Diagnosis Of Chronic Appendicitis Research Articles

A Case of Incidental Chronic Appendicitis: Appendiceal Wall Thickening in an Asymptomatic Patient

Chronic appendicitis is caused by inflammation of the appendix for several weeks, and the patients have symptoms such as mild nausea, abdominal pain, and tenderness. Diagnosis of chronic appendicitis is difficult because the symptoms are mild and vague compared to the acute appendicitis. In radiologic examination, appendicitis usually appears dilatation with diffuse wall thickening of appendix. Surgical treatment of the appendix (appendectomy) could be recommended against complications such as acute appendicitis or perforation. We have incidentally experienced an unusual case of chronic appendicitis without symptoms, and report its radiologic findings and clinical manifestations. Key words: Appendix; Appendicitis; Asymptomatic diseases; Chronic disease; Appendectomy

Beyond acute inflammation: a review of appendicitis and infections of the appendix

Although the appendix is the most commonly resected and examined intra-abdominal organ, the pathogenesis and aetiology of acute non-specific appendicitis (the commonest diagnosis made in the appendix) remains enigmatic. This review encompasses the pathology and diagnosis of acute non-specific appendicitis, as well as controversial issues such as the diagnosis of chronic appendicitis, the implications of granulomatous appendicitis, and the significance of a morphologically unremarkable appendectomy specimen in the clinical context of appendicitis. The pathological features, pertinent diagnostic techniques, and clinical significance of several specific bacterial, viral, fungal, and parasitic infections affecting the appendix are presented, including adenovirus, cytomegalovirus, Yersinia species, Actinomyces, Mycobacteria species, Histoplasma, Enterobius vermicularis, schistosomiasis, and Stronyloides stercoralis.

Appendicitis and infections of the appendix

The pathologic spectrum of the acutely inflamed appendix encompasses a wide range of infectious and noninfectious entities. The appendix suffers alone in some of these disorders, and in others may be involved through extension from other areas of the gastrointestinal tract. Although the appendix is the most commonly resected and examined intraabdominal organ, the pathogenesis and etiology of acute nonspecific appendicitis (the most common diagnosis made in this organ) remains enigmatic. This review encompasses the pathology, pathogenesis, and bacteriology of acute appendicitis, as well as controversial issues such as the diagnosis of chronic appendicitis and the significance of a morphologically unremarkable appendectomy specimen in the clinical context of appendicitis. In addition, the pathologic features, pertinent diagnostic techniques, and clinical significance of several specific bacterial, viral, fungal, and parasitic infections affecting the appendix are presented, including adenovirus, cytomegalovirus, Yersinia species, actinomycosis, Mycobacteria species, histoplasmosis, pinworms, schistosomiasis, and Strongyloides stercoralis.

Epidermoid Cyst of Cecum

To the Editor:— Recently I have had the opportunity to observe the third reported case of epidermoid cyst in the cecum. Only two other references were found in the literature. 1,2 A 27-year-old woman had been complaining of intermittent pain in the right lower abdominal quadrant for one year. A diagnosis of chronic appendicitis was made and the patient was operated on, but the appendix was normal. The pain persisted. On x-ray examination a right ovarian cyst was diagnosed, and the patient was operated on for the second time; the right ovary was normal. However, the cecum was markedly enlarged; it was excised along with the appendix and the adjacent part of the ileum. The postoperative course was normal. Grossly, the surgical specimen (kept in the museum of the pathology department, No. 4025/1964/72,-847) consisted of the cecum with the appendix and the adjacent part of the ileum, the latter being

Associate Professors V. A. Bakhtiyarov and G. M. Kazakov (Sverdlovsk). Pathomorphology of chronic nonspecific mesenteric lymphadenitis in children

A detailed histological study (hematoxin-eosiin and Van Gieson staining) of mesenteric lymph nodes and vermiform processes was performed in 16 children (7 boys and 9 girls) suffering from chronic nonspecific mesenteric lymphadenitis and mistakenly operated on with a diagnosis of chronic appendicitis, since the children complained of cramping short-term abdominal pain, poor appetite, periodic constipation or diarrhea at normal temperature.

