Cecal Appendix Research Articles

Intestinal occlusion secondary to De Garengeot’s hernia resolved by laparoscopy

Introduction: Femoral hernias constitute a minority of abdominal wall hernias and an entrapment of the appendix in the femoral hernia is called Garengeot's hernia. Case report: A 93-year-old woman was admitted to the emergency department of our hospital presenting abdominal pain accompanied by intestinal occlusion. She underwent laparoscopy for a diagnosis of femoral hernia with inflamed cecal appendix inside, with an adequate postoperative period. Discussion: The incidence of De Garengeot hernia is approximately 0.1-5% of reported femoral hernias and 0.1% of acute appendicitis. Conclusion: Despite this uncommon pathology, emergency surgical treatment is generally required, and the laparoscopic approach is the best option as long as the patient's condition and the surgeon's experience allow it.

Systemic toxoplasmosis in 2 domestic rabbits in Georgia, United States.

Toxoplasma gondii infections are common in a range of mammalian and avian species, but clinical disease has been reported only rarely in domestic rabbits. Two cases of toxoplasmosis in domestic rabbits from the same premises were submitted to a diagnostic pathology facility in Athens, GA, USA. Both rabbits died after exhibiting clinical signs of gastrointestinal stasis. The gross findings observed in both rabbits comprised miliary, random, white-to-tan, necrotic foci throughout the spleen, liver, and lungs. Histologically, tachyzoites were observed within necrotizing inflammatory foci in the spleens of both rabbits, and in various other organs (tracheobronchial lymph node, lung, heart, and cecal appendix) of one rabbit. In both cases, the tachyzoites were immunoreactive with anti-Toxoplasma gondii antibodies. In addition, T. gondii DNA was detected via PCR and sequencing from a fresh lung sample from one rabbit and formalin-fixed, paraffin-embedded spleen, liver, femoral bone marrow, and haired skin from the second rabbit. Given that T. gondii can cause disease in domestic rabbits and is also a concern for other potential intermediate hosts (e.g., humans, other domestic animals), this parasite warrants consideration in the diagnostic evaluation of lagomorph tissues with compatible lesions.

WCN24-1190 Eosinophilic peritonitis in a patient in CAPD associated with neuroendocrine carcinoma of the cecal appendix, an incidental finding in an appendectomy. Case Report

WCN24-1190 Eosinophilic peritonitis in a patient in CAPD associated with neuroendocrine carcinoma of the cecal appendix, an incidental finding in an appendectomy. Case Report

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.

Correlation between the presence of a cecal appendix and reduced diarrhea severity in primates: new insights into the presumed function of the appendix

Increased severity or recurrence risk of some specific infectious diarrhea, such a salmonellosis or Clostridium difficile colitis, have been reported after an appendectomy in human patients. While several other mammals also possess an appendix, the suspected protective function against diarrhea conferred by this structure is known only in humans. From a retrospective collection of veterinary records of 1251 primates attributed to 45 species, including 13 species with an appendix and 32 without, we identified 2855 episodes of diarrhea, 13% of which were classified as severe diarrhea requiring a therapeutic medication or associated with a fatal issue. We identified a lower risk of severe diarrhea among primate species with an appendix, especially in the early part of life when the risk of diarrhea is maximal. Moreover, we observed a delayed onset of diarrhea and of severe diarrhea in species possessing an appendix. Interestingly, none of the primates with an appendix were diagnosed, treated or died of an acute appendicitis during the 20 years of veterinarian follow-up. These results clarify the function of the appendix among primates, as protection against diarrhea. This supports its presumed function in humans and is congruent with the existence of a selective advantage conferred by this structure.

Flow cytometric characterization of cecal appendix lymphocyte subpopulations in children: a pilot study

