Search

Large B‐cell lymphomas (LBLs) comprise a genetically heterogeneous group of clinically aggressive non‐Hodgkin lymphomas, frequently exhibiting overlapping features with diffuse large B‐cell lymphoma and Burkitt's lymphoma. We report a case of a 24‐year‐old, previously healthy male with a classical clinical presentation of acute appendicitis. The pathologic examination discovered a large B‐cell lymphoma with MYC and BCL6 rearrangements in the excised appendix. The patient was assigned Stage IEA, IPI = 0 and received chemotherapy. This case depicts a very uncommon occurrence of fully localized LBL in a patient of an unusually young age and clinical presentation for this type of lymphoma. [ABSTRACT FROM AUTHOR]

Purpose: The variable positions of the appendix can mislead surgeons and physicians to a wrong diagnosis. When appendicitis happens in subhepatic caecum, it can be misdiagnosed and can lead to severe complications during surgical procedures. Therefore, this study aimed to understand the histomorphometric development of the appendix and caecum and to identify when lymphoid follicles appear in the appendix during fetal life. Methods: The study was conducted on a total of 50 fetuses. The caecum and appendix were carefully dissected. Their position and various measurements were observed. Afterwards, the appendix was taken out for histological processing. All three layers, mucosa, submucosa, and muscularis externa were measured using Image Analyzer Software Image Pro Premiere 9.1, and the appearance of lymphoid follicles was also examined. Results were analyzed using SPSS statistical software. Results: During the 1st, 2nd, and 3rd trimesters the most common caecum type was type 1: as a lengthy tube, type 3: The lateral wall expanded more, thus it has an asymmetric saccule, and type 4: adult-like caecum. The caecum was mostly situated in the right lumbar region in the 2nd and 3rd trimesters. In the 1st trimester, it was subhepatic in position. The most common position of the appendix was 11 o'clock in 1st and 3rd trimesters. 2nd trimester's most common position of the appendix was 12 o'clock. The thickness of the mucosa, submucosa, and the muscularis externa increases as the trimester increases. The lymphoid follicles have appeared during the 2nd trimester. Conclusion: The knowledge from this study will be useful in the diagnosis and treatment of malformations, pathology, and anomalies of the caecum and appendix due to congenital causes. [ABSTRACT FROM AUTHOR]

Objective: Rare coexistence of disease or pathology. Background: Pelvic inflammatory diseases and tubo-ovarian abscesses (TOAs) are rarely seen in non-sexually active (NSA) women. While the pathogenesis of TOA remains unclear, its risk factors include ascending infection of the genital tract, gastrointestinal tract translocation, congenital genitourinary anomalies, as well as virulence of the causative agents, with preceding bacteremia and septicemia. Case Report: Herein, we present the case of a 25-year-old female patient who was initially diagnosed with ovarian torsion and underwent diagnostic laparoscopy. Her intraoperative findings included bilateral TOAs and adhesions. Owing to this uncommon presentation, further investigation was conducted, including postoperative computed tomography. The results showed a likelihood of a perforated appendix, with a repeat laparoscopy confirming this diagnosis. Appendectomy and drainage were done. The microbial culture from the ovarian abscess revealed Streptococcus constellatus, a commensal organism found in the oral, gastrointestinal, and urogenital flora. This microorganism is rarely isolated as a pathogenic organism in immune-competent populations. Furthermore, the histopathology report of the appendix showed a rare occurrence of chronic active diverticulitis, with perforation and peri-appendicitis. Conclusions: TOA in NSA women should be considered when evaluating differential diagnoses, with the possibility of infection with an atypical organism. Broad-spectrum antibiotics or multidrug therapy should be administered. When suspicion is raised, an imaging study with a broader view to detect the pathology of other organ systems is recommended. Lower abdominal pain in young female patients still poses a diagnostic dilemma and should be investigated; however, when the clinical presentation suggests a gynecological emergency, the time frame can pose challenges. [ABSTRACT FROM AUTHOR]

