Incidental Appendectomy Research Articles

Persistence of the omphalomesenteric duct in adults: Case report and literature review

Introduction: Multiple pathologies can affect the umbilical cord, either due to infectious causes or malformation causes (acquired or congenital). However, the persistence of the omphalomesenteric duct and the urachus are the most frequent congenital malformations, especially in the pediatric setting, but not in the case of adults. Case report: The case of a 68-year-old male patient from a rural area, a farmer, with an enterocutaneous fistula, who received surgical treatment, is presented. He went to the consultation due to yellowish fluid leaking from the umbilical region, pain, and erythema, with a history of prostatectomy, osteoarthritis, and arterial hypertension. He was admitted with a diagnostic impression of cellulitis vs wall abscess. According to the assessment by the surgical team, a clear discharge of intestinal fluid was observed through the navel, for which reason emergency surgical resolution was decided for exploratory laparotomy. The patient reports discharge of yellowish fluid from the navel since childhood; there is a high suspicion of a picture compatible with the persistence of the omphalomesenteric duct in the adult. The patient underwent surgery with the following finding: A fully patent omphalomesenteric duct (enteroumbilical fistula) was found 70 cm from the ileocecal valve, plus incidental appendectomy. He was discharged on the eighth day of hospitalization, with a favorable evolution, outpatient treatment, and outpatient control. In addition, a bibliographical review in scientific databases such as Pubmed, Scopus, Proquest, Lilacs, Scielo, and Google Academic. Conclusions: surgical treatment with a favorable evolution, outpatient treatment, and outpatient control

Complicated incidental appendectomy in a patient with inflammatory bowel disease: Case report

Inflammatory bowel disease (IBD) is an immune-mediated disorder of the gastrointestinal tract, encompassing chronic conditions resulting in inflammation in the region. Its prototypical forms, Crohn's Disease (CD) and Ulcerative Retocolitis (UC), are influenced by genetic-environmental interactions, and their incidence has shown an increase due to the westernization of dietary patterns, registering around 7 million cases in 2017. Both CD and RU are characterized by chronic inflammation, and CD can affect any part of the gastrointestinal tract, from the mouth to the anus, with intermittent inflammation prone to complications such as stenosis and fistulas. RU, on the other hand, predominantly affects the colon and rectum, exhibiting continuous inflammation that can culminate in ulcers and bleeding.

Pilonidal Sinus at The Appendectomy Incision

Pilonidal sinus is a disease that progresses with inflammation due to hairs that penetrate the epidermis layer of the skin. This case report presented the diagnosis and treatment process of the incisional pilonidal sinus case, which occurred at an appendectomy incision. A 47-year-old male patient was admitted with purulent discharge and erythema for about three days in the appendectomy incision. The patient underwent appendectomy with a right paramedian incision approximately eight years ago, and recurrent abscesses developed in the incision scar in the postoperative period. The skin and subcutaneous tissues, including the abscess sac, were surgically excised. In the excision material taken from the patient, there was an intense inflammatory reaction with hair covering the entire dermis and erosion and ulceration of the epidermis.

Incidental appendicectomy in pancreas transplantation: A single-center study.

Appendicitis in pancreatic transplant recipients can be challenging to diagnose and manage. Incidental appendicectomy (IA) during pancreas transplantation obviates the risk of appendicitis but potentially at the cost of increased operating time or early post-operative complications. This study reviewed the value of IA at a single center. This was a retrospective study of patients who underwent a pancreas transplant in our unit from January 1st, 2012 to December 31st, 2020, with end of follow-up on May 21st, 2023; recipients were grouped by whether or not an IA was performed during pancreas transplantation. Donor, recipient, operative, and graft outcomes were compared between the two groups. Post-transplant complications related to appendiceal pathology (or IA) were recorded and classified. Two hundred forty-three patients underwent a pancreas transplant; 227 (93%) patients had an appendix in situ at transplantation, and of these 53 (23%) underwent an IA and 174 (77%) did not. There were no statistically significant differences in operative time (p=.06) or hospital stay (p=.50) between the two groups. In the IA cohort, there were no Clavien-Dindo Grade III-V complications relating to the appendicectomy. In those that did not undergo an IA, two patients (1%) subsequently required appendicectomy due to appendicitis. Comparison of pancreatic graft survival showed no statistically significant difference between the groups (p=.44). This study suggests that IA is effective at reducing risks of post-transplant appendiceal complications without significantly prolonging inpatient stay or impairing graft survival. These data support the consideration of undertaking an IA for all patients undergoing a pancreas transplant.