IntroductionScientific literature regarding the characterization of lymphocyte subpopulations of the cecal appendix is sparse, with few precedents limited to immunohistochemical techniques.MethodsWe conducted a prospective pilot study to characterize lymphocyte subpopulations of the cecal appendix in children. Participants were divided into three groups: (1) patients without histological acute appendiceal inflammation, (2) patients with histological uncomplicated acute appendicitis, and (3) patients with histological complicated acute appendicitis (gangrenous, perforated). A fresh sample of the base of the appendix was taken from all patients and a flow cytometric study was performed. Quantitative variables were compared using Kruskal–Wallis test and Mann–Whitney U test.ResultsThis study included 57 patients divided into Group 1 (n = 5), Group 2 (n = 37), and Group 3 (n = 15). Median values (IQR) of the percentage of B-lymphocytes were 67.8 [66.8–68.1] in group 1, 61.15 [53.74–66.4] in group 2, and 52.1 [33–62.02] in group 3 (p = 0.02). Median values (IQR) of the percentage of NK-lymphocytes were 0.26 [0.2–0.3] in group 1, 0.55 [0.37–0.66] in group 2, and 0.84 [0.35–1.45] in group 3 (p = 0.008). Median values (IQR) of the percentage of T-lymphocytes were 31.9 [31.7–33.1] in group 1, 37.68 [32.15–45.69] in group 2, and 46.9 [37.03–67] in group 3 (p = 0.02). Pair comparisons of groups 2 and 3 also showed significant differences in the percentage of B lymphocytes (p = 0.03) and NK-lymphocytes (p = 0.02).ConclusionsSignificant differences in lymphocyte subpopulations were identified according to the histologic grade of the cecal appendix. More specifically, a lower percentage of B-lymphocytes and a higher percentage of T- and NK-lymphocytes were observed in cases of acute appendicitis. These findings must be confirmed and their etiopathogenic, diagnostic, and prognostic implications elucidated in future studies with larger sample sizes.

Hallazgo intraoperatorio de hernia de Amyand: reporte de caso y revisión de literatura.

Abstract. Amyand’s hernia is an inguinal hernia that contains the cecal appendix inside. It is a rare entity and its discovery is generally made intraop-eratively. We present the case of a older male adult, with a soft tumor, with pro-gressive increase in volume, in the right inguinal region accompanied by local pain, reducible at rest. During surgery, a hernial sac was found with an enlarged cecal appendix inside it, with signs of inflammation. An appendectomy was per-formed. The hernia sac was reintroduced and the posterior wall of the inguinal canal was repaired (Lichtenstein and Bassini mixed technique). Postoperative evolution was satisfactory.

Amyand's Hernia: Review of the Literature

Amyand's hernia is defined as the presence of the cecal appendix inside the sac of an inguinal hernia. The appendix can be normal, inflamed, perforated or gangrenous, but the first situation is the most frequent. The name "Amyand's hernia" is due to the English surgeon Claudius Amyand (1681-1740), who in 1735 performed the first appendectomy on an 11-year-old boy during surgery for an incarcerated inguinal hernia that contained the perforated cecal appendix in its inner.1,2 When the vermiform appendix is found inside a femoral hernia, it is called Garengeot's hernia, in recognition of René Jacques Croissant de Garengeot (1688-1759), a French surgeon who was the first to describe the presence of the vermiform appendix inside the femoral hernia sac from an indirect inguinal hernia in 1731; in this case, the appendix did not present inflammatory signs. Diagnosis is generally intraoperative, since being an infrequent pathology, without specific symptoms and requiring high diagnostic suspicion, preoperative diagnosis is usually exceptional.

Liver transplantation in gastroenteropancreatic neuroendocrine tumors.

Neuroendocrine tumors are part of a heterogeneous group of tumors located in organs such as the gastrointestinal tract (GIT), lungs, thymus, thyroid, and adrenal glands. The most prevalent sites are the small intestine, cecal appendix, and pancreas. More than 50% of these tumors are associated with metastases at the time of diagnosis. Neuroendocrine tumors are classified according to the degree of cell differentiation and the histopathological proliferation index of the lesion. Neuroendocrine tumors can be well differentiated or poorly differentiated. G3 tumors are characterized by Ki-67 expression greater than 20% and can be either well differentiated (G3 NET) or poorly differentiated (G3 NEC). Neuroendocrine carcinoma (NEC G3) is subdivided into small-cell and large-cell types. When neuroendocrine tumors present clinical and compressive symptoms, carcinoid syndrome is evident. Carcinoid syndrome occurs when the tumor produces neuroendocrine mediators that cannot be metabolized by the liver due to either the size of the tumor or their secretion by the liver itself. Several therapeutic strategies have been described for the treatment of metastatic neuroendocrine tumors, including curative or palliative surgical approaches, peptide receptor radionuclide therapy, percutaneous therapy, systemic chemotherapy, and radiotherapy. Liver surgery is the only approach that can offer a cure for metastatic patients. Liver metastases must be completely resected, and in this context, orthotopic liver transplantation has gained prominence for yielding very promising outcomes in selected cases. The aim of this study is to review the literature on OLT as a form of treatment with curative intent for patients with gastroenteropancreatic neuroendocrine tumors with liver metastasis.