Introduction: Appendicitis is a common cause of acute abdomen. Rarely, it may form adhesions to nearby structures, complicating surgeries, especially when involving vascular structures such as the internal iliac artery, potentially causing severe intraoperative hemorrhage. Case presentation: A 65-year-old Middle Eastern male presented with abdominal pain and anorexia for 5 days. Examination and imaging confirmed acute appendicitis with complications. Additionally, a large pelvic mass was noted. During surgery, severe bleeding was encountered due to an adhesion between the appendix and the right internal iliac artery, managed by ligating the artery. The patient recovered well and was discharged in stable condition. Histopathology confirmed the diagnosis. Conclusion: This case highlights a rare vascular complication of appendectomy due to abnormal adhesions between the appendix and the internal iliac artery, associated with a large pelvic mass. This study emphasizes the need for thorough preoperative evaluation and careful surgical planning in patients with unusual anatomical variations or specific underlying conditions such as neurofibromatosis. Early recognition and strategic management of vascular adhesions are essential to optimize patient outcomes in appendectomies complicated by such rare scenarios. [ABSTRACT FROM AUTHOR]

Low‐grade appendiceal mucinous neoplasm (LAMN) is principally characterized by low‐grade cytology without evidence of invasion to other organs. We report a LAMN surgical case whose appendiceal tumor penetrated the sigmoid colon wall. An 87‐year‐old man was referred for endoscopic resection (ER) of a colon polyp. Despite four ERs over 5 years, the polyp recurred at the same site. Laparoscopic surgery revealed a dilated appendix firmly attached to the sigmoid colon. We performed en bloc resection of both the sigmoid colon and appendix without tumor exposure. The histopathological evaluation showed that the LAMN had penetrated the sigmoid colon wall, forming two polyps on the colonic mucosa. In cases where the appendiceal‐colonic fistula is suspected, en bloc resection of the appendix and colon wall should be considered. [ABSTRACT FROM AUTHOR]

Introduction. Amyand’s hernia is a condition in which the cecal appendix is contained within the inguinal hernia sac, its diagnosis and management continue to be a challenge as it is a rare pathology. Case report. A 10-month-old male infant with a history of extreme prematurity presented a right Amyand’s hernia and a normal appendix. The appendix was returned to the cavity and the hernia was repaired. Result. After one year of follow-up, the patient had no complications. Conclusions. Has been reported that the risk of incarceration in full-term children is 12% and in premature babies it is 39%, therefore, surgical repair of an inguinal hernia is always necessary. There is no standard treatment for Amyand hernia in children, therefore the CiX classification could be considered for management. A treatment proposal is presented in the pediatric population, where three types were included, considering the evolutionary stage of the cecal appendix and that almost all inguinal hernias in children are due to persistence of the vaginal process; therefore, surgical treatment only includes herniotomy. By not using prosthetic material, handling is facilitated and the risk of infection is reduced. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Rarely, appendiceal neuroendocrine tumours (NET) are an incidental finding when an appendicectomy is undertaken for suspected appendicitis. The role of further imaging in this setting is poorly defined. Positron emission tomography (PET) using 68Ga‐DOTATATE is requested to evaluate post‐surgical status, however, there is little evidence to guide how it should be employed. The aims of this project are to: (i) characterize 68Ga‐DOTATATE PET findings in patients with incidental appendiceal NETs and (ii) discuss how these data might inform post‐surgical imaging with PET.We reviewed 47 PET scans in 30 patients, undertaken from 2009 to 2018. Scintigraphic findings, histopathological characteristics of the initial appendiceal lesion and medical records were reviewed.Most patients (n = 15) had small (<10 mm) appendiceal NETs with low grade (Ki67 < 2%) features. Eight patients had tumours between 10 and 20 mm, and seven had tumours >20 mm. Goblet cell features were identified in two patients. Three positive PET scans were reported in one patient with an index tumour measuring 40 mm and Ki67 < 2%. The remaining 29 patients had 44 negative scans. Clinical outcome data were available in 27 patients (mean follow‐up time 57 months; range 6–123 months). There was no evidence of recurrent neuroendocrine disease at the time of the last follow‐up.These data indicate that in most cases, post‐surgical 68Ga‐DOTATATE PET is negative in patients with incidentally detected appendiceal NETs. Clinical outcome data suggest that 68Ga‐DOTATATE PET should be reserved for patients with large tumours (>20 mm) or those displaying goblet cell features. [ABSTRACT FROM AUTHOR]