Incidental Appendectomy-current Management: A Narrative Review

Incidental appendectomy has always been a matter of debate as to whether it should be performed or not. The morbidity and mortality of the procedure is low, and it allows histological examination to detect any abnormal pathology. The introduction of laparoscopic surgery has also made surgeons question if incidental appendectomy should be performed or not. We have conducted this narrative review article to look at the current indications, patients’ demographics, and types of surgery that incidental appendectomy is performed on.

Oncological aspect of incidental appendectomy with regard to histopathological findings: A retrospective cohort study

IntroductionThe aim of this retrospective cohort study was to describe the findings on histopathological examination of removed, macroscopically non-diseased, vermicular appendix during another primary surgical procedure (incidental appendectomy (IA)). Previous studies disapproved IA but were based on the possibility of complicated appendicitis. We observed the prevalence of neoplasms of the appendix in IA versus the appendectomy performed due to acute appendicitis (AA). MethodsThe database of histopathology reports of the Surgery Department, University Hospital of Split was reviewed in the period from January 1, 2017, to December 31, 2021. A total of 2832 histopathology reports were reviewed. ResultsThere was no difference in gender distribution between these two groups, but AA had a statistically significantly lower median patient age compared to the group IA (40 vs. 68 years; P < 0.001). In the AA group, there were 84.5% acute appendicitis, 11.1% normal appendiceal reports, 3.2% appendiceal neoplasms, and 1.2% other pathologies. The group IA had 89.5% normal findings of the appendix, 7.2% appendiceal neoplasms, and 0.5% other pathology. The difference in neoplasm prevalence between IA and AA groups was 4.0% (95%CI: 2.2 to 5.8), P < 0.001. The number of incidental appendectomies needed to detect one neoplasm of the appendix is 25. ConclusionIncidental appendectomies in patients undergoing abdominal surgery revealed a relatively high prevalence of appendiceal neoplasms above the age of 60 years. Prospective studies about incidental appendectomies, their clinical consequences, and impact on prognosis should be performed to define the value of incidental appendectomy in those patients.

Outcomes of Incidental Appendectomy During Ovarian Operations in a National Pediatric Cohort

IntroductionThe utility of incidental appendectomy (IA) during many ovarian operations has not been evaluated in the pediatric population. This study sought to compare outcomes after ovarian surgery with IA in the pediatric population. MethodsFemales (≤20 y old) undergoing ovarian surgeries (oophorectomy, detorsion and/or drainage) were identified from the Nationwide Readmissions Database (2016-2018). Those with appendicitis were excluded. A propensity score-matched analysis (PSMA) with 46 covariates (demographics, comorbidities, hospitalization factors, etc.) was performed between those receiving ovarian surgery with or without IA. ResultsThere were 13,202 females (median age 17 [IQR 14-20] y old) who underwent oophorectomy (90%), detorsion (26%), and/or ovarian drainage (13%). There were more episodes of torsion in the PSMA cohort receiving ovarian surgery alone (17% versus 10% IA; P = 0.016), while other indications (ovarian mass, cyst) were similar. Open (66% versus 34% laparoscopic) IAs were more frequent. Length of stay (LOS) was longer for those undergoing IA (3 [2-4] versus 2 [2-4] days ovarian surgery alone; P < 0.001). There was a higher rate of postoperative GI complications in the IA cohort. Subgroup analysis of those undergoing laparoscopic operations demonstrated no difference in LOS or postoperative complications between patients undergoing IA or not. ConclusionsThese data indicate that IA in pediatric ovarian operations is associated with longer LOS and higher GI postoperative complications. However, laparoscopic IA was not associated with higher cost, complications, LOS, or readmissions. This suggests that IA performed during ovarian surgeries in select patients may be cost-effective and worthy of future study.

Amyand's Hernia: Appendix in Hernia or Hernial Appendicitis?