Atypical Presentation of Acute Appendicitis: Amyand's Hernia in a COVID-19 Patient Case Report

An Amyand's hernia is described as the phenomenon of the vermiform appendix entrapped inside the sac of an inguinal hernia and is regularly overlooked as an obstructive hernia. In this case report, we describe a 73-year-old male patient who presented to the emergency room with a presenting complaint of painless bilateral masses in the inguinoscrotal region. During the admission process, the patient’s rapid COVID-19 test also tested positive for IgM SARS-CoV-2. A bilateral hernioplasty with the Lichtenstein technique was decided as the appropriate surgical intervention. During the procedure, the right inguinal hernia (Nyhus IIIB) with a hernial sac containing the right colon with the cecal appendix in the suppurative phase (Amyand's hernia) was observed, alongside a left inguinal hernia (NyHus IIIA). This case report depicts a unique presentation of Amyands Hernia and a discussion section aiding healthcare professionals in the diagnosis and management of this rare occurrence and patient education on post-surgical management.

Comportamiento productivo y aspecto histológico del intestino delgado y apéndice cecal de conejos alimentados con triticale adicionando xilanasa

The objective was to evaluate the addition of xylanase on the productive performance and histological aspects of the small intestine and cecal appendix of rabbits fed diets containing triticale. 120 rabbits were randomly distributed to one of the four treatments differentiating them from the inclusion of xylanase (0, 4000, 8000 y 12000 XU/kg, respectively), the animals were weighed weekly and at the end of the experimental period, the rabbits were slaughtered taking samples of the duodenum, jejunum and cecal appendix to perform the technique of staining with Hematoxylin-Eosin (HE). An analysis of variance was performed using the GLM procedure of SAS (2002) and Tukey’s test. The addition of xylanase enzyme increased (p<0.05) the live weight at day 4 and 7 of the rabbits and increased (p<0.05) the areas of intestinal villi of the duodenum, jejunum and cecal appendix.

The vermiform cecal appendix, expendable or essential? A narrative review.

The vermiform cecal appendix is a small thin pouch-like tube of intestinal tissue situated in the lower right abdomen. It is attached at the junction of the large intestine between the ascending colon and small intestine. Historically, the appendix has been labeled redundant with no significant function, a remnant of evolution. This idea was thought to represent a function that may have been critical for survival that became nonsignificant over time. Evolutionary biologists deemed it to be a vestigial organ that early in human evolution was a dedicated organ that was useful and exploited by herbivorous ancestors. Currently, the vermiform cecal appendix has generated significant renewed research interest. As such it has been reported to present a site with a high concentration of lymphoid tissue and a biofilm microbiome that approximately mirrors that which is found in the large bowel. Research suggests that the vermiform cecal appendix may be the site of a safe-house biofilm that could re-inoculate the large bowel. Given that the appendix has no known role in digestion, the network of lymphoid tissue and microbiome could constitute an initial site of bacterial translocations that can influence early life ontology and immunological tolerance. A dysbiotic microbiome in the appendix is posited to trigger inflammatory sequelae.

Adenocarcinoma Mucinoso de Apéndice Cecal, informe de caso

Cecal appendix adenocarcinoma occurs in approximately 0.1% to 0.2% of all appendectomies. One subtype, mucinous adenocarcinoma, represents 0.08% of all neoplasms. Diagnosis is usually incidental and surgery is the best treatment option. We describe the case of a 55-year-old male patient, evaluated for severe pain in the right iliac fossa, who was found to have an appendiceal mass during open appendectomy. A fragmented appendix measuring 7 x 1.8 x 0.8cm, with mucoid content in its lumen; as well as mucin pools in more than 50% of the sample and signet ring cells in light microscopy, revealed the pathological diagnosis of mucinous adenocarcinoma. Therefore, the pathological analysis of surgical pieces is transcendental, since there are infrequent diagnoses that can change the prognosis and course of clinical management of a patient.

Ultrasonographic evaluation of cecal appendix diameter in pediatric population.

