Periappendiceal Abscess Research Articles

Malignant Appendiceal GIST: Case Report and Review of the Literature

Gastro-intestinal stromal tumors (GISTs) of the appendix are a rare entity. To date, only a handful has been described in the literature, all of which have been of the benign type. We present the first reported case of a malignant appendiceal GIST. The tumor was discovered when the patient presented with a peri-appendiceal abscess which appeared suspicious on CT. The abscess was drained and managed medically. The patient responded to antibiotic treatment but subsequent CT and biopsy confirmed the diagnosis of appendiceal GIST, and the patient was started on treatment with imatinab mesylate. One week after initiation of therapy, the patient returned with frank peritonitis necessitating surgery. Abdominal exploration revealed an appendiceal GIST locally invading and perforating adjacent bowel. We describe the complex presentation and course of the case as well as a literature review of the appendiceal GISTs and the current approach to treatment.

Analysis on early diagnosis and treatment of 276 cases with acute appendicitis in elderly

Objective To investigate early diagnosis, clinical effect of surgical treatment and prognosis of a-cute appendicitis in elderly. Methods The clinical data of acute appendicitis in elderly undergoing surgical therapy between January 1994 and November 2008 was analyzed retrospectively, and predisposing factors, diagnostic meth-ods, therapeutic effect of operation and prognosis were studied. Results Acute appendicitis in elderly was diagnosed in 276 cases(114 female/162 male). There were 7 cases of deaths. MoRality was 2.5% (7/276). Stitches were taken out from 6 to 8 days after operation. Average stay was 8 days. 196 cases(71.0%) of wound healing at grade A, 43 cases(15.6%) at grade B ,37 cases(13.4%) at grade C. 86 cases(31.2%) with perforated acute appendici-tis, and 7 cases(2.5%) with periappendiceal abscess were confirmed after operation. 76 cases auompanied with con-comitant diseases, 87 cases auompanied with postoperative early complications, and 39 cases(14.1%) with postop-erative wound or intra-abdominal septic complications. Conclusion Key point of improvement of operative therapeu-tic effect and prognosis of acute appendicitis in elderly are early diagnosis, operation in time, and effective treatment of associated diseases and complications. Key words: Appendicitis; Appendectomy; Aged

The Effect of Delayed Surgery in Adult Patients with Acute Appendicitis

Purpose: There are many reports that delayed operation of appendicitis in children is safe, but it is controversial whether the same principle can be applicable in adult patients. The aim of this study was to evaluate the relationship between the interval from onset of symptoms to operation and the pathologic degree of appendicitis. Methods: In this retrospective study, 783 adult patients (16 years old or more) diagnosed with appendicitis pathologically between 2004 and 2007 were included. The time from onset of symptoms to hospital arrival (patient interval) and time from hospital arrival to operation (hospital interval) were investigated. Pathologic and gross state of the appendicitis was graded as G1 (suppurative), G2 (gangrenous), G3 (ruptured), G4 (periappendiceal abscess). Results: The median time from symptom onset to operation (total interval) was 35 hours. The percentage of G1, G2, G3, and G4 was 86.3%, 11.4%, 2.4%, and 0% when total interval was ＜24 hours, 61.3%, 21.3%, 15.8%, and 1.6% when between 24 and 72 hours, and 23.8%, 13.9%, 36.9%, and 25.4% when the interval was over 72 hours. The advanced grade of appendicitis correlated with increased hospital stay (P＜0.0001). Conclusion: This study suggests that delayed appendectomy in acute appendicitis in adults is a risk factor for advanced grades, and that the sooner the operation is undertaken, the better the outcome is.

A Case of Left Ureteral Obstruction due to Acute Appendicitis

Appendicitis is a common cause of acute abdomen in pediatrics. Periappendiceal abscesses are frequently found in the pediatric population. Acute appendicitis in children can, at times, be a difficult clinical diagnosis because of its highly variable history? and physical manifestations and its unpredictable course. Despite the uncertainty of the diagnosis, appendicitis demands prompt treatment because of the risk of perforation, which occurs in approximately one third of cases. Urological manifestations of appendicitis and appendiceal abscess can vary. Acute appendicitis presenting with ureteral stenosis and hydronephrosis is very rare. Here, we report a case of acute appendicitis with perforation and left hydronephrosis in a 3-year-old female. This case presents a 3-year-old girl with dysuria having hydronephrosis that originated from a perforated appendix.

