Inflamed Appendix Research Articles

Subhepatic appendicitis in a 27-year-old male: a case report from Odahulle General Hospital of Ethiopia

The appendix is a small, tube-shaped organ that connects to the cecum, the beginning of the large intestine. Though its role is unknown, it can become infected, resulting in acute appendicitis, which, if not detected and treated early, can lead to serious consequences. Though the symptoms and signs of acute appendicitis are straightforward in most cases, atypical locations might result in unexpected presentations, which can lead to complications as it might not be detected and treated early. This case report describes a 27-year-old Black Ethiopian male patient who presented with right upper abdominal pain, low-grade fever, palpitations, and diarrhea. He also had some episodes of vomiting of ingested matter. Upon physical examination, the patient appeared acutely sick with some degree of tachycardia. An abdominal examination revealed right upper abdominal quadrant tenderness, though there was no palpable mass noted. Laboratory investigations were unremarkable apart from the stool examinations which revealed many pus and red blood cells and was full of actively motile bacteria. An abdominal ultrasound showed an enlarged subhepatic appendix with an internal fecalith 1 cm in depth, that was partially compressible, with no obvious peri appendiceal free fluid or other pathology. An assessment of subhepatic acute appendicitis was suspected and an emergency operation was conducted which revealed an inflamed subhepatic appendix that was on the verge of rupture. At a subsequent follow-up, the patient had significantly improved as evidenced by the lack of symptoms including abdominal pain, fever, and palpitation. Subhepatic appendix is a rare condition caused by either the non-descent of the cecum or intestinal malrotation during early development. As its presentation is not classical and hence mimics other pathologies, the diagnosis may be overlooked, resulting in perforation and abscess formation and leading to increased morbidity and possibly mortality. A high level of suspicion is required for early diagnosis and treatment to improve patient outcomes.

Frequency and Association of Perforated Appendix with Patient’s Characteristics in Acute Appendicitis

Objective: To determine the frequency of perforated acute appendicitis in patients with acute appendicitis and its association with patients clinic demographic characteristics. Study design and setting: This cross sectional study was conducted in general surgery unit from 1st January 2022 to 31st December 2022. Methodology: 171 patients were included. Patients who were provisionally diagnosed as acute appendicitis were included in the study. Sampling technique was nonprobability consecutive sampling. Statistical analysis was done through SPSS Version 23. Results: The study included 171 patients, with 58.5% male and 41.5% female. The majority of patients were aged between 25-35 years and had a normal weight. Grossly inflamed appendix was the most common finding (69.6%), followed by perforated appendix (19.3%), normal appendix (8.2%), and gangrenous appendicitis (2.9%). There was no statistically significant difference between gender and intraoperative findings. Age categories and duration of symptoms were significantly associated with intraoperative findings. Conclusion: In conclusion, 19.3% of patients with acute appendicitis presented with perforation. Age and duration of symptoms were found to be significantly associated with intraoperative findings, highlighting the importance of early diagnosis and timely surgical intervention

A Case Series of Appendicitis and Pseudo-appendicitis in a Paediatric Intensive Care Unit.

Appendicitis is a common childhood condition that can be diagnostically challenging. Severe cases may necessitate support in the critical or intensive care unit. These "critical appendicitis diagnoses" have rarely been described. We retrospectively reviewed the Paediatric Intensive Care Unit (PICU) database of the Hong Kong Children's Hospital and identified cases of suspected and confirmed appendicitis. Clinical features, radiologic findings and final diagnosis of each case were summarized and reported in this case series. We review six anonymized cases of appendicitis managed in a PICU to illustrate the different age spectrum and clinical manifestations of the condition. Rupture of the inflamed appendix, peritonitis and pancreatitis were some of the complications encountered. Crohn's disease was found in one case as an underlying diagnosis. Also, one girl clinically diagnosed with appendicitis was found to be a case of ruptured hepatoblastoma with no appendicitis (i.e., pseudoappendicitis). Prompt diagnosis, surgical removal of the inflamed appendix, and use of appropriate antimicrobials when indicated are essential in reducing mortality and morbidity associated with severe appendicitis. Significant premorbid conditions such as acute myeloid leukemia, Mitochondrial Encephalopathy Lactic Acidosis Syndrome (MELAS), inflammatory bowel disease and complications may be present in patients needing intensive care as is illustrated in the present cases. Pseudoappendicitis is an important differential diagnosis. Imaging is crucial and useful in establishing and confirming the diagnosis of appendicitis and pseudo-appendicitis in these PICU cases.