This paper addresses the idiosyncratic cluster simplification patterns observed in a child with disordered phonological development, who is acquiring Greek. The child has mastered word-internal and word-final codas and clusters of reversed sonority. However, the child does not realise the target well-formed tautosyllabic [Obstruent+Liquid] clusters with rising sonority. The child's system requires a single onset with maximum sonority dispersion between the onset and the syllable nucleus. As a result, cluster simplification occurs, via reduction to the less sonorous Obstruent – the most prevalent reduction pattern cross-linguistically. However, at the same time, the grammar requires faithful realisation of the target segment number. This requirement is fulfiled through two distinct conspiring metathesis patterns, distributed complementarily, resulting in the realisation of marked structures. The patterns depend on the position of the cluster within the target word. In word internal position, a compensatory metathesis of the Liquid takes place in the preceding syllable coda. In word initial position, the Manner of Articulation of the metathesised Liquid is delinked, while its Coronal Place of Articulation is faithfully preserved, and is realised by default as a Coronal Sibilant [s]. The latter Sibilant is attached as an appendix to the syllable node at the word left-edge. We argue that, in the grammar of this child, there is a-synchronisation between the development of the prosodic word layer and the development of syllable layer. Specifically, a-synchronisation is evident in the development of the (branching) onset syllabic subconstituent. [ABSTRACT FROM AUTHOR]

Lipoleiomyoma is relatively rare, and even rarer to appear in the uterus and extrauterine at the same time. We report a case of multiple lipoleiomyoma of uterine and extrauterine. The patient was suggested the possibility of a teratoma of the right ovary, and recommended laparoscopic exploratoration. A right posterior uterine wall inter teratoma muscular exophytic nodule, a solid mass at the end of the appendix and a solid peritoneal mass in the posterior wall of the bladder were found during operation. Postoperative histological pathology and immunohistochemistry showed the lipoleiomyoma. Lipoleiomyoma is a rare benign tumor, mostly in the uterus. The occurrence of extrauterine lipoleiomyoma may be attributed to implantation after gynecological surgery. Clinical symptoms of uterine and extrauterine lipoleiomyoma are atypical. As the fat within the mass can be detected on imaging examination, especially when the mass is adjacent to the adnexal, it is more likely to be misdiagnosed as ovarian teratoma. MRI should be performed if necessary, to improve the detection rate. The treatment of uterine and extrauterine lipoleiomyoma is mainly surgical resection, with a good prognosis. There is a risk of malignant transformation or coexistence with other gynecological malignancies, so the long-term postoperative follow-up is required. [ABSTRACT FROM AUTHOR]

The vermiform appendix, once deemed vestigial and largely overlooked in medical circles, has recently captured renewed attention for its potential immunological functions. This review comprehensively explores various aspects related to the appendix, including its historical marginalization, anatomical characteristics, and emerging insights into its role in immunity. Discussion extends to the clinical relevance of the appendix in human health and disease. Additionally, evolutionary perspectives shed light on its persistence across species and potential adaptive significance. As researchers explore further into its immunological roles, new avenues for investigation emerge, promising to uncover further complexities in human physiology. This review aims to present a nuanced understanding of the appendix, encouraging ongoing exploration and recognition of its importance within the human body. [ABSTRACT FROM AUTHOR]

Purpose: Despite their similar clinical characteristics, appendiceal diverticulitis (AD) and acute appendicitis (AA) are pathologically distinct. This study compared the clinical features of AD and AA and identified relevant risk factors. Methods: Patients who underwent appendectomy with a preoperative diagnosis of either AD or AA were categorized based on histopathological findings. The two groups were compared in terms of various clinical factors. Results: Among the 854 patients included in the study, a histopathological evaluation revealed 49 and 805 cases of AD and AA, respectively. A univariate analysis demonstrated that AD was more prevalent than AA among older, taller, and heavier males. A multivariate analysis revealed that male sex, a white blood cell (WBC) count < 13.5 × 103/μL, an eosinophil count ≥ 0.4%, and a mean corpuscular volume (MCV) ≥ 91.6 fL were significant factors differentiating AD from AA. In addition, pathological AD emerged as an independent risk factor for abscess and/or perforation. Conclusions: AD was associated with an older age, robust physique, and significant risk of abscess and/or perforation despite a low WBC count. In addition to imaging modalities, the preoperative factors of male sex, a WBC count < 13.5 × 103/μL, an eosinophil count ≥ 0.4%, and a MCV ≥ 91.6 fL may be useful for distinguishing AD from AA. [ABSTRACT FROM AUTHOR]

