Resected Appendix Research Articles

Low mitochondrial DNA copy number of resected cecum appendix correlates with high severity of acute appendicitis.

The roles of mitochondrial DNA alterations in acute appendicitis (AA) remain unclear. We evaluated the alterations of mtDNA copy number and mtDNA integrity [proportion of mtDNA templates without 8-hydroxyl-2'-deoxyguanosine (8-OHdG)] of the resected cecum appendixes in clinically suspected acute appendicitis (CSAA). A total of 228 CSAA patients, including 50 harbored negative AA (NAA), 155 true AA (TAA) without rupture and 23 TAA with rupture, who underwent appendectomies were enrolled. Tissues of resected cecum appendixes from the paraffin-embedded pathological blocks were subjected to DNA extraction, and their mtDNA copy number and mtDNA integrity were determined by quantitative real-time polymerase chain reaction (Q-PCR). During the progression of disease severity from NAA to TAA without rupture and further TAA with rupture, increases of white blood cell (WBC) counts (p=0.001), positive bacterial culture rates in turbid ascites (p=0.016) and area (p<0.001)/or volume (p<0.001) indices of resected cecum appendixes were noted among CSAA patients. On the contrary, decrease of mtDNA copy number (p=0.003) was observed during disease progression of CSAA patients, especially in female patients (p=0.007). Furthermore, lower mtDNA copy numbers were correlated with higher WBC counts (p=0.001) and larger area (p=0.003) or volume (p<0.001) indices of the resected cecum appendixes. However, such an alteration was not observed in mtDNA integrity of resected cecum appendixes. We conclude that a low mtDNA copy number of the resected cecum appendix may reflect high severity of acute appendicitis.

Unusual Histopathological Findings in Appendectomy Specimens: A Retrospective Analysis of 2047 Cases.

In this study, we retrospectively evaluated cases of patients who had undergone appendectomy in our hospital and aimed to present the efficiency of diagnostic tests and demographic data of cases. Pathological reports were analyzed for the following parameters: age, gender, and pathological diagnosis. In addition, the demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and reanalysis of archived resected appendix specimens was carried out. Files of 2047 patients (1329 males, 718 females, sex ratio: 1.85, age range: 1-87 years, mean age: 26, 50 years), who had been operated with a diagnosis of acute appendicitis in the emergency department of Bezmialem Vakıf University Medical Faculty from November 2011 to June 2014, were retrospectively evaluated. Cases were separated into 2 groups. Cases with histopathologic examination reported as acute appendicitis constituted group 1 (n = 2013, 98.34%), and cases with pathologic findings other than acute appendicitis constituted group 2 (n = 34, 1.66%). The second group consisted of 8 low-grade mucinous neoplasms, 7 mucoceles, 6 carcinoid, 5 granulomatous inflammation, 4 intraluminal Enterobius vermicularis, 1 endometriosis externa, 1 adenocarcinoma infiltrated to serosa, 1 mesenteric cyst, and 1 low-grade adenocarcinoma formed in mucinous cystic neoplasm background. Acute appendicitis is the most common emergency surgical condition. Although most of the resected appendectomy specimens showed typical histopathologic findings, some (1.66%) showed unusual histopathologic findings. Even if the macroscopic appearance of the specimen is normal or acute appendicitis, we suggest routine histopathological examination.

Isolated Acute Appendicitis Caused by Aspergillus in a Patient Who Underwent Lung Transplantation: A Case Report