Neuromas da mucosa do apêndice

A general survay was made of the so-called neuromata of the appendix mucosa and the works of Masson, Maresch and Rossle were mainly focussed. The author accepts the hypothesis that the nervous hyperplasia that give rise to the so-called neuromata possibily results from inflamation stimuli but these structures are not amputation neuromata. Regarding the clinical meaning of such structures the author calls attention to the difficulty in stablishing the facts. The wrong conclusions come to a certain extent from a too short follow-up postoperative period but mainly from the unreliable informations of the patients whether conscious or, more commonly, subconsciously. The great cure percentages formerly reported after operations for chronic appendicitis were, in the past, highly exaggerated and, on such false basis, wrong conclusions were drawn regarding the value of the minor pathological findings of the appendicis. Even Masson may have been partially misled. Of course one may admit that, very exceptionally, these so-called neuromata of the mucosa may be so numerous and bulky as to cause stenosis of the appendix lumen and give rise to disease curable by appendectomy; but that is nothing compared to the enormous number of cases operated on for chronic appendicitis in whose appendicis there were neuromata, with or without active inflamation, but which did not obtain cure because a chronic typhlo-colitis and not amputation neuromata of the cut basis of the appendix was at the botton of the disease. The author reports 45 cases operated on by him with the diagnosis of chronic appendicitis. The histological sections of the appendicis were stained by the trichromic method of Masson and some by silver impregnation. In nine of the above mentioned appendicis there were found the so-called neuromata. One patient was cured, but, in his appendix there was also a focus infiltrated with leucocytes situated in the muscular coats and extending down to the submucosa, occupying an area of about one millimeter. Five of the patients were not relieved of their symptoms and they have now a chronic inespecific colitis which they probably had concommittantly with the appendicitis, from the begining, for two of them had obliterating appendicitis which the author regards as sugestive of chronic colitis when met with in young people. Since the symptomatology of chronic appendicitis is as a rule equal to that of chronic typhlitis (colitis) and since these two affections often coexist it is impossible in such cases to assign the roles played by the appendix lesions even when such organ is extirpated. Various types of these so-called neuromata described by Masson are illustrated

The Present Status of Appendiceal Diagnosis

The papers on appendiceal pathology, in 1886, and the reports of the first operation for the removal of the appendix, in 1887, had far-reaching effects. The spectacular results in a certain percentage of the cases led to operations for acute or chronic appendix for a wide range of abdominal symptomatology, either real or imagined. The inevitable reaction followed and the pendulum swung far back until operation for any except acute appendices was condemned. The diagnosis of chronic appendicitis was disputed by many surgeons. There must be a calm or a cyclone—no gentle breeze was tolerated. My work in diagnosis began at a time when, of patients entering the clinic in which I worked, nearly 50 per cent had previously had their appendices removed. At least one-half of these had received no admitted benefit from the operation. Routine X-ray examinations of 6-hour and immediate meal, 24-hour, 48-hour and enema, revealed few appendices outlining. Naturally we accepted the prevalent view and in those early years I remember only two diagnoses of appendicitis being made. Yet from time to time reports filtered back of patients who had suffered removal of ruptured appendices at later dates. Re-checking of our records revealed no sure criterion for a diagnosis. Upon seeking the opinions of others on this subject which was of tremendous interest to us, we found a wide variation of opinion among roentgenologists. I well remember a discussion in which I was interested to hear one roentgenologist maintain that all appendices which did not outline were pathologic and should come out. His opponent was equally certain that any appendix that did outline was pathologic and should come out. We decided that more work was necessary before the subject could be closed. Our efforts to obtain evidence redoubled. 110re careful and more frequent screenings of the emptying cecum revealed filling in the majority of appendices. Careful palpation discovered tenderness often appearing at a screening although it had been absent on previous exposure. In some cases this pain was referred to the region of the solar plexus and the patient compared it to digestive discomforts that had been complained of in his history. At about this time A. L. Gray, M.D., of Richmond, Virginia, reading in Washington, D. C., on “Cyclic Vomiting in Children,” traced the etiology to the appendix. He stated his belief that children showing an appendix with an emptying time of over 100 hours had a pathologic appendix. In cases in which the appendix was removed, the patients were relieved of the vomiting. Rejoicing that this work in children coincided with our studies of adults, we continued our investigation. In checking the literature we found a gradually increasing number of articles on this subject.