The presence of an appendix in the inguinal hernia sac is defined as Amyand's hernia (AH). This study intends to present the authors' experience in dealing with this entity and also to present a discussion on possible need of updating its definition, classification, and management. A retrospective analysis of records of all pediatric patients undergoing surgery for congenital inguinal hernia in a single unit from January 2017 to March 2021 was done. Patient's demographics, clinical presentation, preoperative investigations, peroperative findings, and postoperative outcomes were recorded and analyzed. AH was found in eight patients. All were boys. The median age of presentation was 20.5 months (range 2 months to 36 months). The mean duration of symptoms was 2 days (range 2 to 4 days). All patients presented with incarcerated inguinoscrotal swelling (right sided = 5, left sided = 3); associated with pain. An abdominal radiograph and ultrasonography were done for all. All patients underwent emergency surgery. Exploration was done for all through an inguinal incision. The appendix was found inflamed for two patients, and appendectomy was done for the same. None of the patients underwent incidental appendectomy. Wound infection, secondary appendicitis, and recurrence were not seen for any of the patients. The authors have also proposed a revised definition and classification of AH. AH is an interesting entity and many questions like the need for incidental appendectomy remain unanswered. An updating of the definition and classification system can probably offer some solution in this regard. However, more research is warranted in this regard.

Volvulus of the Small Intestine in adults with intestinal malrotation: case report

Introduction: The volvulus of the small intestine with intestinal malrotation is a rare disease when occuring in adults, though, a surgeon’s ignorance of this diagnosis can result in potentially fatal extensive small intestinal necrosis. Presentation of case: Here, we present the case of a 57years old woman admitted and operated for a volvulus of the small intestine with intestinal malrotation after radiographic and pre-operative confirmation, whom follow up was unmarked. Discussion: The usual mechanism of obstruction in the volvulus of the small intestine with intestinal malrotation is adhesive compression of the duodenum and volvulus of the small intestine, this condition is the result of an arrest in the normal counterclockwise rotation of the cecum from the left lower quadrant to the right upper quadrant. Pre-operative diagnosis not always an easy task but the abdominal CT-scan is with a great help mainly by identifying the "WHIRL-WIND" sign. The Ladd procedure, consisting of division of Ladd’s bands, widening of the mesentery, and incidental appendectomy, is considered the worldwide standard up til now. Conclusion: This condition is rare and can be diagnosed mainly by CT-scan, however,the surgical management worldwide standard is the Ladd's procedure which can be led by laparotomy or laparoscopy and results in great outcome.

7905 Incidental Laparoscopic Appendectomy for Women with Chronic Pelvic Pain and Endometriosis

<h3>Study Objective</h3> Pathologic evaluation of otherwise normal appearing appendices identifies abnormalities in a significant percentage of cases. This includes a significant minority of patients with preoperatively undiagnosed appendiceal endometriosis which can lead to morbidity if left untreated. The objective of this video is to review the safety and rationale for incidental appendectomy as it applies to gynecologic patients, and to show a safe and efficient method of laparoscopic appendectomy utilizing suture endoloop. <h3>Design</h3> NA. <h3>Setting</h3> NA. <h3>Patients or Participants</h3> Patients already undergoing laparoscopic gynecologic surgery for known pathology or chronic pelvic pain are good candidates for incidental appendectomy. <h3>Interventions</h3> NA. <h3>Measurements and Main Results</h3> NA. <h3>Conclusion</h3> Incidental appendectomy is a safe, straightforward procedure that should be offered to patients undergoing gynecologic surgery, especially those with concurrent chronic pelvic pain and endometriosis.

Nationwide Outcomes of Incidental Appendectomy During Cholecystectomy vs Cholecystectomy Alone in Children: A Propensity Score–Matched Analysis