Invasive aspergillosis is an important cause of morbidity and mortality in patients who have undergone lung transplantation. Aspergillus infections usually involve the respiratory tract, with vascular invasion and subsequent dissemination. However, acute appendicitis associated with localized aspergillosis is rare, especially among patients who have undergone prophylaxis with voriconazole. We present a case of primary Aspergillus appendicitis diagnosed by histologic examination in a patient who underwent lung transplantation. A 51-year-old woman with dermatomyositis underwent lung transplantation for acute interstitial pneumonitis. According to our institution's protocol, the patient was treated with immunosuppressive therapy and prophylaxis with voriconazole, ganciclovir, and trimethoprim sulfamethoxazole during the post-transplantation period. Twenty-eight days after transplantation, the patient developed mild abdominal pain and paralytic ileus. There was no apparent infection sign. Abdominal computerized tomography indicated a wall defect of the appendix with multifocal fluid collection, mesenteric leave thickening, and pneumoperitoneum. These findings were consistent with perforated appendicitis, and the patient underwent an appendectomy. The histopathology examination of the resected appendix showed inflammation and abscess. Periodic acid–Schiff–positive and Grocott-Gomori methenamine silver–positive fungal hyphae with acute-angle branching were observed, demonstrating muscular invasion. A galactomannan antigen test obtained on the same day had negative results. The trough level of voriconazole was well maintained and was subsequently adjusted through monitoring of circulating drug concentration. Simultaneously, other potential sites of disseminated Aspergillus were considered and examined, but no other site of systemic Aspergillus infection was detected. Voriconazole treatment was maintained for 3 months, and no aspergillosis relapse or other invasive fungal infections were observed.

Prevalence of Parasitic Infections in Surgically Removed Appendices: Parasitological and Histopathological Studies.

SummaryIntestinal parasites may cause symptoms similar to acute appendicitis. Moreover, the diagnosis of parasitic infections is only done by post-operative histopathological examination of the appendices. Therefore, our aims are to assess the prevalence of intestinal parasitic infections among patients who were be appendectomized at Tanta Hospitals, Egypt and to investigate the possible association between these parasitic infections and appendicitis. To achieve these objectives, we performed a cross-sectional study including 65 patients chosen randomly who had undergone appendectomy over a period of one year from Oct 2015 to Oct 2016. Demographic data were retrieved. Complete blood picture was done. Moreover, appendiceal faecolith were examined macroscopically then by direct smear examination, formol-ether concentration technique, modified Ziehl-Nelseen stain and rapid immunochromatographic test. Histopathological examination of resected appendices was done. We found that parasitic infections were detected in 24.6 % of examined cases. Most of parasitic infections were prevalent in patients belonging to the school age group. Different parasitic infections were detected in the faecolith specimens. Moreover, Enterobious vermicularis adult female and Schistosoma mansoni granuloma were detected in histopathological sections. Also, a spectrum of pathological changes in the appendices was found ranging from lymphoid hyperplasia to acute inflammation with peritonitis. In conclusion, intestinal parasites may cause clinical picture similar to that of acute appendicitis. Therefore, careful attention to clinical history, stool examination and high eosinophilia may aid diagnosis and avoid unnecessary appendectomy. Moreover, the presence of different parasitic stages in the narrow lumen of the appendix may have a role in the development of appendicitis and this needs further studies.

Adenocarcinoma of the appendix mimicking complicated appendicitis in the elderly: A report of two cases

Introduction. Primary appendiceal adenocarcinoma is a very rare malignancy which accounts for 0.1% of all appendectomy specimens. In both patients presented in this paper, appendectomy was performed due to suspected acute complicated appendicitis. Case Reports. The first patient, a 77-year-old man, presented with a low grade colonic-type pT3 adenocarcinoma of the appendix, diagnosed by histopathological examination of the resected appendix delivered in a fixative. A month after appendectomy, the patient underwent right hemicolectomy of a tumor at the edge of the resection. Due to a cardiovascular disease, adjuvant chemotherapy was not indicated. The second patient, a 74-year-old female, presented with a low grade mucinous adenocarcinoma of the appendix with subserous infiltration, diagnosed by histopathological analysis of the resected appendix. Eight months after appendectomy, the patient developed a recurrent tumor in the cecal area. After radical surgical excision of the recurrent tumor, the patient received adjuvant chemotherapy. Both patients had a 5-year survival without relapse. Conclusion. Preoperative diagnosis of appendiceal adenocarcinoma is a challenge due to overlapping symptoms of complicated acute appendicitis. Our results suggest that in elderly patients with symptoms of complicated acute appendicitis, appendectomy should be done with intraoperative histopathological frozen section consultation. In advanced stages of adenocarcinoma, right hemicolectomy is a better choice than appendectomy.