Background: Stump appendicitis—a rare, delayed complication of appendectomy—is most commonly managed with surgical exploration and stump appendectomy. Conservative management in the pediatric population is poorly characterized in the literature. Case Report: We report a case of a 10-year-old male who was diagnosed with stump appendicitis and initially treated nonoperatively. He received intravenous antibiotics and supportive therapy while in the hospital, was discharged on a course of oral antibiotics, and remained asymptomatic for the following 9 weeks until he underwent an elective interval stump appendectomy. We also review the literature on this uncommon condition and treatment plan. Conclusion: Considering stump appendicitis in the differential of children with history of appendectomy is imperative. Nonoperative management of stump appendicitis may be successful and beneficial in select pediatric cases compared to the standard surgical management. [ABSTRACT FROM AUTHOR]

Low mucinous neoplasm of the appendix (LAMN) and appendiceal diverticulum are both uncommon pathologies that may pose a diagnostic challenge. Both may present as either appendicitis or asymptomatically and have a risk of perforation. LAMN, carries the additional risk of pseudomyxoma pertitonei and metastasis. Ensuring correct histopathology is crucial, as computed tomography (CT) abdomen/pelvis may only demonstrate a mildly dilated appendix, delaying diagnostic laparoscopy and appendicectomy. Here, we describe the case report of a 56-year-old woman who presented with chronic intermittent right iliac fossa pain initially determined to be chronic appendicitis. Following laparoscopic appendicectomy, histopathology demonstrated LAMN, however, on further re- assessment of histopathology, as well as the completion of a normal pan-CT and colonoscopy, a final diagnosis of ruptured appendiceal diverticulum was made. Our case demonstrates the utility of a multi-disciplinary approach in evaluating patients with possible appendiceal LAMN or appendiceal diverticulum. [ABSTRACT FROM AUTHOR]

Introduction: The accessory appendicular artery (AAA) is an accessory source of blood supply to the appendix. Its existence and potential point of origin are seldom addressed in the literature. Methods: To fill this knowledge gap, we performed a systematic review of all available studies involving both cadaveric and surgical specimens and documented the presence and the origin of the AAA, following the guidelines outlined in the preferred reporting items for systematic reviews and meta‐analysis (PRISMA) statement. Results: Eleven studies, with an overall of 604 specimens were included. Our research revealed that the AAA is notably absent in most cases (83.6%). When present, it most commonly originates from the posterior cecal artery (12.4%), followed by the descending branch of the ileocolic artery (2%), and the ileal branch of the ileocolic artery (0.7%). Instances of origin from the anterior cecal, common cecal, or the ileocolic trunk were even more infrequent. Based on our observations, we introduced a new simplified classification system. Discussion: The effect of an accessory artery on the process of appendicitis remains to be clarified. We firmly recommend that surgeons should consider the possible presence and various origins of the AAA during appendectomy procedures to avoid serious complications. [ABSTRACT FROM AUTHOR]

The role of appendectomy in the pathogenesis of colorectal cancer (CRC) is a recent topic of contention. Given that appendectomy remains one of the most commonly performed operations and a first‐line management strategy of acute appendicitis, it is inherently crucial to elucidate the association between prior appendectomy and subsequent development of CRC, as there may be long‐term health repercussions. In this review, we summarize the data behind the relationship of CRC in post‐appendectomy patients, discuss the role of the microbiome in relation to appendectomy and CRC pathogenesis, and provide an appraisal of our current understanding of the function of the appendix. We seek to piece together the current landscape surrounding the microbiome and immunological changes in the colon post‐appendectomy and suggest a direction for future research involving molecular, transcriptomic, and immunologic analysis to complement our current understanding of the alterations in gut microbiome. [ABSTRACT FROM AUTHOR]

Introduction: To draw attention to possible causes of atypical radiological condition with a "secondary view" in atypical pediatric acute appendicitis cases. To offer solutions in order to minimize possible false negative ultrasonographic evaluation in atypical cases. Materials and Methods: 51 cases were included in this retrospective study. These cases were referred to our hospital because of an atypical acute appendicitis clinic, although ultrasonography was interpreted as normal in other centers in the last 24 hours. All cases were operated on with the diagnosis of acute appendicitis by "second look ultrasonography" performed in our department. Results: None of the cases had typical acute appendicitis clinic. Reasons such as perforation/plastron of the appendix, an atypical localization of the appendix, inflammation only in the distal part of the appendix, visualization of the appendix only with deep-compression, and failure to establish adequate communication with the patient for various reasons were conditions that could lead to atypical acute appendicitis and make imaging difficult. One or more of these were present in all cases. [ABSTRACT FROM AUTHOR]