Endometriosis Involving the Appendix Mimicking Acute Appendicitis and Appendiceal Tumor: Report of a Case

Endometriosis of the appendix is infrequent, and even rarer when it presents as appendiceal tumor. A case of endometriosis of the appendix that manifested as acute appendicitis and appendiceal tumor in a 44-year-old female patient is reported here. The woman visited the emergency room due to lower abdominal pain and high fever for 2 days. At ER, physical examination showed severe tenderness and rebounding pain at the McBurney's point. Abdominal computed tomography (CT) an Abdominal ultrasound suggested appendicitis with rupture. Therefore, she was immediately operated upon under the suspicion of acute appendicitis with rupture. Intra-operatively, an apparent appendiceal tip tumor with several enlarged mesentery lymph nodes was found. As appendiceal cancer with lymph node metastasis was highly suspected, a right hemicolectomy was performed. Later histological examinations showed endometriosis of the appendix and ileum, along with periappendiceal abscess. Post-operatively, the patient recovered with no residual pain.

Experience with Two Cases of Intestinal Tuberculosis: Utility of the QuantiFERON-TB Gold Test for Diagnosis

Intestinal tuberculosis is rare in Western countries, with incidence rates of 35.7 and 0.43 per 100,000 per year for the immigrant and native populations, respectively. Despite a clear increase in the frequency of extrapulmonary tuberculosis in immunosuppressed patients, the clinical features of intestinal tuberculosis are seen rarely. A typical clinical presentation includes abdominal pain, weight loss, fever, weakness, nausea, vomiting, obstruction, and bleeding. Intestinal tuberculosis often mimics inflammatory bowel disease or malignant neoplasia, and its preoperative diagnosis is a challenge. Microbiologic diagnosis often is difficult because the causative microorganism requires a long incubation period. Two case reports and review of the pertinent literature. We report two cases of colonic tuberculosis mimicking cecal carcinoma in one patient and periappendiceal abscess in the other. A 75 year-old man underwent right hemicolectomy for a right colon mass. Preoperative laboratory, radiologic, and endoscopic evaluations were negative for tuberculosis and carcinoma. The QuantiFERON-TB Gold test was positive. Surgical specimen histologic review showed non-caseating granulomas and rare Ziehl-Neelsen-positive bacilli. A 35 year-old man, born in Sri Lanka but living in Italy for 10 years, came to our attention for a periappendiceal abscess. Multiple peritoneal micro-nodules were found at laparotomy. Their extemporaneous histologic examination showed granulomas and giant-cell inflammation. A right hemicolectomy was performed. The QuantiFERON-TB Gold test, performed on peritoneal fluid and blood, was positive in both. The QuantiFERON-TB Gold test may hold promise for use in intestinal inflammatory diseases when tuberculosis is suspected but conventional workup is not diagnostic.

Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess

Objective Given the perceived technical demands of laparoscopic appendectomy and the expected postoperative morbidity in patients with a well-defined abscess, initial percutaneous drainage has become an attractive option in this patient population. This strategy allows for a laparoscopic appendectomy to be performed in an elective manner at the convenience of the surgeon. However, the medical burden on the patient and on the quality of patient outcomes has not been described in the literature. Therefore, we audited our experience with initial percutaneous drainage followed by laparoscopic interval appendectomy to evaluate the need for a prospective trial. Methods After institutional review board approval, a retrospective chart review was performed on all children who presented with perforated appendicitis and a well-defined abscess and were treated by initial percutaneous aspiration/drainage followed by interval appendectomy between January 2000 and September 2006. Continuous variables are listed with standard deviation. Results There were 52 patients with a mean age of 9.0 ± 3.9 years and weight of 34.4 ± 18.8 kg. The mean duration of symptoms at presentation was 8.4 ± 7.6 days. Percutaneous aspiration only was performed in 2 patients. The mean volume of fluid on initial aspiration/drain placement was 76.3 ± 81.1 mL. The mean time to appendectomy was 61.9 ± 25.2 days. The laparoscopic approach was used in 49 patients (94.2%), of which one was converted to an open operation. The mean length of hospitalization after interval appendectomy was 1.4 ± 1.4 days. A recurrent abscess developed in 17.3% of the patients. Six patients (11.5%) required another drainage procedure. The mean total charge to the patients was $40,414.02. There were 4 significant drain complications (ileal perforation, colon perforation, bladder perforation, and buttock/thigh necrotizing abscess). The child with the ileal perforation after drain placement is the only patient who failed initial nonoperative therapy. Conclusions The use of initial percutaneous aspiration/drainage of periappendiceal abscess followed by interval appendectomy is an effective approach. However, this management poses complication risks and uses considerable resources. Therefore, this strategy should be compared with early operation in a prospective trial.