INTRODUCTION: The utility of incidental appendectomy (IA) or prophylactic appendectomy in the absence of appendicitis has been studied for many concomitant procedures. However, IA during cholecystectomy has not been evaluated in the pediatric population or using a propensity score–matched analysis (PSMA). This study sought to compare nationwide outcomes after cholecystectomy with IA in children. METHODS: Patients ≤18 years old who underwent cholecystectomy from 2010- to 2014 were identified from the Nationwide Readmissions Database. Characteristics were compared using standard statistical tests. PSMA with >30 covariates including demographics, comorbidities, postoperative complications, and hospitalization factors was performed between those receiving cholecystectomy (CCY) alone vs CCY with IA. RESULTS: A total of 34,390 patients underwent cholecystectomy during the study period with a median age of 15 (interquartile range 13 to 17) years old. Laparoscopic (92%) and open (6%) cholecystectomies were performed most frequently, with 2% requiring conversion to an open approach. PSMA demonstrated a longer length of stay and higher index admission cost in those receiving CCY alone, while all admission complications including wound infection rates were not significantly different (Table 1). No significant differences in readmissions within 30 (9% CCY vs 8% CCY with IA) or 365 days (4% CCY vs <2% CCY with IA) were detected. Those undergoing CCY alone had higher overall readmission costs ($11,783 [$4,942 to $39,836] vs $6,100 [$2,358 to $19,719] CCY with IA; p = 0.010). Table 1. - Propensity Score–Matched Analysis of Cholecystectomy vs Cholecystectomy with Incidental Appendectomy Characteristic Cholecystectomy n = 405 (50%) Cholecystectomy with incidental appendectomy n = 405 (50%) p Value Length of stay (median days [interquartile range]) 4 [2–9] 3 [2–5] <0.001 Index admission cost (median $USD [interquartile range]) $13,438 [$8,047–$23,100] $8,403 [$6,437–$12,727] <0.001 Complication Wound infection <1% <1% 1.00 Wound disruption <1% <1% 1.00 Sepsis/bacteremia <1% <1% 1.00 Pneumonia <2% <1% 0.546 Other infections <3% <2% 0.625 Nausea, vomiting, and diarrhea 6% 9% 0.085 CONCLUSION: This nationwide PSMA indicates that IA in pediatric cholecystectomies is not associated with higher postoperative complications, cost, or readmissions. This suggests that IA performed during cholecystectomy is safe, cost-effective, and worthy of future study.

A retrospective study about incidental appendectomy during the laparoscopic treatment of intussusception.

PurposeWe aim to see incidental appendectomy (IA) was worth or not during the laparoscopic treatment of intussusception.MethodsThis study included forty-eight patients who underwent a laparoscopic procedure for idiopathic intussusception without intestinal resection between April 2014 and April 2021. The Chi-square or Fisher's exact tests for categorical variables and the Student t-test for continuous variables were used to analyze and compare patient characteristics.ResultsIA was performed on 63% (30/48) of patients after surgical reduction, while 18 (37%), did not. Patients who underwent IA had a higher total cost (16,618 ± 2,174 vs.14,301 ± 5,206, P = 0.036), and a longer mean operation duration (59 ± 19 vs.45 ± 21, P = 0.025). The distribution of the PO time, length of hospital stay, PCs, and RI did not differ significantly. The histopathological evaluation of the 30 resected appendices revealed five (17%) with signs of acute inflammation, 20 (66%) with chronic signs of inflammation, and five (17%) with inconspicuous appendices.ConclusionIA is linked to a longer average operation time and a higher total cost. There is insufficient evidence to recommend IA during laparoscopic intussusception treatment. The risks and benefits of IA need further study.

SP9.1.5 Occult appendix pathology in patients undergoing colorectal cancer resection suggests a role for appendectomy at left colon or rectal cancer resection

Abstract Aims There is epidemiological evidence suggesting that the incidence of appendicular neoplasms is increasing. The purpose of this study is to assess the incidence of appendix neoplasms in patients undergoing colorectal cancer resection in a unit where standard of care is appendectomy, with consent, when left colon or rectal cancer resection is performed. Methods This is a retrospective single-centre study on a prospectively collected data base of 718 consecutive patients undergoing colorectal cancer resection between January 2015 and June 2021. The primary outcome was the proportion of histologically abnormal appendix specimens at incidental appendectomy. Secondary outcome was complications from incidental appendectomy. Results Overall, 222/718(31%) patients had previous appendectomy. The remaining 496 comprised 169/496 (34%) who had a right-/extended-right hemicolectomy or sub-total colectomy which incorporates appendectomy, and 327/496(66%) who had left-sided resection (left-hemicolectomy, anterior resection or abdomino-perineal excision) with incidental appendectomy. At definitive histology, 454(92%) had a normal appendix, 13(2.6%) had inflammatory appendix pathology, 17(3.4%) had a hyperplastic/serrated polyp and 12(2.4%) had an appendix neoplasm, which included 5 carcinoids and 7 low-grade appendiceal mucinous neoplasms (LAMN). In the 327 patients who had incidental appendectomy, 7(2.1%) had a neoplasm (4 carcinoid and 3 LAMN). There were no complications attributable to appendectomy. Conclusion Patients undergoing left sided colorectal cancer surgery with an appendix in situ should be counselled on the benefits of co-incidental appendectomy to treat the small proportion with synchronous neoplasms and inflammation and eradicate the risk of metachronous appendicitis or a subsequent appendix tumour.

Nationwide outcomes of incidental appendectomy during cholecystectomy versus cholecystectomy alone in children: a propensity score-matched analysis.