Objective: Loop ligation of the appendix is a challenging surgical skill and well suited to be trained in a simulator. We aimed to develop an affordable and easy-to-build simulator and test its training effect. Design and participants: Different materials were tested, and the best training modality was identified by researching the literature. The developed simulator training was tested on 20 surgical novices. Results: A video was produced including an instruction on how to build the simulator and a step-by-step tuition on how to ligate the appendix. The Peyton approach was utilized to guide learners. Training with the simulator leads to reliable skill acquisition. All participants improved significantly in completing the task successfully during the structured learning. Conclusion: We succeeded in developing a simulator for loop ligation of the appendix during laparoscopic appendectomy. Participants significantly improve in handling the loops. The transferability of the skill learned during simulation to the operating room will be subject of a follow-up study. [ABSTRACT FROM AUTHOR]

Introduction: Mucocoele of the appendix occurs in 0.2-0.7% of people in the world without any well-defined clinical symptoms. It occurs when there is an accumulation of mucous in the lumen of the appendix. Case Presentation: We present three cases: a 48-year-old male admitted to the emergency room with a one-day history of right iliac fossa pain. Abdominal examination was suggestive of acute appendicitis. The initial abdominal computerised tomography scan was reported as being unremarkable. At surgery, a firm tumour of the appendix was found, and a limited right hemicolectomy was done. Histopathology confirmed a mucocoele of the appendix with borderline mucinous histology. The second case is a 63-year-old man who presented with a one-year history of abdominal distension and weight loss. Previous abdominal ultrasound was suggestive of liver cirrhosis with significant ascitic fluid. Abdominal magnetic resonance imaging found an appendix mucocoele with infiltration of the omentum and scalloping of the liver surface suggestive of pseudomyxoma peritonei. A percutaneous biopsy of the omental mass confirmed metastatic mucinous adenocarcinoma of the appendix. The third case is a 68-year-old man who, during an annual medical check-up, had an incidental finding of a cystic right iliac fossa mass on ultrasound, confirmed on abdominopelvic computerised tomography scan to be an appendix mucocele. He had laparoscopic appendicectomy. The histopathological diagnosis confirmed a mucinous cystadenoma of the appendix. Conclusion: Preoperative diagnosis of appendiceal mucocoele is difficult and commonly discovered intraoperatively. The prognosis is good for the histologically benign type, but it is poor when malignant or peritoneal lesions are present. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bowel obstruction is a common surgical emergency worldwide. It may result into high morbidity or mortality whenever intervention is delayed. It affects all age groups. The most commonly seen etiologies of bowel obstruction are post-operative adhesions, neoplasm and hernia in that order. Intestinal knot syndrome is an extremely rare cause of intestinal obstruction, and when it occurs, it poses diagnostic challenges. We report a case of appendico-ileal knotting causing strangulated small bowel obstruction due to its rarity and diagnostic difficulty. Our objective is to discuss the clinical presentation and management of this rare cause of surgical emergency. CASE: A-72-year old man was seen at the emergency unit of our center with 4 days history of gradual onset of colicky abdominal pain with nausea and vomiting. He had a two-day history of constipation and a one-day history of fever. He was acutely illlooking and his vital signs were abnormal. Urgent abdominopelvic ultrasound and plain abdominal x-ray was performed and were suggestive of intestinal obstruction. He had emergency laparotomy, and intra-operatively appendico-ileal knotting was seen with gangrenous appendix and terminal ileum. This necessitated limited right hemicolectomy and ileo-colonic anastomosis. The patient was managed post-operatively and discharged on post-operative day 10. CONCLUSION: Appendico-ileal knotting is a cause of small bowel obstruction although it is very rare. The diagnosis is commonly confirmed intra-operatively. There are reports of simple small bowel obstruction secondary to appendico-ileal knotting, but this case confirmed that it could also lead to strangulated intestinal obstruction. [ABSTRACT FROM AUTHOR]