Impact of histopathological examination of appendix in context to clinical management of patients

Background: Acute appendicitis is one of the common conditions requiring emergency surgery. In routine practice , appendix is sent for histolopathological examination only when the operative findings are inconclusive. In view of this trend in clinical practice this study was carried out to assess the value of routine histopathological examination of surgically resected appendices, to review spectrum of histopathological diagnosis of appendectomy done at our institute over a 22 months period, some of which would further have effect on patient management and prognosis. Methods: A retrospective study was done including appendicectomy specimens received at histopathology section of Department of Pathology at Tertiary care centre in South Gujarat during January 2015 till October 2016 . Result: Total 400 cases were reviewed . Out of these, clinically suspected appendicitis was found in 365 (91.3 %) cases including spectrum of appendicitis (acute, subacute, chronic, ulcerative, suppurative, necrotizing, gangrenous, acute with periappendicits,acute on chronic) . Unusual unexpected findings were found in 20 (5 %) cases[tuberculosis, amoebiasis, faecolith, congestion with sickle RBCs, mucocele and neoplastic lesions including carcinoid, adenocarcinoma, mucinous cystadenoma(low grade appendiceal mucinous neoplasm)]. Conclusion: Though majority of cases had the usual features, 20 of these 400 specimen (5 %) had an impact on patient management or outcome. They were not suspected on macroscopic examination at the time of surgery and would have been missed had the specimens not been examined microscopically. Intraoperative diagnosis of surgeon is therefore unreliable in detecting abnormalities of appendix. This study supports the sending of all appendicectomy specimens for routine histopathological examination.

Incidental appendectomy during robotic laparoscopic prostatectomy-safe and worth to perform?

The purpose of this study is to investigate the safety and patients' benefit of incidental appendectomy during robot-assisted laparoscopic radical prostatectomy (RALRP). Fifty-three patients, who had incidental appendectomy during RALRP between January 2012 and March 2014, were enrolled to this study. To evaluate the safety of the procedure, following parameters were evaluated: patient age, duration of surgery, perioperative complications (classified by Clavien-Dindo), time to bowel movement, and length of hospital stay. Furthermore, intraoperative visual appearance, location, and histopathological evaluation of the appendix were evaluated. Data was analyzed by descriptive statistics. Mean age of patients was 61years, the average hospital stay 5days. No perioperative complications occurred. The appendix was unsuspicious in 39 patients (73.6%); 14 patients (26.4%) had macroscopically signs of inflammation. Of the 53 resected appendixes, the histopathological evaluation showed 33 (62.2%) inconspicuous appendices, 11 (20.8%) post-inflammatory changes, 4 (7.5%) with chronical signs of inflammation and 3 (5.7%) with signs of acute inflammation. In 2 patients (3.8%), low-grade mucinous neoplasms were found in the specimens. Incidental appendectomy during RALRP is a feasible procedure. With regard to inflammation and neoplastic changes, incidental appendectomy can be considered for patients scheduled for robot-assisted prostate surgery.

Right lower quadrant pain as the first manifestation of appendiceal diverticulosis in a 66-year-old male

Appendiceal diverticulosis is a rare condition that can lead to diverticulitis, which imitates the clinical findings of acute appendicitis. Preoperative diagnosis is difficult, and identification is usually made postoperatively, on the basis of the histological examination of the resected appendix. The case is reported here of a 66-year-old male, who presented with the symptoms and signs of acute appendicitis, which proved on surgery to be due to rupture of an appendiceal diverticulum, with no underlying neoplasm.

Incidental appendectomy during mini incision post-partum sterilization (Chokchai technique): A prospective cross-sectional study.

We aimed to determine the success rate of incidental appendectomy during post-partum sterilization (PPS) using the Chokchai technique and to compare the postoperative morbidity between patients who underwent this procedure with those who underwent simple PPS. Appendectomy during PPS was performed in 141 patients from 1 May 2012 to 30 April 2014. The control group consisted of 182 simple PPS patients. Primary outcomes were the success rate of the procedure and secondary outcomes were postoperative morbidity and complications. The success rate of this procedure was 98.6%. There was no statistically significant difference in intraoperative blood loss, hospital length of stay, or postoperative morbidity. Appendectomy added 7.5 min to the total procedure. Intravenous sedation requirements were 13.7% and 33.3% in the control and study groups, respectively. Pathologic evaluation of resected appendices revealed 15 abnormalities (10.8%), including two cases of periappendicitis (1.4%). When carried out by experienced surgeons and with appropriate anesthesia, incidental appendectomy during PPS is safe. The Chokchai technique (approach through a small periumbilical incision) achieved a high success rate and resulted in minimal scar. Incidental appendectomy not only prevents any future appendicitis but also helps to detect periappendicitis and treat its primary cause. However, this is an option for only selected patients who are clearly informed about the possible risks and benefits of the procedure.