ABSTRACTObjective To stratify ultrasound samples in a pediatric population undergoing evaluation for acute appendicitis to examine the variability in cecal appendix diameter, in different age groups, and to determine whether there is a prevalent value for each age group.Methods A retrospective cross-sectional study with 196 children aged 0 to 15 years. Data were extracted from reports of ultrasound examinations carried out between 2008 and 2015. Children with sonographic diagnosis of appendicitis or other signs of periappendiceal inflammation were excluded.Results The evaluation of the anteroposterior measurement of the cecal appendix revealed a mean diameter of 4.14mm (standard deviation: 0.93mm; 95%CI: 3.86-4.14). Cecal appendix diameter did not differ significant between age groups.Conclusion Evaluation of the anteroposterior diameter of the cecal appendix in centimeters in a sample of 196 children aged 0 to15 years revealed a mean diameter of 4.14mm (standard deviation, 0.93mm. There were no significant differences in cecal appendix diameter following stratification by age. Results indicate a single value can be adopted for mean cecal appendix diameter in pediatric populations.

A review of the function and evolution of the cecal appendix.

Since its initial discovery in the 1500s, the cecal appendix has been an anatomical structure of great intrigue, notorious for its inconvenient tendency to become inflamed and often require surgical intervention. Appendicitis is one of the most common indications for emergency abdominal surgery, costing healthcare systems billions of dollars globally and causing tens of thousands of deaths annually. Yet, recent studies have indicated that the appendix may serve important protective functions in fortifying the body's immune response against invading pathogens and re-inoculating the gut with commensal bacteria after periods of gastrointestinal illness. While the cecal appendix was once believed to be a synapomorphy of hominoids (humans and other great apes), recent studies suggested that it is a recurrent trait found in several other species of primates, rodents, lagomorphs, marsupials, and monotremes. Mapping appendiceal and other gastrointestinal traits across a mammalian consensus phylogeny revealed that the cecal appendix has evolved independently numerous times throughout mammalian evolution, significantly more than would be expected due to chance alone, suggesting that the appendix is adaptively advantageous. However, attempts to identify an overarching ecological, behavioral, dietary, or environmental factor driving some species to evolve an appendix have been largely unsuccessful, indicating that the cecal appendix has a complex and diverse evolutionary history. This review discusses the current understanding of the pathophysiology, evolution, and possible functions of the appendix, both within humans and broadly across the class Mammalia.

Computed tomographic findings of the gastrointestinal tract in rabbits

Gastrointestinal (GI) diseases are common in rabbits. Although diagnostic imaging studies can assist clinicians in selecting therapeutic approaches, there are few reports of advanced imaging findings in normal rabbits. Computed tomography (CT) is recognized as a useful tool in dogs and cats, but there are few reports of normal findings on multidetector computed tomography (MDTC) in rabbits. The goals of this study are to describe the CT anatomic imaging appearance of the GI tract and their normal variation in healthy pet rabbits and to obtain the normal wall thickness measurements of normal GI tract structures. Twenty-three rabbits were scanned under general anesthesia and the CT abdominal images were analyzed by two experienced radiologists. Location and size of the major GI organs and structures were determined, and wall thickness of the stomach, small and large intestines were measured, including the interobserver agreement. Statistical analysis of quantitative and qualitative variables was performed. Wall thickness values were established for the different parts of the stomach (cardia: 3.4 ± 0.4mm; fundus: 1.4 ± 0.2mm; body: 1.4 ± 0.1mm; pylorus : 2.9 ± 0.5mm), small intestines (duodenum: 1.4 ± 0.1mm; jejunum : 1.2 ± 0.1mm; ileum: 1.4 ± 0.1mm), and large intestines (cecum: 1.2 ± 0.1mm; colon ascending: 1.4 ± 0.3 mm and descending: 1.3 ± 0.3mm). When distended the stomach did not extend beyond the caudal limits of the L2 vertebra . The cecum occupied the ventral abdominal region from T12/T13 to L7/S1, the sacculus rotundus was identified in 11 of the 23 rabbits. The sacculus rotundus and vermiform cecal appendix were identified only in rabbits with mild large intestinal distension. It was possible to use CT to evaluate the different portions of the GI tract that are not normally readily visible on radiographs and ultrasound (US). Normal wall thickness values of the different portion of the GI tract were stablished. These results provide new and important reference values for CT studies in normal pet rabbits and provide data for further studies in rabbits with GI diseases.