The risk of preterm delivery after appendectomy during pregnancy is higher in the face of a negative appendectomy

BackgroundReported outcomes after appendectomy during pregnancy remain inconclusive, and the risk for preterm delivery is not necessarily procedure-related. MethodsThis retrospective cohort study included 185 pregnant women who underwent appendectomy during pregnancy and gave birth between 2005 and 2022, compared using a 3:1 ratio to 555 parturients who did not undergo surgery. clinical, obstetrical and neonatal outcomes were analyzed. ResultsLaparoscopic appendectomy was the most common procedure (117/185; 63.2 ​%) whereas 68/185 (36.8 ​%) had open appendectomy. Pathological findings revealed that 141/185 cases (76.2 ​%) had an inflamed appendix, while 44/185 (23.8 ​%) were classified as having a “white appendix” (negative appendectomy).Preterm delivery occurred more frequently in the appendectomy group [22/185 (11.9 ​%) vs 30/555 (5.4 ​%), p ​= ​0.003] with even higher incidence in negative appendectomies compared to inflamed appendix cases [9/44 (20.5 ​%) vs 13/141 (9.2 ​%), p ​= ​0.044]. Multivariate analysis identified appendectomy (but not an inflamed appendix) as the sole significant risk factor for preterm birth (odds ratio 2.3, CI 1.26–4.15, p ​= ​0.006). ConclusionPreterm delivery correlates with negative appendectomies. Careful assessment is essential to avoid unnecessary surgical interventions during pregnancy.

Laparoscopic management of necrotizing granulomatous appendicitis: a diagnostic challenge

We present a case report of necrotizing granulomatous appendicitis, a rare condition that poses significant diagnostic challenges due to its atypical presentation, often mimicking more common conditions like acute appendicitis or inflammatory bowel disease. A 29-year-old female was admitted with a one-month history of abdominal pain, diarrhea, vomiting, and recent urinary symptoms. Laboratory tests revealed leukocytosis, elevated C-reactive protein, and anemia. A CT scan indicated an inflamed appendix, prompting a laparoscopic appendectomy. Intraoperatively, findings raised the suspicion of inflammatory bowel disease; however, histopathological analysis confirmed necrotizing granulomatous appendicitis. Further microbiological testing excluded bacterial and fungal infections, while the IGRA test was positive for tuberculosis. This case emphasizes the dual role of laparoscopic surgery in both diagnosing and treating necrotizing granulomatous appendicitis. It highlights the importance of considering rare etiologies, such as tuberculosis, especially in patients presenting with atypical symptoms. Early recognition and appropriate management are crucial for improving patient outcomes.

Mechanical Properties of Inflamed Appendix Tissues.