Visceral and somatic pain modalities reveal NaV 1.7-independent visceral nociceptive pathways.

Voltage-gated sodium channels play a fundamental role in determining neuronal excitability. Specifically, voltage-gated sodium channel subtype NaV 1.7 is required for sensing acute and inflammatory somatic pain in mice and humans but its significance in pain originating from the viscera is unknown. Using comparative behavioural models evoking somatic and visceral pain pathways, we identify the requirement for NaV 1.7 in regulating somatic (noxious heat pain threshold) but not in visceral pain signalling. These results enable us to better understand the mechanisms underlying the transduction of noxious stimuli from the viscera, suggest that the investigation of pain pathways should be undertaken in a modality-specific manner and help to direct drug discovery efforts towards novel visceral analgesics. Voltage-gated sodium channel NaV 1.7 is required for acute and inflammatory pain in mice and humans but its significance for visceral pain is unknown. Here we examine the role of NaV 1.7 in visceral pain processing and the development of referred hyperalgesia using a conditional nociceptor-specific NaV 1.7 knockout mouse (NaV 1.7Nav1.8 ) and selective small-molecule NaV 1.7 antagonist PF-5198007. NaV 1.7Nav1.8 mice showed normal nociceptive behaviours in response to intracolonic application of either capsaicin or mustard oil, stimuli known to evoke sustained nociceptor activity and sensitization following tissue damage, respectively. Normal responses following induction of cystitis by cyclophosphamide were also observed in both NaV 1.7Nav1.8 and littermate controls. Loss, or blockade, of NaV 1.7 did not affect afferent responses to noxious mechanical and chemical stimuli in nerve-gut preparations in mouse, or following antagonism of NaV 1.7 in resected human appendix stimulated by noxious distending pressures. However, expression analysis of voltage-gated sodium channel α subunits revealed NaV 1.7 mRNA transcripts in nearly all retrogradely labelled colonic neurons, suggesting redundancy in function. By contrast, using comparative somatic behavioural models we identify that genetic deletion of NaV 1.7 (in NaV 1.8-expressing neurons) regulates noxious heat pain threshold and that this can be recapitulated by the selective NaV 1.7 antagonist PF-5198007. Our data demonstrate that NaV 1.7 (in NaV 1.8-expressing neurons) contributes to defined pain pathways in a modality-dependent manner, modulating somatic noxious heat pain, but is not required for visceral pain processing, and advocate that pharmacological block of NaV 1.7 alone in the viscera may be insufficient in targeting chronic visceral pain.

Is the Pinworm Causing Acute Suppurative Perforating Appendicitis in Children? A Case Series

Introduction: The pinworm Enterobius vermicularis is the most common parasite reported to be associated with appendicitis. It frequently occurs in children between the age of 5 to 10 years. The aim of our study is to focus on the relationship between the pinworm and acute suppurative perforating appendicitis. Case series: 4 children from rural areas of Upper Egypt with mean age 11 years presented to emergency department Aswan and Assiut universities hospitals during the period from March 2016 to January 2017 complained of right lower quadrant abdominal pain. The appendix in all children was perforated at the base or the middle of the appendix with mobile pinworm was noted moving around the perforated edge. Discussion: Pinworm was associated with different pathologic changes ranging from lymphoid hyperplasia, acute appendicitis, and suppurative appendicitis to a normal appendix. It is wrangling whether pinworm can cause appendicitis or if they are an incidental finding during an appendectomy. Conclusion: The awareness of pinworm and its preventive measures should be delivered to school children and their mothers to overcome the risk of infection and its dangerous drawback. The importance of histopathological and faecolith examinations to the resected appendix specimens to detect the correct incidence of pinworm causing appendicitis in Egypt.

Appendicitis caused by the metastasis of HER2-positive breast cancer.

