Periappendiceal Lesions Research Articles

S1545 The Efficacy and Safety of Endoscopic Submucosal Dissection in Peri-Appendiceal Lesions: A Systematic Review and Meta-Analysis

S1545 The Efficacy and Safety of Endoscopic Submucosal Dissection in Peri-Appendiceal Lesions: A Systematic Review and Meta-Analysis

Mesoappendiceal and periappendiceal lesions

Lesions of the mesoappendix are rare. The majority are benign and incidental pathologic findings. They rarely present clinically or radiologically. A spectrum of infectious, tumor-like, and neoplastic lesions can involve the mesoappendix and the periappendiceal tissue. Pathologists usually pay little attention to the gross examination of the mesoappendix in appendectomy specimens in comparison to the appendix itself. This could lead to a missed opportunity to identify mesoappendiceal lesions, despite being rare, but some are clinically important for the patient's management. Pathologists should perform careful gross examination and sectioning of the mesoappendix.A retrospective review study of 4371 appendectomy specimens over four years showed eight cases (0.18%) with a variety of mesoappendiceal and periappendiceal lesions. Most (five cases) were benign incidental pathologic findings (lymph nodes with reactive follicular hyperplasia, ectopic decidua, infarcted epiploica and peritoneal cyst), one case was a rare occurrence (inflammatory fibroid tumor), and few others (two cases) were clinically important findings (tuberculosis and schistosomiasis). They were more commonly found in young adult males with a male to female ratio of 7:1.

Clinical Significance of Isolated Peri-Appendiceal Lesions in Patients With Left Sided Ulcerative Colitis.

BackgroundUlcerative colitis is classically described as a condition originating in the rectum and extending proximally towards the cecum. In recent years, a discontinuous peri-appendiceal lesion has been described. Our aim was to evaluate the risk of progression to pancolitis in patients presenting with an isolated peri-appendiceal lesion on ileocolonoscopy.MethodsEndoscopy databases at three tertiary care centers were searched for patients undergoing ileocolonoscopy for diagnosis or surveillance of ulcerative colitis. Patients with isolated periappendiceal lesions as well as histologically confirmed left sided colitis were enrolled. Controls were defined as patients with left-sided ulcerative colitis without evidence of peri-appendiceal inflammation. The main outcome was the need for escalation of therapy to systemic corticosteroids, immunomodulators or biologic agents. Secondary outcomes were progression to pancolitis or requirement for colectomy. A secondary analysis of other risk factors for proximal extension/progression of colitis was also performed.ResultsWe identified 228 patients with ulcerative colitis, 123 were included in the analysis. Four point eight percent of patients had isolated peri-appendiceal lesions. In the group with peri-appendiceal lesions, 47.4% required escalation of therapy vs. 70% in the control group (P = 0.53). There was no difference in progression to pan-colitis or colectomy rates between the two groups. Progression was not predicted by inflammatory markers, age, gender, initial Mayo UC score or IBD therapy utilization.ConclusionsThe presence of isolated peri-appendiceal lesions is not a risk factor for future escalation of therapy for ulcerative colitis and is not correlated with proximal extension of disease.

Clinical Significance of Isolated Peri-Appendiceal Lesions in Patients with Left Sided Ulcerative Colitis