Background/Objectives: Histopathological examination enables visualization of morphological changes in cells and tissues. In recent years, there has been increasing interest in assessing the mechanical properties of tissues that cannot be determined by standard histopathological examinations. Mechanobiology is crucial in human physiology and holds promise for uncovering new diagnostic markers for disease processes such as carcinogenesis and inflammation. In this study, we concentrated on measuring the mechanical properties of appendix biopsy specimens to identify potential mechanomarkers of inflammation. Appendix tissues provided the opportunity to measure mechanical properties both with an atomic force microscope and a shear rheometer. Methods: The atomic force microscope AFM-NanoWizard 4 BioScience JPK/Bruker was used for the evaluation of the elastic modulus (i.e., Young's modulus) of appendix tissues. Young's modulus was derived from the Hertz-Sneddon model applied to force-indentation curves. The rheological properties of macroscopic samples were measured on a parallel-plate, strain-controlled shear rheometer Anton Paar MCR302. Results: The data collected suggest that elasticity, expressed as Young's modulus and the storage modulus, could be considered a marker indicating appendix tissue inflammation. Young's modulus of inflamed appendix tissues was found to be significantly lower than that of healthy ones, with an average reduction of 67%. Furthermore, it was observed that inflamed appendix tissues, in comparison to healthy ones, respond differently under varying axial and shear stresses, enabling their identification. Conclusions: Our findings suggest that the specific mechanical properties of inflamed vermiform appendices could serve as novel mechanomarkers for the early detection and monitoring of appendicitis.

072. Subhepatic Appendicitis in A 23 Year Old Woman: A Rare Case Report

Background: Subhepatic appendicitis is a rare condition that occurs in only 0.01% of all acute appendicitis cases. The subhepatic position of the appendix is due to a developmental anomaly resulting from the failure of the caecum to descend during embryonic development. Its symptoms often resemble those of other diseases such as cholecystitis, pyelonephritis, and urolithiasis, which can lead to a delay in diagnosis and treatment. Case: A 23-year-old woman presented with four-day history of pain in the right upper quadrant of her abdomen, fever, anorexia, nausea, and vomiting. Abdominal examination revealed tenderness of all abdominal quadrants, which was more pronounced over the right upper and middle quadrant with positive rebound tenderness. Laboratory tests showed high levels of neutrophilic leukocytosis. Ultrasound imaging revealed an inflamed vermiform appendix in the subhepatic region. A diagnosis of an abnormally located appendix was made, and the patient underwent laparotomy. During exploration, an inflamed appendix was found covered by omentum in the right upper quadrant, and appendectomy was carried out smoothly. The patient was in good clinical condition without any complications. Conclusion: Subhepatic appendicitis presents a significant challenge to clinicians due to its unusual location. Failure to diagnose and manage it promptly can lead to complications such as abscesses, peritonitis, sepsis, and increased morbidity. Midline laparotomy is recommended due to the subhepatic location of the appendix and the possibility of retrocecal, dense adhesion or fibrosis, and perforation, which would make a laparoscopic approach unsafe.

Congenital Appendiceal Atresia: An Extremely Rare Disorder Presenting with Acute Abdomen

Abstract Introduction/Objective Congenital malformations of the appendix are extremely rare and difficult to diagnose preoperatively. One of those anomalies include congenital appendiceal atresia (CAA) which mimics acute appendicitis and is usually ignored in the differentials of acute abdomen. Herein, we present a case study of congenital appendiceal atresia associated with periappendicitis. Methods/Case Report A 62-year-old female with past history of diverticulitis presented with complaints of crampy, diffuse and progressive lower abdominal pain and nausea for two days. She denied fevers, chills or change in bowel movements. Physical examination revealed vitally stable patient with soft, non-distended and tender abdomen in bilateral lower quadrants, worse on the right side and showing positive rebound test. Her complete blood count and chemistry were within normal limits. A computerized tomography arterial portography (CTAP) scan with contrast demonstrated inflammatory stranding around the appendix without abscess, concerning for acute appendicitis. She then underwent laparoscopic appendectomy. Grossly, the appendix consisted of a cylindrical portion of yellow-pink fatty tissue covered by peritoneum measuring 6.2 x 3.3 x 0.5 cm. The peritoneal surface displayed patchy fibrinous exudates. Sectioning revealed yellow adipose tissue with no identifiable appendix. Microscopically, the entire specimen demonstrated a poorly formed, mainly fatty appendix without a discernible lumen or submucosal lymphoid tissue. There were scattered sparsely distributed non-continuous bundles of smooth muscle (muscularis propria) at the periphery, which were highlighted by desmin and trichrome stains. This atretic appendix, mesoappendix and peritoneal covering were acutely inflamed. The final diagnosis was poorly formed, acutely inflamed fatty appendix consistent with congenital appendiceal atresia with accompanying acute periappendicitis. Results (if a Case Study enter NA) NA Conclusion This case would add to the very limited existing literature for congenital appendiceal anomalies and highlight the importance of thorough surgical intraoperative abdominal exploration and submission of the entire specimen for microscopic examination in order to render a definitive diagnosis.