The appropriate therapy for metastatic breast cancer must be selected based on the immunohistochemical phenotype of the cancer. However, biopsy for metastatic lesions is difficult. We herein report a patient with incidental appendicitis caused by a metastatic breast cancer which was successfully treated with effective therapy chosen based on the pathological diagnosis obtained on resection. The patient was a 56-year-old female with right breast cancer and an immunohistochemical status of estrogen receptor (ER) (+), progesterone receptor (PgR) (+), human epidermal growth factor receptor 2 (HER2) (3+), and Ki67 40 %. She received epirubicin and cyclophosphamide therapy followed by docetaxel and trastuzumab, and total mastectomy with axillary dissection was performed. Thereafter, she received postmastectomy radiation, adjuvant trastuzumab, and adjuvant hormone therapy with letrozole. One year and 8 months after the operation, she developed right hydronephrosis and swollen para-aortic lymph nodes and her hormone therapy was changed to fulvestrant therapy. However, she additionally developed left hydronephrosis and multiple bone metastases, and pertuzumab, trastuzumab, and docetaxel therapy was started. After six cycles, her disease became well-controlled, and maintenance with pertuzumab and trastuzumab was introduced. However, after another 7 months, she developed new vertebral metastasis and acute appendicitis and laparoscopic appendectomy was performed. A pathological investigation of the resected appendix revealed some clusters of atypical cells in the subserosa and muscle layer, which showed an immunohistochemical status of ER (+), PgR (−), HER2 (3+), and E-cadherin (−). These findings led to the diagnosis as appendiceal metastasis of invasive lobular carcinoma (ILC) from the breast. Thereafter, she received trastuzumab-DM1 and her disease was well-controlled again. Appendicitis caused by breast cancer is very rare. However, ILC sometimes develops metastases in the abdominal cavity; an appendiceal tumor should therefore be included in the differential diagnosis. A pathological diagnosis of metastatic tumor could be very useful for selecting the effective therapy.

Acute Appendicitis and Periappendicitis Revealing Squamous and Transitional Cystic and Solid Nests in Adult Patients: Metaplasia or Vestigeal Remnants?

Squamous metaplasia of the appendix serosa is rare. We aimed to report the clinical and morphological features of 3 such cases. The patients presented with abdominal pain (n = 1 man, 2 women; age range, 29–35 years). The clinical diagnosis was appendicitis/periappendicitis (in the context of hydro/pyosalpinx). The surgical resected appendix showed several cystic and solid epithelial nests (1 mm and less) in the serosa/subserosa. Epithelial cells expressed p63, cytokeratin 5/6, as well as cytokeratins 7, 20, and CD10. Cystic and solid squamous and transitional epithelial nests of the appendix subserosa/serosa in adult patients may be revealed by acute appendicitis/ periappendicitis. The presence of such lesions, metaplastic or vestigial in nature, should be acknowledged since they can be misdiagnosed with metastatic epithelial tumor nests or they may undergo malignant change.

Recurrence rates of resected appendix carcinoid tumors: A 20-year experience at Memorial Sloan Kettering Cancer Center.

221 Background: NETs of the appendix are rare neoplasms most often discovered during incidental appendectomy. Risk of nodal metastases based on single institution series has suggested that appendix carcinoid tumors &gt; 2 cm should undergo a right colectomy. Unlike other tumors, lymph node involvement does not change management given the lack of adjuvant therapies. We sought to evaluate our experience of patients with resected appendix carcinoid, the risk of recurrence, and the benefit of surveillance following resection. Methods: A single institution database of all patients with diagnosis of neuroendocrine tumors was queried for all resected appendix carcinoid tumors. Excluded were patients with large and small cell neuroendocrine tumors, goblet carcinoid, and patients with inaccessible patient records. Results: 88 patients were included from August, 1994 through December, 2013. The mean age at diagnosis was 37.1(9.9-75.8). There were 19 (22%) children (less than 18 years of age) and 69 (78%) adults. Females represented 72% of all patients. All patients had well differentiated tumors. Median follow-up was 2.5 years (1-16.5 years, 45% of which had longer than 3-year follow-up). 43/88 (49%) patients underwent right hemicolectomy (average size 2 cm) and 45/88 (51%) simple appendectomy (average size 0.9 cm). Most patients were followed with CT scans and laboratory evaluations and frequency of surveillance was inconsistent. There were no recurrences (0/88). Ten-year survival was 100%. Conclusions: This is one of the largest series of resected appendix carcinoid reported and no patients recurred. Prognosis was excellent and in the absence of metastatic disease, excessive imaging and/or laboratory testing should be avoided. We question the use of routine right hemocolectomy in these patients.