The utility of incidental appendectomy, appendectomy during another index surgery in the absence of appendicitis, has not been evaluated in the pediatric population during cholecystectomy. This study sought to compare nationwide outcomes after cholecystectomy with incidental appendectomy in children. Patients ≤ 18years old who underwent cholecystectomy from 2010-2014 were identified from the Nationwide Readmissions Database. A propensity score-matched analysis (PSMA) with > 40 covariates including demographics, comorbidities, and hospitalization factors was performed between those receiving cholecystectomy alone versus incidental appendectomy at the time of cholecystectomy. 34,390 patients underwent cholecystectomy (median age 15 [13-17] years). Laparoscopic (92%) approach was utilized most frequently, with 2% requiring conversion to open cholecystectomy. PSMA demonstrated a higher frequency of perforation or laceration of adjacent organs occurring in those receiving cholecystectomy alone during index admission. No significant differences in readmissions within 30days or the calendar year were detected. Those undergoing cholecystectomy alone had higher overall readmission costs ($11,783 [$4942-$39,836] vs. $6,100 [$2358-$19,719] cholecystectomy with appendectomy; p = 0.010). This nationwide PSMA indicates that incidental appendectomy in pediatric cholecystectomies is not associated with higher postoperative complications, cost, or readmissions. This suggests that incidental appendectomy during cholecystectomy is safe, cost-effective, and worthy of future study. Level III.

O046 Incidental appendicectomy in pancreas transplantation: a single-centre study

Abstract Introduction Pancreas transplantation is associated with a significant rate of surgical complications, some of which have similar clinical features to acute appendicitis. An incidental appendicectomy (IA) at the time of pancreas transplantation could reduce future diagnostic uncertainty. This study aimed to establish the number of IA undertaken during pancreas transplantation in our unit and examine outcomes. Of those patients that did not undergo an IA, we identified those that subsequently required intervention for their appendix. Methods A database of patients who underwent a pancreas transplant in our unit from 01/01/2012 to 10/12/2020 was obtained and patients were followed up until 01/03/2021. Electronic records were examined. Standard statistical analyses were undertaken and death-censored graft survivals were compared using the log-rank test. Results 243 patients underwent a pancreas transplant. Of the 227 (93%) patients that had not previously had an appendicectomy, 53 (23%) underwent an IA during transplantation. There were no complications and 2 carcinoid tumours were identified. Of the 174 (77%) patients that did not undergo an IA, 3 (2%) patients required subsequent intervention for the appendix. There was no statistically significant difference in operative time (p=0.06), index inpatient length of stay (p=0.50), ICU stay (p=0.80), pancreatic graft survival (p=0.50), or kidney graft survival (p=0.70) between patients who had an IA and those who did not. Conclusion IA during pancreas transplantation appears to be safe, and does not significantly prolong pancreas transplantation or adversely affect other outcomes. Surgeons should consider whether incidental appendicectomy should become standard practice. Take-home message Appendiceal complications after pancreas transplantation can be challenging and surgeons should consider whether incidental appendicectomy should become standard practice.

TEKNIK RELAKSASI GENGGAM JARI TERHADAP INTENSITAS NYERI PADA PASIEN POST APPENDIKTOMI

&#x0D; Pain is a condition more than a single sensation caused by a certain stimulus. One of the non-pharmacological erections in handling pain is a hand-held relaxation technique. Finger hand-held real-time techniques can reduce physical and emotional strain that will relax the body. This study aims to examine the effect of finger hand relaxation technique on the intensity of pain in post appendectomy patients. This research uses Quasy Experiment design with One Group Pre-test Post- Stestdesign. The total population of this study were all patients of post appendectomy in Achmad Mochtar Hospital. Sampling technique using purposive sampling technique. This study was conducted on February 17 until 1 May 2017 in the hospital surgery room Achmad Mochtar Bukittinggi. Data were analyzed by using Paired T-Test with significant value α = 0,005. The results showed that the average before hand-held finger relaxation technique was 4.80 and the mean result after hand-held relaxation technique was 3.87. Bivariate results obtained p value 0,000. So it shows there are differences in pain intensity before and after hand-held relaxation techniques in patients post appendectomy. From the results of the above research can be concluded that the implementation of handheld relaxation techniques affect the reduction of post incision appendectomy incision.&#x0D;

Should We Perform Incidental Appendectomy in Trauma Patients Undergoing Laparotomy?