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.

WP1.17 - Double Trouble - A Case of Duplex Appendix

Abstract Introduction Duplex appendix, a rare anatomical anomaly is often encountered incidentally during appendicectomy procedures. It is characterised by the presence of two appendiceal lumens and can be classified using the Cave-Wallbridge classification system. Case An 18-year-old male presents to the Emergency Department with a two-day history of migratory right iliac fossa pain. He was consented and booked for a laparoscopic appendicectomy based on clinical suspicion of acute appendicitis. Intra-operatively, an unexpected finding surfaces—a second pendunculated mass adjacent to the inflamed appendix. Employing laparoscopic linear staples, both the appendix and the adjacent mass were divided. One day post-discharge, the patient presents with severe abdominal pain and computed tomography imaging suggests an intra-abdominal leak. The patient underwent an emergency laparotomy and ileo-caecal resection overnight. Histology revealed the second pedunculated mass was indeed a second appendix, a phenomenon with a reported incidence of 0.004 to 0.009%. Discussion Addressing the nuances of using imaging modalities in the diagnosis and operative planning of acute appendicitis, our discussion raises pertinent questions regarding the necessity of definitive pre-operative imaging in suspected cases. Considering potential pitfalls of incorrect clinical diagnoses; the presence of anatomical anomalies; and other factors influencing surgical decision-making; we scrutinise the proposition of pre-operative imaging protocols in suspected acute appendicitis. Conclusively our case encapsulates the diagnostic and therapeutic conundrums posed by duplex appendix instances, prompting a deeper exploration into the use of imaging techniques in a traditionally clinically diagnosed presentation and the implications thereof in surgical management.

Amyand’s Hernia: Incidental Finding of Inflamed Appendix as Hernial Sac Content and its Management

Amyand’s Hernia: Incidental Finding of Inflamed Appendix as Hernial Sac Content and its Management

"Amr Sign": A Case-Control Study Evaluating the Diagnostic Value of a New Clinical Sign in the Diagnosis of Acute Appendicitis.

Introduction Acute appendicitis, a prevalent cause of acute abdominal pain and a common indication for emergency surgery, presents a diagnostic challenge due to its diverse clinical presentation and variability in appendix location and symptoms. Traditional diagnostic approaches, including physical examination, clinical scoring systems, and imaging techniques, have limitations. This study introduces the "Amr sign," a new diagnostic indicator characterized by sudden reflex hyperextension of the neck upon palpation of the right iliac fossa, which is hypothesized to reflect local peritoneal irritation from an inflamed appendix. Methods We conducted a prospective observational study at Alwakra Hospital from November 2016 to January 2019 that included 195 patients aged 15 years and older with right iliac fossa pain and an Alvarado score of four or more. The "Amr sign" was evaluated alongside standard clinical examination and imaging results. Diagnostic accuracy was assessed via histopathological confirmation, which is the gold standard. Results The "Amr sign" had a sensitivity of 68.6% and a specificity of 67.3%. The positive predictive value (PPV) was 89%, whereas the negative predictive value (NPV) was 45%. Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.679 for the "Amr sign" compared with 0.622 for the other imaging modalities, suggesting comparable diagnostic performance. The "Amr sign" demonstrated a higher likelihood ratio of a positive test (2.3) and a lower likelihood ratio of a negative test (0.46). Conclusion The "Amr sign" is a promising diagnostic tool for acute appendicitis, offering a simple, reliable, and quick test that can be performed by less experienced physicians. While its sensitivity and specificity are moderate, its high PPV suggests that it is particularly useful in confirming appendicitis. Further research and validation are needed to fully establish its role in clinical practice.