On the connection of the musculature of the vermiform process and the Bauginian flap

Recently, the curve of appendectomies, as can be seen from numerous statistics, has been steadily growing, and this massive operation is predominant in the work of some clinics (Burlakov31% of appendectomies out of all operations). Undoubtedly, such a huge percentage of appendectomies forces surgeons to critically analyze the material of their clinics. But what causes particular concern is the longterm results of appendectomies, which often compromise this operation, giving large percentages of relapses of the same painful symptoms that existed before the operation. The percentage of relapses from 3.9% in Rozanov according to other authors rises sharply (Horn 21%, Lick 40%, Rodzievsky 57.8%, Goffs 50%). Such huge fluctuations in the nature of the outcomes of diseases, the diagnosis of which, it would seem, should be well developed, are directly striking. Involuntarily, the question arises about the expediency of such a number of appendectomies and the closely related issue of diagnostic errors. It is necessary to make a reservation that we mean painful phenomena coming under the diagnosis of chronic appendicitis, and not acute, because with regard to the latter, diagnosis and indications for surgery are not particularly difficult, and therefore operations in acute cases of appendicitis give results that satisfy surgeons.

Medical aspects of chronic appendicitis

1. 1. The diagnosis of chronic appendicitis is based largely on roentgen-ray findings, although history and physical examinations are at times of value in diagnosis. 2. 2. The treatment is essentially medical, consisting of search for and eradication of infective foci and of proper dietetic and hygienic care. 3. 3. Surgical treatment is to be confined to the complications of chronic appendicitis, resulting in deformities of the appendix, cecum and ileum. 4. 4. Preoperative and postoperative care help to prevent disagreeable after-effects.

ACCESSORY LOBE OF LIVER ATTACHED ONLY TO THE GALLBLADDER

While recently exploring the abdomen of a young woman, with a clinical and a roentgen-ray diagnosis of chronic appendicitis with adhesions deforming the duodenum, which diagnosis was correct, I encountered a neat curiosity never previously noted in my work. Attached to the upper surface of a perfectly normal gallbladder was a miniature lobe of liver tissue, measuring about 1½ inches (3.7 cm.) transversely and about 1 inch (2.5 cm.) in the opposite direction. The center was about one-fourth inch (0.6 cm.) thick and was attached firmly to the gallbladder, while the edges were thin, well defined, and could be lifted a short distance from the surface of the gallbladder. This little accessory lobe had no connection whatever with the liver, being some distance away, and no connecting blood vessels were visible. As the gallbladder appeared perfectly normal and it seemed unwise to add any more raw surfaces to those already

A Few Remarks on the X-Ray in the Diagnosis of Chronic Appendicitis and Chronic Cholecystitis

A Few Remarks on the X-Ray in the Diagnosis of Chronic Appendicitis and Chronic Cholecystitis

A SIGN INDICATIVE OF CHRONIC APPENDICITIS

The condition I am about to describe has often been found, but I present it in order to induce other observers to assist in coming to some conclusion as to its value in the diagnosis of chronic appendicitis. Chronic concealed without active inflammation is difficult to diagnose. Ewald has well named this condition appendicitis larvata. Exploratory operation in these cases frequently reveals an obliterative appendicitis. In 1898 a patient consulted me for an obstinate hyperchlorhydria. She gave a history of repeated attacks of appendicitis. On examination I found that a continuous firm pressure with the ends of the first three fingers over McBurney's point induced a referred distress or pain in the epigastrium or precordial region. Later on the patient had a recurrent attack of acute which necessitated immediate operation. The appendix was found to have sloughed off and the wound was simply packed. The patient made a