The ectopic appendicolith from perforated appendicitis as a cause of tubo-ovarian abscess

Acute appendicitis is a common surgical cause of abdominal pain in the pediatric population. History and physical examination are atypical in up to a third of patients. Known potential complications of untreated or delayed management of acute appendicitis include appendiceal perforation, periappendiceal abscess formation, peritonitis, bowel obstruction and rarely septic thrombosis of mesenteric vessels. We report an unusual complication of perforated appendicitis. A tubo-ovarian abscess developed secondary to appendicolith migration into the right fallopian tube in a patient who had undergone interval laparoscopic appendectomy for perforated appendicitis. The retained appendicolith was visualized within the obstructed and dilated fallopian tube on contrast-enhanced CT. We discuss the CT imaging features of this unusual complication of perforated appendicitis.

Usefulness of Capsule Endoscopy and Double Balloon Enteroscopy in Juvenile Patients

Background/Objective: Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) have been introduced as modalities for examining the entire small bowel. There had been very few report on the special characteristics of small bowel disease in juvenile patients. The aim of this study is to evaluate both characteristics of small bowel disease and usefulness of CE and DBE in juveniles. Methods: From August 2003 through June 2007, CE (PillCamTMSB, Given Imaging Ltd. Israel) and/or DBE (EN-450P5, EN-450T5, Fujinon Co., Saitama, Japan) was performed in 16 juvenile patients suspicious of small bowel disease (7 male, 9 female; mean age 19.3 years, range 11-22 years). Twelve of 16 patients underwent CE whereas 9 patients did DBE, that is, 5 patients had both exam. Results: The reasons for the study were gastrointestinal bleeding (n = 7), multiple colon polyps(n = 4), unexplained abdominal pain (n = 3), and chronic diarrhea(n = 2). Small bowel abnormalities were detected using CE in 7 (58%) of the 12 patients and in 7 (78%) of the 9 patients using DBE.(Table). Among the 5 patients performed with both examination, 2 patients had small bowel ulcers and 1 patient showed no abnormality with both examination. One patient had small bowel erosion detected only in CE finding and another patient had vascular malformation was seen only in DBE. The final diagnosis of 16 patients were made as small bowel erosion or ulcers (n = 4), Peutz-Jegher syndrome (n = 2), Crohn's disease (n = 2), hyperplastic polyposis (n = 2), vascular malformation(n = 2) and peri-appendiceal abscess (n = 1). Other three patients did not have any abnormalities in both exams. There were no any serious complications including bleeding, retention or perforation. Conclusion: Similar to pattern in adults, Our study showed various small bowel disease in juvenile patients suggesting CE and DBE as useful and well-tolerated method with a high diagnostic yield for the management of suspected small bowel disease in juveniles. Tabled 1Endoscopic findings Erosion or ulcer Polyp Lymphoid hyperplasia Angiodysplasia Ileal edema & extrinsic compression Nonspecific finding CE (N = 12) 4 1 1 1 0 5 DBE (N = 9) 4 1 0 1 1 2 Open table in a new tab

Acute Perforated Appendicitis in a Patient with Nonrotation of the Midgut: A Case Report

The presence of a malrotation of the midgut in adults is identified in asymptomatic patients most commonly as an incidental finding during a workup for an unrelated disease. We report here a rare case of acute perforated appendicitis in a patient with nonrotation of the midgut. A 28-year-old man was referred to our hospital with lower abdominal pain. The radiological examination, including abdominal computed tomography, ultrasono graphy, an upper gastrointestinal series, and a barium enema, revealed acute perforated appendicitis accom panied by nonrotation of the midgut. Emergency surgery revealed a complicated appendix located in the middle area of the lower abdomen with a periappendiceal abscess and nonrotation of the midgut. An ileocecal resection was performed with no postoperative complication. In this case, the atypical position of the appendix led to confusion regarding the diagnosis and to a more invasive surgical intervention.