The Association of Isolated Cecal Necrosis Symptoms with Acute Appendicitis: A Case Report

We report a case of isolated cecal necrosis (ICN) associated with acute appendicitis in a geriatric patient in order to underline the didactic, diagnostic and therapeutic interest. This was a 70-year-old widowed female farmer living in a rural area who presented with localized abdominal pain in the right iliac fossa. The diagnosis of acute appendicitis was made. A Mac Burney incision approach revealed ICN and an inflamed appendix. The patient had an ileostomy and a partial cecal necrosectomy with an epiploic patch. A digestive fistula occurred on postoperative Day 60. The patient was transferred to a more technical center where she had a right hemicolectomy with latero-lateral ileocolic anastomosis. The prognosis was poor. The patient died 4 days later in respiratory distress.

Through Different Lenses: A Retrospective Analysis of the Agreement Between Laparoscopic and Histopathological Evaluations of the Appendix.

Appendicectomy is the most frequently performed emergency general surgical procedure. Previous research has highlighted discrepancies between initial intraoperative laparoscopic diagnoses and subsequent histopathology reports following appendicectomy. In the United Kingdom (UK), routine histopathological examination is the established practice, ensuring precise diagnosis of appendiceal specimens. This retrospective analysis aims to compare intraoperative laparoscopic assessments of the appendix with corresponding histopathology findings. We conducted a retrospective analysis of 418 consecutive emergency laparoscopic appendectomies at Peterborough City Hospital in the UK between April 2018 and June 2019 for suspected appendicitis. Intraoperative findings were compared with histopathological examination outcomes using kappa statistics. Of the 418 appendectomies analysed, we found a substantial agreement between surgeons and pathologists (kappa = 0.71, P < 0.001) in detecting overall abnormalities of appendices. This agreement was also high for detecting inflamed appendices (kappa = 0.72, P< 0.001). However, of the six neoplastic lesions confirmed in the pathologists' final report, only two were suspected during laparoscopy. While laparoscopic assessments of the appendix demonstrate a statistically significant and improved agreement with histopathological findings in detecting abnormal and inflamed appendices, the ability of surgeons to identify neoplasia appears suboptimal based on our small sample of neoplasia cases. The data strongly support the continued practice of routine histopathological examination following appendicectomy due to its crucial role in avoiding missed diagnoses and ensuring better patient outcomes.