Xanthogranulomatous Appendicitis Mimicking Residual Burkitt's Lymphoma After Chemotherapy.

The case of a 23-year-old female treated with aggressive high-dose therapy for Burkitt's lymphoma is reported. A positron emission tomography and computed tomography scan after completion of chemotherapy revealed a residual hypermetabolic lesion in the right pelvic cavity. A pelvic magnetic resonance imaging scan showed circumferential wall thickening at the tip of the appendix. A laparoscopic exploration and appendectomy were performed, and a pathologic examination of the resected appendix revealed xanthogranulomatous appendicitis. This is a rare case of a xanthogranulomatous appendicitis mimicking remnant Burkitt's lymphoma after completion of chemotherapy.

Mucocele of the Appendix: A Rare Disease

Introduction: Mucocele of the appendix is caused by a retention cyst, mucosal hyperplasia, mucinous cystadenoma or mucinous cystadenocarcinoma. It is extremely rare, found in 0.2-0.3% of resected appendices in the United States. Early diagnosis is rare due to absent or nonspecific symptoms like right lower quadrant abdominal pain, gastrointestinal bleeding, intestinal obstruction, genitourinary symptoms or acute abdomen. Early diagnosis and resection are important since some appendiceal mucoceles are malignant and may lead to peritoneal dissemination and the clinical syndrome of pseudomyxoma peritonei. Case report: A 74-year-old male presented with intermittent right lower quadrant abdominal pain and hematochezia for 4-6 weeks. He had no pertinent abdominal symptoms including nausea, vomiting, bloating, diarrhea or constipation or weight loss. Routine laboratory testing showed microcytic anemia. He had a colonoscopy 5 years ago which was normal. Repeat colonoscopy showed a protuberant mass at appendiceal orifice which was firm on palpation with biopsy forceps. Biopsy of the lesion showed mild inflammatory changes. With the above described endoscopic appearance of the lesion, clinical suspicion for mucocele was high, hence CT scan was obtained. CT scan showed low attenuation, well-defined 2.5-cm mass, with no signs of inflammation suggestive of mucocele of the appendix. Patient underwent surgery for ileo-caecal resection. Histopathology of the surgical specimen was reported as mucinous cystadenoma of appendix. On 3-month follow-up, patient is doing well and his anemia is resolving. Discussion: Appendiceal mucoceles may be recognized at colonoscopy as an extrinsic or submucosal lesion with smooth indentation into the caecal lumen. Appearance of the appendiceal orifice in the center of the mound has been labeled as the “volcano sign.” Highly suggestive endoscopic finding is that of a glossy, rounded, balloon-shaped mass protruding from the appendiceal orifice and moving in and out with respiration. This case highlights the importance of endoscopic appearance of appendiceal mucocele which can be missed on a biopsy. Further imaging is warranted when mucocele of appendix is suspected on colonoscopy. Recognition at colonoscopy is important as it enables accurate diagnosis of this rare clinical entity. Surgical excision of the tumor without rupture is of paramount importance because rupture of the lesion causes pseudomyxoma peritonei. Survival is excellent after standard appendectomy of retention cysts, mucosal hyperplasia, or cystadenoma.