Incidental appendectomy (IA) is sometimes performed in patients undergoing abdominal operations to prevent subsequent development of appendicitis. Patients who undergo laparotomy for major abdominal trauma are at high risk of developing dense adhesions, increasing the risk of future operations. Therefore, there is a potential benefit to IA for patients undergoing trauma laparotomy. We performed a retrospective review of patients who underwent IA during laparotomy for abdominal trauma at a Level 1 trauma center between January 2010, and June 2020. Twenty-three patients underwent IA; they tended to be young (33.7 ± 18.9years) and male (87%) with 12 penetrating and 11 blunt injuries. Regarding indications, 13 had no documented intra-operative abnormalities of the appendix, 6 patients had a fecalith, and 3 had trauma to the appendix. One patient's appendix was adhered to the peritoneum and one patient had unusual anatomic location. Only one patient developed an appendiceal stump leak after IA.

A study of incidental appendectomy during diagnostic laparoscopy performed to evaluate the causes of lower abdominal pain

Background: Diagnostic laparoscopy is a minimally invasive method for the diagnosis of intra-abdominal diseases by direct inspection of intra-abdominal organs whenever there is a diagnostic dilemma even after routine diagnostic workup. Incidental appendectomy is defined as the removal of a clinically normal appendix during non-appendiceal surgery. The study is performed to evaluate the causes of lower abdominal pain during diagnostic laparoscopy and to determine the benefits of incidental appendectomy.Methods: This study, performed at the department of surgery, B. J. medical college, Ahmedabad from May 2012 to October 2014 is a prospective study. Incidental appendectomy was performed during diagnostic laparoscopy in 30 patients with abdominal pain. Criteria such as symptomatology, aetiology of pain as found on laparoscopy, post-operative pain relief and complications were analysed.Results: Nearly two third of the patients who presented with intractable lower abdominal pain were females. Mesenteric lymphadenopathy was the commonest per-operative finding affecting half of the patients, followed by adhesions present in about one quarter of the patients. Gynaecological conditions represented about one third of the cases. All, except one patient, had satisfactory pain relief and no complications of incidental appendectomy over a one year follow up.Conclusions: We conclude that diagnostic laparoscopy is a very good and accurate tool to diagnose the causes of abdominal pain and should be routinely used where radiological investigations are inconclusive. Incidental appendectomy indeed has many advantages when performed in an appropriate age group and proper setting.

Incidental appendectomy in surgical treatment of ileocolic intussusception in children. Is it safe to perform?

Surgical treatment of ileo-colic intussusception (ICI) has been reported as the second cause of emergency laparotomy in children. The performance of incidental appendectomy after surgical reduction is currently controversial. The aim is to analyse the outcomes of performing incidental appendectomy after surgical ICI reduction with or without associated bowel resection. A retrospective study was performed in patients with ICI episodes, who underwent surgical treatment in our institution between 2005-2019. Patients were divided in two groups according to the performance of associated appendectomy (AA group) or not (NA group). Subsequently, a stratified analysis was performed according to the need for bowel resection in both groups. Demographic variables, intraoperative findings, surgical time, hospital stay, postoperative complications and recurrences were analysed. A total of 101 patients (77 AA group; 24 NA group) were included, without differences in demographics or intraoperative findings. A total of 36 bowel resections were performed (24 group AA; 10 group NA), with no differences in surgical time (55.7 min in group AA vs. 61.2min in group NA; p=0.587) or hospital stay (median 5 days in both groups). There were also no differences in postoperative complications or recurrences between the two groups. Stratified analysis showed that bowel resection increases operative time, hospital stay and postoperative complications, regardless of whether associated appendectomy was performed or not. Incidental appendectomy during surgical treatment of ICI in children is a safe procedure that does not increase operative time, hospital stay, postoperative complications or recurrence.

Perforation of Meckel's diverticulum by a fishbone

Meckel's diverticulum is the most common congenital defect of the gastrointestinal tract. It is most often silent or asymptomatic. However, acute abdominal signs of obstruction, inflammation, hemorrhage and perforation are possible in other cases. Different foreign bodies can cause perforation of Meckel's diverticulum. We present an 18-year-old male who presented to the emergency department with abdominal pain within 48 previous hours. After evaluation, acute appendicitis was diagnosed and he underwent laparoscopic appendectomy. Meckel's diverticulum perforated by a fish bone was intraoperatively discovered. Incidental appendectomy and segmental resection of the ileum were performed.