the patient to the operating room for the intended surgery. A foreign body was the irritator of the appendix, a differential to consider. • Foreign bodies are a rare cause of appendicitis in children. • Abdominal pain is more common than leukocytosis in appendicitis secondary to a foreign body. • Prompt management of foreign bodies decreases morbidity and prolonged hospital stay.

Torsion of the vermiform appendix in a 16-year-old young man: surgical-radiologic correlation

Torsion of the vermiform appendix is a rare cause of appendicitis. As it results in ischemia of the appendix, it is usually reported as causing the same symptoms and presentation observed in other cases of appendicitis. Torsion can be primary, in the setting of an otherwise normal appendix, or secondary, when associated with an abnormality such as a mucocele or mass. Despite its rarity, appendiceal torsion has been observed in a wide distribution of age groups, from young children to the elderly. In this report, we describe the case of a 16-year-old young man who presented to an outside facility with several days of pain in the right lower quadrant, and was found to have CT scan findings suspicious for torsion of the appendiceal base. He was transferred to our facility and underwent diagnostic laparoscopy which revealed a 720-degree clockwise torsion of the vermiform appendix about its base, and he was treated with stapled appendectomy. As symptoms from appendiceal torsion will usually be identical to those of more conventional appendicitis, correlation of radiographic findings, when available, with symptoms is useful in identifying torsion as the etiology of the patient's appendicitis and for planning the appropriate operative approach.

The neglected role of Enterobius vermicularis in appendicitis: A systematic review and meta-analysis

Although the main cause of appendicitis is unclear, infection with Enterobius vermicularis is suggested as a neglected risk factor. Since, there is no comprehensive analysis to estimate the prevalence of E. vermicularis in appendicitis; therefore, we conducted a global-scale systematic review and meta-analysis study to estimate the prevalence of E. vermicularis infection in appendicitis cases. PubMed, Scopus, Web of Science and Google Scholar databases were systematically searched for relevant studies published until 15 August 2019. Pooled prevalence of E. vermicularis infection was estimated using the random effects model. Data were classified based on the continents and countries. Moreover, subgroup analyses regarding the gender, the human development index (HDI), and income level of countries were also performed. Fifty-nine studies involving 103195 appendix tissue samples belonging to the individuals of appendicitis were included. The pooled prevalence of E. vermicularis infection was (4%, 95%CI, 2–6%), with the highest prevalence (8%, 95% CI: 0–36%) and lowest prevalence (2%, 95% CI: 1–4%) in Africa and Americas continents, respectively. With respect to countries, the lowest and highest prevalence rates were reported from Venezuela (<1%, 95% CI: 0–1%) and Nigeria (33%, 95% CI: 17–52%), respectively. Indeed, a higher prevalence was observed in females, as well as in countries with lower levels of income and HDI. Our findings indicate the relatively high burden of E. vermicularis infection in appendicitis cases. However, our findings suggest the great need for more epidemiological studies to depth understand overlaps between E. vermicularis infection and appendicitis in countries with lower HDI and income levels.