Complicated Periappendiceal Abscess Diagnosed on Colonoscopy

Purpose: Appendicitis with its complications like periappendiceal abscess is diagnosed with 93% to 98% accuracy using CT. In several reported cases, appendicitis with atypical symptoms and/or nondiagnostic imaging was diagnosed during colonoscopy. We present a case of complicated periappendiceal abscess diagnosed on colonoscopy. Case Report: A 37 yr old female presented to our clinic being referred for an abnormal CT scan showing mass extending into the cecum. She had intermittent right lower quadrant pain for past 2–3 months, increasing in intensity with menstruation. She had no change in bowel movements, no urinary symptoms, no nausea or vomiting. CT abdomen showed right pelvic cystic mass attached to the uterus, adnexa, cecum and sigmoid colon with no visualization of appendix (Fig. 1). Colonoscopy showed edematous cecum with clear pus extruding from the appendiceal orifice confirming appendicitis (Fig. 2). Laparotomy showed large mass in the pelvis covered with omentum and small bowel. Pus was expressing from necrotic base of the appendix and from the right ovarian cyst. Appendectomy and hysterectomy with bilateral salphingo-oophorectomy were performed. Pathology confirmed appendicitis with abscess formation along with the ovarian abscesses on both sides. The culture from the pus was positive for Bacteroides fragilis indicating bowel as the source of infection. Our patient had appendicitis with abscess that disseminated causing infection of the ovarian cysts. The infection was walled off by omentum causing atypical symptoms, thus misleading physicians till colonoscopy. Conclusion: This unusual case illustrates a key role played by colonoscopy in diagnosing a complicated periappendiceal abscess presenting with atypical symptoms and non diagnostic radiologic workup.[figure1][figure2]FigureFigure

Infectious mononucleosis manifested as a cecal mass

An 11-year-old boy presented with symptoms of periappendiceal abscess. At laparotomy, a tumor-like mass involving the ileocecal mesentery and adjacent part of the cecum and covered by the omentum was found. A right hemicolectomy was performed, followed by primary ileocolic anastomosis. On histologic examination, the tumor-like mass proved to be a lymph node block pushing the adjacent wall of the cecum. The overall histologic and immunophenotypic findings were consistent with ( a) abnormal immune lesion mimicking lymphomatous process because of infection by Epstein-Barr virus and ( b) extensive acute inflammatory infiltration of the cecum and adjacent tissues.

Acute appendicitis perforating into the bladder mimicking cystitis

Perforation of the appendix can lead to periappendiceal abscess or diffuse peritonitis. The major reason for appendiceal perforation is delay in diagnosis and treatment. We report this rare case of perforated appendix into the bladder, which caused acute abdomen. We also present a review of the literature. The patient underwent an emergency operation in which the appendicitis was found to have perforated into the bladder and produced symptoms that mimicked cystitis. The terminal ileum and the cecum were seriously inflamed. The patient underwent a limited right hemicolectomy, closure of the bladder with a serosal patch, closure of the transverse colon and an end‐ileostomy. Differential diagnosis of acute appendicitis especially in women is very difficult because the surgeon must always consider and look for many other conditions that can mimic appendicitis. From a management viewpoint, the various diagnoses can be divided into those that require surgery and those that do not. The present case was an uncommon case of acute appendicitis where, unfortunately, its primary symptoms and laboratory data had led to the wrong diagnosis of cystitis, which did not require surgery.

A periappendiceal abscess during combination interferon and ribavirin treatment for chronic hepatitis C

A periappendiceal abscess during combination interferon and ribavirin treatment for chronic hepatitis C

The Recurrent Psoas Abscess Caused by Two Different Pathogens - A Case Report -

We report a case of a recurrent psoas abscess caused by two different pathogens. The abdominal CT scans revealed a multiseptated cystic mass along the right psoas-iliacus muscle. The patient was treated with antibiotics treatment in combination with CT-guided percutaneous aspiration and drainage using a catheter. The microbiological examination revealed Klebsiella pneumoniae. Six months later, the patient presented with anorexia, malaise, epigastric pain, lower back pain and fever of 37.8oC for a one-week duration. The abdominal CT scans revealed an abscess cavity on the inferior side of the right psoaos-iliacus muscle. This was accompanied by retrocecal appendicitis and a periappendiceal abscess. Magnetic resonance imaging of the pelvis showed that the psoas abscess was located on the right psoas-iliacus muscle. We performed an appendectomy and laparotomy. Subsequently, the culture yielded Escherichia coli in the psoas abscess. To our knowledge, this is the first case of a recurrent psoas abscess caused by two different pathogens.