Non-hodgkin Lymphoma of Lymphoid Tissue Associated with Extranodal Mucosa of the Cecum and Acute Appendicitis. Report of a Case

Objective: Presentation of an acute appendicitis and non-Hodgkin lymphoma of lymphoid tissue associated with extranodal mucosa from the cecum clinical case. Introduction: The cecal appendix can be affected by Non-Hodgkin Lymphomas (NHL) by extension of the neoplasm; however primary appendicular lymphoproliferative processes are uncommon. The NHL of Mucosal-Associated Lymphoid Tissue (MALT) is exceptional. To establish the diagnosis of MALT, a morphological, molecular and immunohistochemical diagnosis is required, including molecular techniques that reflect B cell clones, PCR analysis or the identification of chromosomal abnormalities. Methods: 40 year old male, with 15 days of evolution of abdominal pain located in Right Lower Quadrant (RLQ) and associated symptoms like decreased appetite, nausea, and adynamia, who was firstly diagnosticated as an urinary tract infection treated as outpatient; upon his readmission, he was performed CT scan evidencing mesenteric panniculitis and thickening of the appendicular wall; he was surgically intervened finding edematous and congestive vermiform appendix with lower third perforation, and indurated cecum with 2 cm perforation from the appendicular base, performing right hemicolectomy with ileo-transverse mechanical anastomosis; he was discharged home 7 days after the postoperative period; the histopathological study and immunohistochemistry panel was compatible with MALT-type lymphoma, with lesion-free edges. Extension CT scans with no evidence of distant disease. He was sent to oncology for follow-up. Conclusion: It is important to get an established diagnosis in this rare pathology with molecular techniques and not only with histopathological cuts, since 30% of patients relapse.

Intrauterine cecal appendix due to uterine perforation: case report

Intrauterine cecal appendix due to uterine perforation: case report

Complex de Garengeot’s Hernia With a Bladder Diverticulum

De Garengeot’s hernia is a type of femoral hernia that also contains the appendix. It is a rare phenomenon and is diagnosed usually intraoperatively, during surgery aimed at reducing and repairing the symptomatic femoral hernia. In some cases the development of appendicitis can further complicate the clinical presentation. This paper presents a recent case of an incarcerated de Garengeot’s hernia containing both the cecal appendix and a voluminous bladder diverticulum. The purpose of this article is to highlight the importance of differential diagnosis in patients with a groin mass. The ability to correctly identify hernial content preoperatively can, in fact, modify the surgical approach taken and allow the operation to be performed more safely. There are currently no specific guidelines for its treatment, as there is no statistical evidence on the best management approaches and their outcomes. The authors of this paper present an ideal flow chart on how to deal with this particular type of hernia safely and effectively. J Curr Surg. 2021;11(4):97-100 doi: https://doi.org/10.14740/jcs451

Rabbit microbiota across the whole body revealed by 16S rRNA gene amplicon sequencing

BackgroundRabbit can produce meat, fur and leather, and serves as an important biomedical animal model. Understanding the microbial community of rabbits helps to raise rabbits healthily and better support their application as animal models.ResultsIn this study, we selected 4 healthy Belgium gray rabbits to collect the microbial samples from 12 body sites, including skin, lung, uterus, mouth, stomach, duodenum, ileum, jejunum, colon, cecum, cecal appendix and rectum. The microbiota across rabbit whole body was investigated via 16S rRNA gene amplicon sequencing. After quality control, 46 samples were retained, and 3,148 qualified ASVs were obtained, representing 23 phyla and 264 genera. Based on the weighted UniFrac distances, these samples were divided into the large intestine (Lin), stomach and small intestine (SSin), uterus (Uter), and skin, mouth and lung (SML) groups. The diversity of Lin microbiota was the highest, followed by those of the SSin, Uter and SML groups. In the whole body, Firmicutes (62.37%), Proteobacteria (13.44%) and Bacteroidota (11.84%) were the most predominant phyla. The relative abundance of Firmicutes in the intestinal tract was significantly higher than that in the non-intestinal site, while Proteobacteria was significantly higher in the non-intestinal site. Among the 264 genera, 35 were the core microbiota distributed in all body sites. Sixty-one genera were specific in the SML group, while 13, 8 and 1 were specifically found in the Lin, SSin and Uter groups, respectively. The Lin group had the most difference with other groups, there were average 72 differential genera between the Lin and other groups. The functional prediction analysis showed that microbial function within each group was similar, but there was a big difference between the intestinal tracts and the non-intestinal group. Notably, the function of microorganism in uterus and mouth were the most different from those in the gastrointestinal sites; rabbit’s coprophagy of consuming soft feces possibly resulted in little differences of microbial function between stomach and large intestinal sites.ConclusionOur findings improve the knowledge about rabbit microbial communities throughout whole body and give insights into the relationship of microbial communities among different body sites in health rabbits.