Objective: To develop and validate a radiomics nomogram based on computed tomography (CT) to distinguish appendiceal mucinous neoplasms (AMNs) from appendicitis with intraluminal fluid (AWIF). Method: A total of 211 patients from two medical institutions were retrospectively analysed, of which 109 were pathologically confirmed as having appendicitis with concomitant CT signs of intraluminal fluid and 102 as having AMN. All patients were randomly assigned to a training (147 patients) or validation cohort (64 patients) at a 7:3 ratio. Radiomics features of the cystic fluid area of the appendiceal lesions were extracted from nonenhanced CT images using 3D Slicer software. Minimum redundancy maximum relevance and least absolute shrinkage and selection operator regression methods were employed to screen the radiomics features and develop a radiomics model. Combined radiomics nomogram and clinical-CT models were further developed based on the corresponding features selected after multivariate analysis. Lastly, receiver operating characteristic curves, and decision curve analysis (DCA) were used to assess the models’ performances in the training and validation cohorts. Results: A total of 851 radiomics features were acquired from the nonenhanced CT images. Subsequently, a radiomics model consisting of eight selected features was developed. The combined radiomics nomogram model comprised rad-score, age, and mural calcification, while the clinical-CT model contained age and mural calcification. The combined model achieved area under the curves (AUCs) of 0.945 (95% confidence interval [CI]: 0.895, 0.976) and 0.933 (95% CI: 0.841, 0.980) in the training and validation cohorts, respectively, which were larger than those obtained by the radiomics (training cohort: AUC, 0.915 [95% CI: 0.865, 0.964]; validation cohort: AUC, 0.912 [95% CI: 0.843, 0.981]) and clinical-CT models (training cohort: AUC, 0.884 [95% CI: 0.820, 0.931]; validation cohort: AUC, 0.767 [95% CI: 0.644, 0.863]). Finally, DCA showed that the clinical utility of the combined model was superior to that of the clinical CT and radiomics models. Conclusion: Our combined radiomics nomogram model constituting radiomics, clinical, and CT features exhibited good performance for differentiating AMN from AWIF, indicating its potential application in clinical decision-making. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a 78-year-old female who presented with lower abdominal pain due to an obstructing fecolith at the entrance of the appendix. The patient had a history of medically treated acute appendicitis. The article describes the endoscopic removal of the fecolith using an endoscopic snare, followed by intubation into the distal appendiceal lumen to drain pus. The patient experienced complete resolution of symptoms after the procedure. The study highlights the effectiveness of endoscopic retrograde appendicitis therapy (ERAT) in managing this rare and challenging clinical condition, avoiding the need for surgery. [Extracted from the article]

Mucinous appendicular neoplasms are a rare and heterogeneous group of tumors, whose treatment may vary based on histologic features and extent. We present a case of low-grade appendiceal mucinous neoplasm mimicking an acute appendicitis scenario. The patient underwent appendectomy along with resection of the caecal fundus. Choosing the correct treatment according to the case by following current guidelines is crucial to avoid under- or overtreatment. [ABSTRACT FROM AUTHOR]