Suprapubic single-incision versus conventional laparoscopic appendectomy

BackgroundSuprapubic single-incision laparoscopic appendectomy (SSILA), a promising new approach with potential benefits such as improved cosmetic results, has been preliminarily shown to be safe and feasible in previous single-arm studies. This study used a propensity-matched analysis to compare SSILA and conventional laparoscopic appendectomy (CLA). MethodsPatients undergoing SSILA between March 2012 and November 2013 were matched with patients undergoing CLA during the same period at a single institution. These patient groups were compared using a propensity score analysis. The model covariates for the propensity scores included gender, age, body mass index, American Society of Anesthesiologists score, history of abdominal operation, and pathology of the resected appendix. The clinical outcomes were compared between the two groups, and the cosmetic results were evaluated via a patient scar assessment questionnaire and an objective scar evaluation scale. ResultsNo patient in either group required additional port placement or conversion to open surgery. One patient in the SSILA group developed a wound infection, and one patient in the CLA group developed a postoperative intra-abdominal abscess. No significant differences were observed between the groups with respect to the length of hospital stay, time to semi-liquid diet, time to first flatus or hospital cost. The operative time and the number of patients requiring postoperative analgesics were greater with SSILA. Compared with CLA, SSILA was associated with better scores in the patient scar assessment questionnaire consciousness subscale and with similar scores in the appearance, satisfaction with appearance and satisfaction with symptoms subscales. The two approaches yielded similar results for the objective scar evaluation scale. ConclusionsSSILA is a feasible and safe approach with similar outcomes as CLA. SSILA results in reduced scar consciousness at the expense of relatively longer operative times and more postoperative analgesic use.

Histopathological correlations of appendectomies: a clinical audit of a single center.

Acute appendicitis is a common presentation in surgical assessment units and appendectomy accounts for a large number of emergency operations in the UK. Histopathological examination of the appendectomy specimens are routinely carried out. The aim of this study is to correlate the histological findings of appendectomy specimens with the clinical diagnosis of acute appendicitis. This is a retrospective analysis of 238 appendectomies carried out in a single UK center between January and December 2013. The Histopathology reports of appendectomy specimens were retrieved. A total of 238 appendectomies were performed during the study period. The mean age of the patients was 32 years (range, 7-81 years). Adult patients (>16 years) represented 79.4% of the study population. The female sex accounted for 46.6% of all the patients. Of the 238 resected appendix, 211 (88.7%) had histopathology findings consistent with appendicitis. Approximately 1.7% of the 238 specimens were abnormal pathologies other than inflammation of the appendix. The negative appendectomy (normal appendix on histology) rate was 11.3%. The female sex accounted for 59.1% of the negative appendectomies. Adults (>16 years) represented 77.8% of the negative appendectomies. The observed high rates of negative appendectomy in the female sex can be reduced by utilizing combined clinical assessment and diagnostic imaging modalities. The findings of abnormal pathologies on histopathological examination of the appendix which could potentially impact on the management of the patients justify the current practice of routine histopathological examination of resected appendix.

Cytomegalovirus appendicitis in solid organ transplant patients, two cases and a review

Cytomegalovirus (CMV) disease is a common complication following solid organ transplantation with a variety of gastrointestinal (GI) tract manifestations. CMV appendicitis, however, is a rare complication in a solid organ transplant patient, having been reported only once previously. We have recently seen two cases in solid organ transplant recipients at our institution, one a liver recipient and the other a heart recipient. Both patients underwent surgical resection. Pathologic evaluation of both resected appendices as well as polymerase chain reaction (PCR) amplification for CMV from the serum revealed the virus as the etiology. Both patients received induction intravenous ganciclovir followed by oral valganciclovir and have done well post-operatively. Tissue-invasive CMV disease should be considered in the differential diagnosis for solid organ transplant patients with symptoms suggesting acute or chronic appendicitis. Both PCR testing as well as pathologic review of tissue specimens should be considered to ensure accurate diagnosis and management.

Carcinoid tumor of the appendix: A case report.

Carcinoid tumors are the most common neoplasm of the appendix. The clinical presentation of these lesions is often similar to that of acute appendicitis, or the tumors are asymptomatic. The carcinoids are commonly found incidentally during histopathological examination of the resected appendix following appendectomy or other abdominal procedures. Appendiceal carcinoids usually behave as benign tumors and appendicectomy alone is a sufficient treatment in the majority of cases, while for larger lesions, right colectomy should be performed. The prognosis of patients with local appendiceal carcinoids is excellent. The present study reports the case of a 22-year-old female patient that presented with recurrent right lower abdominal pain of a three-year duration. The patient underwent successful appendectomy and recovered four days later. Subsequently, an appendiceal carcinoid tumor located at the tip of the appendix was diagnosed by histopathological examination. Follow-up examination one year after surgery revealed that the patient was well with no discomfort.