Enterobius Vermicularis Unusual Cause of Appendicitis: A Case Report

Abdominal pain is common in children (under 18 years) with a strong female preponderance in those aged over 8 years. Of those presenting with acute abdominal pain requiring inpatient assessment, only 25% have acute appendicitis. Pinworms are the most common helminth infection in the USA and Western Europe, with prevalence rates in some communities of as high as 30-50%. Pinworms generally live in the gastrointestinal tract, and helminth infestations have been noted in over one-quarter of acute appendectomies on histologic examination. Acute appendicitis is one of the most common emergent surgeries. Generally, appendicitis is inflammation of the appendix. The medical procedure for the departure of the reference area is called an appendectomy. Appendectomy can be performed through an open or laparoscopic medical procedure, and it is the most effective way to prevent complications is to remove the inflamed appendix early by open surgery or laparoscopically. This case was a 14 years old female with abdominal pain and acute appendicitis that underwent surgery shows Occiur patch was the cause of her signs and symptoms of acute appendicitis that performed resection of appendix and discharge healthy. The present study presents a classic case of parasitic appendicitis in a teenage girl and discusses the clinical features, treatment and global burden of disease. Atypical presentations may indicate an unusual anatomical placement of the appendix. Preoperative diagnosis using cross-sectional computed tomography imaging and a thorough understanding of these situations frequently result in early diagnosis and expeditious surgical care. EV was seen in 9.8% of pediatric appendectomies in our study. Pruritus anus, normal WBC count, normal neutrophil count, and normal CRP level at presentation could predict EV infection in children who present with right iliac fossa pain. E. vermicularis is responsible for 7% of acute appendicitis. It is responsible for a significantly higher negative appendectomy rate which if predicted may avoid unnecessary appendectomy and associated morbidity. Enterobius vermicularis associated appendicular colic and acute appendicitis are rarely encountered in the United States. The high rate of inflammation on pathology found among our patients with pinworm appendicitis suggests an association with presentation as acute appendicitis. Enterobius vermicularis is known to be associated with appendicitis, however a causal relationship between Enterobius and appendicitis has not been established. The aim of this study was to explore the relationship between appendiceal Enterobius and histologic appendicitis. Enterobius-associated appendicitis cases and compare them with acute appendicitis cases in terms of parameters such as the neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP)-to-lymphocyte ratio (CLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Enterobius vermicularis infections are usually asymptomatic and may only cause anal pruritis, with occasional reported cases of ectopic migration into the appendix or the female genital tract by adult pinworms.

Epidemiology, clinical features, and outcomes of intussusception in young children: A tertiary center experience

Background: Intussusception in young and old children is different. A study of clinical features, associations, and outcomes of these cases would enhance understanding to guide proper management. Objectives: Analysis of the epidemiology, associations, clinical features, and management outcomes of intussusception in children younger than 2 years. Patients and Methods: A retrospective descriptive study on intussusception patients younger than 2 years was conducted from January 2018 to December 2022 in the department of pediatric surgery at a tertiary center. Demographic details, clinical features, and management outcomes data were collected and analyzed. Results: A total of patients were 133 with mean, median, and modal age of 9.5, 7, and 6 months, respectively; the maximum incidence was in March. 81.95% of cases were idiopathic; important lead points were Meckel diverticulum, inflamed appendix, roundworm, cecal duplication, and intraluminal polyps. Two postoperative cases occurred in Wilms’ tumor and congenital diaphragmatic hernia patients, whereas two postrotavirus vaccination cases were seen. Ten (7.5%) had associated malrotation which necessitated Ladd’s procedure. Only 15 cases presenting early responded to nonoperative treatment (9/15 hydrostatic reduction and 6/15 conservative management); among late presenters, 12.71% had manual reduction, 68.64% had resection and anastomosis while in 16.95%, temporary stoma was needed. Wound infection, burst abdomen, subacute intestinal obstruction, recurrent intussusception, peristomal excoriation, and stomal prolapse were a few complications along with one death. Conclusion: Intussusception in children younger than 2 years is a heterogeneous group. Although mostly idiopathic, several associations and well-defined lead points require additional intervention. Early diagnosis and prompt intervention ensure a favorable outcome with fewer complications.

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

Appendiceal mucocele, a rare condition characterized by the accumulation of mucus in the appendix, presents a diagnostic challenge due to its nonspecific clinical features. We present the case of a 60-year-old female with recurrent right lower quadrant abdominal pain, nausea, and anorexia, suggestive of appendicular origin. Abdominal ultrasound revealed a hypoechoic cystic mass, prompting further investigation with magnetic resonance imaging (MRI), which confirmed an inflamed appendix. Exploratory laparotomy revealed a retroperitoneal cavity containing mucous gelatinous material, indicative of a mucocele. Histopathological examination confirmed extensive mucosal sloughing, neutrophilic infiltrate, lymphoma cells, and muciphages, along with areas of dystrophic calcification and fibrosis. The patient recovered postoperatively and remained symptom-free during follow-up. Appendiceal mucocele poses a diagnostic challenge due to its variable presentation and resemblance to other abdominal pathologies. Radiological imaging plays a crucial role in diagnosis, with abdominal ultrasound and MRI aiding in preoperative evaluation. Surgical resection remains the cornerstone of management, with laparotomy preferred to avoid mucocele rupture.