Ganglioneuromas (GN) are benign neuroblastic tumors that arise from neural crest cells. Since they present with nonspecific symptoms, diagnosis is often incidental. We are reporting a case of an adult appendiceal GN incidentally found during rectal cancer surgery. A 42-year-old male was diagnosed with recurrent rectal cancer after experiencing urinary difficulties and buttock pain. A multiple-stage pelvic exenteration was carried out after neoadjuvant chemotherapy and chemoradiation. Prophylactic appendectomy was done during the course of surgery, and pathology reported an appendix with GN at the distal tip. GN are often found incidentally and rarely cause appendicitis. Depending on their location and size, they might become symptomatic. While there is some controversy on whether surgery is the treatment of choice for all GN, diagnosis is rarely apparent preoperatively, and all appendiceal masses should be resected. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis (AA) is the most common surgical emergency in patients who visit the emergency department with abdominal pain. In some of the patients who were operated with a prediagnosis of AA, lymphoid hyperplasia, fecalitis, enterobius vermicularis, carcinoid tumor, or adenoma are determined without transmural inflammation in microscopic examination. 'Submucosal lipomatosis' is also another entity that has been rarely reported in appendix localization. In this study, we aimed to determine the frequency and severity of submucosal fatty tissue (SFT) in appendectomy specimens and identify risk factors. Materials and Methods: 293 appendectomy specimens were evaluated retrospectively. The amounts of SFT (A0: None, A1: Isolated adipocytes (Mild), A2: Small adipocyte groups (Moderate), A3: Prominent adipocyte groups (Marked), A4: Severe adipocyte groups that narrow the lumen (Severe)) and the groups that were created according to the amounts of SFT (Group 1: Cases with A1,2,3,4, group 2: Cases with A2,3,4, group 3: Cases with A3,4) were determined in hematoxylin-eosin sections. Results: 91.47% of the cases had different amounts of SFT. Amounts of SFT were mild in 23.89%, moderate in 46.76%, marked in 18.09%, and severe in 2.73%. All of the cases without SFT were in pediatric age. It was observed that the a mount of SFT increased with i ncreasing age (p<0.05). As 68% of the cases without SFT were female, male predominance was observed in cases with SFT. There was a correlation between male gender and increase in the amount of SFT (p<0.05). AA wasn't determined in 26,28% of the cases. The AA rate in the group without SFT (20%) was marked lower than group 1 (78,73%), group 2 (82,32%), and group 3 (83,87%) (p<0.05). The most prominent increase in AA rate was between the group without SFT and group 1 which was the most sensitive group to the amount of SFT. When group 1,2,3 were compared, no significant increase in the AA ratio was found. Conclusions: The presence of SFT in the appendix is a common condition. Age increase and male gender are risk factors for the accumulation of SFT. Because of SFT accumulation increases the risk of AA, it would be logical to classify it as mild/moderate/marked/severe, and accept it as 'Submucosal lipomatosis'. [ABSTRACT FROM AUTHOR]

Aim of the Study To determine if the site of perforation of appendix has any effect on post-operative complications. Methodology Patients with diagnosis of appendicular perforation confirmed intra-operatively were allocated into 3 groups based on the site of perforation (Group A - Tip, Group B - Base, Group C - Body of appendix). The patients where a definite site of perforation could not be found were excluded. Baseline data, Intra-operative complications, prevalence of risk factors and post-operative outcomes were noted. Results Total of 57 patients were included in the study. Group A had 31 patients, Group B had 20 patients and Group C had 6 patients. The prevalence of risk factors found in this study were, time delay till appendectomy (68.42%), male gender (68.42%), presence of faecolith (57.89%), age over 50 years (43.86%), diabetes mellitus (33.33%) and history of previous surgery (36.84%). 4 out of 20 patients in Group B had iatrogenic bowel injury compared with 2 out of 31 patients of Group A. 3 patients of Group B had a gangrenous base without a residual healthy stump. The patients with perforation at the base had higher length of hospital stay (p- value 0.031) and mean CCI score (p- value 0.036) compared with other groups. Conclusion Patients with perforation of appendix base had higher incidence of intraoperative and postoperative complications. Knowing the site of perforation may help the surgeon to plan a proper intraoperative and postoperative management protocol. [ABSTRACT FROM AUTHOR]

Background: In the most severe stage of endometriosis, Stage IV, intestinal involvement is common. The true prevalence of endometriotic disease of the appendix in this population is not well described. A macroscopically normal looking appendix may harbour endometriosis. Aims: Our study aims to assess the role of routinely performing appendicectomy in Stage IV endometriosis surgery, and the histopathological prevalence of true appendiceal endometriosis in this population. Methods: This is a retrospective study of women undergoing surgery for Stage IV endometriosis between 2018 to 2022 in a tertiary public hospital in New South Wales, Australia. Patient demographics, age and post‐operative complications were retrospectively retrieved from hospital medical records. Inclusion criteria were women with Stage IV endometriosis who underwent routine appendicectomy as part of their endometriosis surgery. Exclusion criteria were women who did not have Stage IV endometriosis, those who had cancer surgery or emergency surgery for endometriosis. The primary outcome of this study was to determine the incidence of appendiceal endometriosis. Secondary outcomes included post‐operative complications and length of stay. Results: Sixty‐seven patients were included. The mean age was 36 years. All patients also underwent bowel resection for colorectal endometriosis. There were 35.8% who had confirmed appendiceal endometriosis on histopathology. Post‐operative complications included port site infections, colitis, urinary tract infection and ureteric injury. There were no complications related to appendicectomy. Mean length of stay was 4.4 days. Conclusion: Laparoscopic appendicectomy can be safely performed at time of laparoscopic surgical excision of Stage IV endometriosis and should be routinely considered in a subset of Stage IV endometriosis patients with colorectal involvement undergoing surgery. [ABSTRACT FROM AUTHOR]