Purpose: Ulcerative colitis has classically been described as a continuous mucosal inflammation originating in the distal colon and spreading proximally. Isolated peri-appendiceal lesions (cecal patch) have been recognized in the patients with ulcerative proctitis for over 30 years, but their clinical significance remains unclear. The purpose of this study was to evaluate the risk of progression to pancolitis in patients presenting with a skipped peri-appendiceal lesion on ileocolonoscopy. Methods: In this retrospective chart review study we have searched the endoscopic database at the University of Minnesota and the Minneapolis VA Medical Center from 1997 to 2007 for patients undergoing ileocolonoscopy for either the initial diagnosis or surveillance of ulcerative colitis. Those patients with a biopsy-proven, isolated peri-appendiceal lesion as well as histologically confirmed left sided colitis or proctitis were enrolled in the study. Controls were defined as patients with left-sided ulcerative colitis without endoscopic evidence of peri-appendiceal inflammation. Progression was defined as endoscopic proximal extension to at least the transverse colon. Secondary markers for disease progression were utilization of a TNF inhibitor therapy or colectomy. A secondary analysis of other risk factors for proximal extension/progression of colitis was also performed. Results: We reviewed 158 patients with ulcerative colitis: 19% with proctitis, 34% left-sided colitis, 36% pancolitis. Disease extent was unknown in 11% of patients. We identified 6 patients with peri-appendiceal lesions yielding a prevalence of 3.8 percent. There was no statistically significant difference in inflammatory marker levels, initial therapy required, or the average Mayo endoscopic severity score at the time of diagnosis for cases and controls. In the group with a peri-appendiceal lesion, 25% of the patients progressed to pancolitis vs. 38 % of the controls (p = 0.60). Utilization of TNF inhibitors trended toward being greater in the cecal patch group (50% vs. 19%, p = 0.06) but colectomy rates did not differ (12% vs. 17%, p = 0.72). Of the 89 patients with left-sided colitis or proctitis, 58 had adequate data to include in the analysis for risk for progression. Among those with proximal extension of colitis, this progression was not predicted by inflammatory markers, age, gender, initial Mayo UC score or IBD therapy utilization. Conclusion: Isolated cecal patches are rare. Patients with isolated peri-appendiceal lesions are at no greater risk for colectomy or utilization of TNF inhibitors. No other predictors of disease progression were identified in this cohort.

Clinical and Colonoscopic Investigation of Skipped Periappendiceal Lesions in Ulcerative Colitis

Background: Ulcerative colitis (UC) is typically a continuous and diffuse inflammation extending proximally from the rectum. However, skipped lesion in the appendiceal region has been reported recently. Although appendectomy has been shown to reduce the risk of UC, the clinical significance of skipped periappendiceal lesion remains unclear. The present study examined the relationship between the continuous distal lesion of UC and the skipped periappendiceal lesion by observing colonoscopic changes in both lesions. Methods: Among 279 patients with UC who underwent total colonoscopy from January 1994 to December 2000, 54 patients (19.4%) had skipped periappendiceal lesions. Serial colonoscopic examinations were performed in 35 of the 54 patients to determine the activities in the distal UC lesion and skipped periappendiceal lesion during the course of disease. Results: Patients with skipped periappendiceal lesions were younger and had a longer history of UC than those without them, but no differences in sex ratio and treatment modality were observed between the two groups. In 28 of 35 patients (80%), the activity in the distal lesion correlated well with that in the skipped periappendiceal lesion. Both lesions were improved in 17 patients, unchanged in 5 patients and worsened in 6 patients. Linear regression analysis showed a significant correlation between the changes in colonoscopic activity index in the two lesions. Conclusion: A close association is found between disease activity in the skipped periappendiceal lesion and that in the distal lesion of UC.

THE SEQUENCE OF THE PATHOLOGIC CHANGES IN APPENDICITIS.A STUDY OF THE SIGNIFICANCE OF THE LESIONS FOUND IN DIFFERENT STAGES OF APPENDICITIS, BASED ON THE PATHOLOGIC FINDINGS IN A SERIES OF OPERATIVE CASES.

Within recent years much has been written concerning the pathology of appendicitis. The anatomic characteristics of the different varieties of appendicitis, together with the secondary lesions accompanying the primary appendiceal inflammation, have been most carefully described and abundant statistics dealing with the relative frequency of the different types of appendiceal and periappendiceal lesions exist. In spite of all this accumulated knowledge, the subject of the pathology of appendicitis is not by any means a closed chapter, but continues to be prominent in medical discussions and literature. The reason for this, perhaps, may lie in the fact that it has not yet been generally recognized that the different pathologic conditions, as they are encountered at operation in cases of appendicitis, represent, for the most part, simply different stages of an inflammatory process involving primarily the appendix and accompanied, in a large proportion of cases, by a more or less extensive secondary involvement of the peritoneal cavity.