A case of Perforated Retroperitoneal Appendicitis Mimicking Pyelonephritis

Introduction: Appendicitis is one of the most commonly diagnosed surgical diseases in childhood with emergency abdominal pain. Retrocecal retroperitoneal appendicitis is uncommon and potentially difficult to diagnose. This condition might present with atypical clinical, and radiological signs. Here, we present a patient with perforated retrocecal appendicitis in whom the clinical findings mimicked acute pyelonephritis. Case Report: A 3-year-old boy presented with right flank pain, fever, and vomiting since a two days. The abdomen was soft but right costovertebral angle tenderness positive. There was pyuria. The clinical impression was pyelonephritis. Ultrasonography showed perirenal fluid collection but did not show any collections pericecal area. In the Multi-detector CT (MDCT) MDCT a long inflamed retrocecal retroperitoneal appendix was seen with surrounding inflammation that extended to anterior pararenal space, and retroperitoneal air. At surgery, there was retrocecal retroperitoneal appendicitis with perforation and retroperitoneal collection. Appendectomy and drainage were performed. Conclusions: Patients with retroperitoneal appendicitis is that these patients often present with atypical and less severe abdominal complaints. In this situation, MDCT could be a rapid and efficient tool for localizing the appendix and for the differential diagnosis.

Schistosomal appendicitis: a case report

BackgroundSchistosomiasis is one of the endemic parasitic diseases in many developing countries. Despite this, appendicitis secondary to schistosomiasis is an uncommon condition even in some endemic areas. Schistosomal appendicitis, an incidentally discovered appendicitis associated with schistosomiasis histological findings, affects young males predominantly. Timely diagnosis and treatment, including appendectomy and anti-helminthic therapy, are crucial.Case reportA 24-year-old Sudanese male patient presented with abdominal pain. Diagnosed with acute appendicitis, he underwent appendectomy, revealing appendix inflammation with Schistosoma ova in histopathology. Abdominal ultrasound detected no complications. Weakly positive Schistosoma serology was noted, but stool and urine analysis showed no infection evidence. Prescribed praziquantel, patient had 3-year post-op follow-up without complications.ConclusionsThis case report underscores the significance of including schistosomiasis in the differential diagnosis of appendicitis, particularly in regions where the disease is endemic. It underscores the necessity of histopathological evaluations for accurate diagnosis, emphasizing the potential implications for clinical practice in similar settings.

MAIT cell activation and recruitment in inflammation and tissue damage in acute appendicitis.

Mucosal-associated invariant T (MAIT) cells are antimicrobial T cells abundant in the gut, but mechanisms for their migration into tissues during inflammation are poorly understood. Here, we used acute pediatric appendicitis (APA), a model of acute intestinal inflammation, to examine these migration mechanisms. MAIT cells were lower in numbers in circulation of patients with APA but were enriched in the inflamed appendix with increased production of proinflammatory cytokines. Using the patient-derived appendix organoid (PDAO) model, we found that circulating MAIT cells treated with inflammatory cytokines elevated in APA up-regulated chemokine receptors, including CCR1, CCR3, and CCR4. They exhibited enhanced infiltration of Escherichia coli-pulsed PDAO in a CCR1-, CCR2-, and CCR4-dependent manner. Close interactions of MAIT cells with infected organoids led to the PDAO structural destruction and death. These findings reveal a previously unidentified mechanism of MAIT cell tissue homing, their participation in tissue damage in APA, and their intricate relationship with mucosal tissues during acute intestinal inflammation in humans.