Comparison of therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of periappendiceal abscess

The present study was designed to compare the therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of appendicitis complicated by periappendiceal abscess. In a prospective study, 50 patients with acute appendicitis complicated by periappendiceal abscess > or = 3 cm in size were randomly assigned to two groups. The first group received treatment with ultrasound guided-percutaneous drainage and i.v. antibiotics (ampicillin, cefuroxime, and metronidazole), and the other group received antibiotics only. Patient's baseline characteristics, duration of hospital stay, and treatment outcome and complications were analyzed. Appendectomy was avoided in 16/25 patients in the drainage group and 2/25 patients in the non-drainage group during follow-up with RR of 0.39 (95% CI = 0.22-0.62; p < 0.05). One patient in the drainage group and 8 patients in the non-drainage group underwent surgery in the first month after the beginning of treatment. Eight patients in the drainage group and 15 in the non-drainage group underwent interval appendectomy. There was no statistically significant difference between the two groups regarding patient demographics, abscess size, and pretreatment clinical symptoms. Hospital stay up to the subsidence of clinical and sonographic signs was significantly shorter (p < 0.001) in the drainage group, with a mean difference of 6.4 days (95% CI = 5.0-7.9; p < 0.05). Percutaneous drainage with antibiotics is a safe and effective way of treating acute perforated appendicitis. The recurrence rate for these patients is relatively low, and very often interval appendectomy is not required. For patients with periappendiceal abscess > or = 3 cm in diameter, antibiotic therapy alone is insufficient and the recurrence rate is high.

Acute Appendicitis in a Kidney-Pancreas Transplant Recipient: Report of a Case

The prompt diagnosis and management of acute surgical conditions in immunocompromised solid organ transplant recipients are of critical importance. These conditions may or may not be related or to the transplanted allograft(s). This is a case report of a 41-year-old women who received a simultaneous pancreas-kidney transplant. Nine years after the transplant, she developed acute appendicitis with a periappendiceal abscess and a fecalith, and she was treated with percutaneous drainage of the abscess and eventual semielective appendectomy. This is the first known report of acute appendicitis in a pancreas allograft recipient in the English literature.

A case of breast carcinoma, chemotherapy, and acute appendicitis

In May 2006 a 51-year-old woman with a history of infiltrating ductal carcinoma of the breast presented with atypical symptoms of acute appendicitis. She had undergone a modified radical mastectomy 4 months earlier and had received four courses of chemotherapy (cyclophosphamide doxorubicin and fluorouracil). After the fourth course of chemotherapy she developed a dull low abdominal pain lasting 3 days. She initially visited our gastroenterology clinic where physical examination and laboratory studies were unremarkable; persistent symptoms led her to present to our emergency department 2 days later. Physical examination showed mild tenderness without rebound in the lower abdomen especially on the right side. Laboratory test results showed a low white cell count of 3.1 × 10/--3/L with a normal differential cell count. Abdominal ultrasonography showed a hypoechoic soft-tissue mass about 3 cm in diameter adjacent to the terminal ileum. Acute appendicitis was diagnosed and our patient underwent an appendectomy. Pathology results showed acute suppurative inflammation with periappendiceal abscess formation consistent with perforation. Her postoperative course was uneventful and she was discharged 4 days after the procedure. When last seen in June 2006 the patient was well. (excerpt)

Acute urinary retention in a 9-year-old child: An atypical presentation of acute appendicitis

Acute urinary retention is unusual in childhood and when present is likely to have an identifiable cause. Although the evaluation is often performed by the urologic specialist after relief of the obstruction, it is imperative that some causes be identified in the Emergency Department. This is a case of a 9-year-old boy in acute urinary retention caused by a ruptured appendix with a periappendiceal abscess.

A left-sided periappendiceal abscess in an adult with intestinal malrotation

Left-sided periappendiceal abscesses occur in association with two types of congenital anomaly: intestinal malrotation and situs inversus. It is difficult to obtain an accurate preoperative diagnosis of these abscesses due to the abnormal position of the appendix. We present an unusual case of a left-sided periappendiceal abscess in an adult with intestinal malrotation, the diagnosis of which was a challenge.