Background: Peritonitis is the inflammation of peritoneum, the serosal membrane that lines the abdominal cavity and organs inside. The hollow viscous perforation (HVP) is one of the most common surgical emergencies encountered by surgeons on a daily basis. Mannheim Peritonitis Index (MPI) is a simple and effective method in predicting the morbidity of patients with HVP. Aims and Objectives: This study attempts to evaluate the prognostic value of MPI scoring system in patients with peritonitis due to HVP. Materials and Methods: This is a clinical, prospective, and observational study. There were 50 patients with HVP (stomach, duodenum, ileum, and appendix) admitted in Srirama Chandra Bhanja Medical College and Hospital from March 2021 to October 2022 included in the study. Necessary data were collected; MPI score was calculated for each patient and analyzed. Results: The number of post-operative complications, duration of intensive care unit, and hospital stay proportionately increased with the MPI score. Out of the eight variables used in this scoring system, duration of pain, intraperitoneal fluid and organ failure on admission carried more significance in predicting the morbidity in the post-operative period than the other variables. Conclusion: MPI is a simple and effective method in predicting the morbidity of patients with HVP and to assess it as a clinical tool in stratifying these patients according to individual surgical risk. [ABSTRACT FROM AUTHOR]

Appendiceal diverticulum is a rare condition that usually presents with symptoms similar to acute appendicitis. Although imaging can be used to aid the diagnosis of this condition, it is usually confirmed postoperatively on the basis of histology. Because of an increased risk of appendiceal neoplasms, the usual management is prophylactic appendicectomy. We report the case of a 70-year-old lady with no symptoms referred from her GP surgery for a positive faecal immunochemical test as part of the bowel screening programme. Colonoscopy showed a mass at the appendiceal orifice with normal histology. She underwent an appendicectomy with a small cuff of caecal resection. The lesion was ~8 cm at its maximum dimension and showed appendiceal diverticulum. Appendiceal diverticulum is an important differential diagnosis to consider in patients with atypical history of acute appendicitis or positive faecal immunochemical test with no other symptoms. [ABSTRACT FROM AUTHOR]

Background: Fibrous obliteration or appendiceal neuroma is a rare type of appendiceal tumor that causes appendiceal obstruction and then presents as appendicitis. This neural tumor has no specific presentation and, after appendectomy, is diagnosed by the pathologist accidentally. Fibrous obliteration is described as a proliferative lesion. The pathogenesis of this lesion is unknown, but it is mentioned that the etiology of this problem is secondary to recurrent inflammation processes. These processes cause neuroendocrine cell hyperplasia in the submucosa and lamina propria of the wall of the appendix. The repetitive occurrence of these sub-clinical inflammatory processes causes fibrosis. Cases Report: We presented a 55-year-old woman who was referred to our clinic with persistent pain in the right lower quadrant for five days in this report. The pain mimicked appendicitis presentation, and it suddenly started from the periumbilical area and then shifted to the right lower quadrant of the abdomen. Her laboratory study showed a 9600/microliter white blood cell count with 70% neutrophils. An increase in the appendix loop with 9 millimeters diameter was reported in the ultrasound. There was also severe fat haziness around the tissues and visceral inflammation of the terminal ileum in the sonogram. She underwent an appendectomy after the diagnosis of appendicitis, and the pathologist diagnosed fibrous obliteration or appendiceal neuroma. Conclusion: It is concluded that fibrous obliteration or appendiceal neuroma mimics acute appendicitis, and in patients with this presentation, appendectomy is the best choice for treatment. The main diagnostic method is pathologic assessment, and it is important for the differentiation of this tumor from other malignant tumors of the appendix because fibrous obliteration is a benign tumor. [ABSTRACT FROM AUTHOR]

This report details the case of a 69-year-old male who had presented to the emergency department at the suggestion of his dentist after ingesting a diamond-tipped drill bit during a routine dental procedure. Through the use of radiograph, computed tomography, and colonoscopy, the drill bit was determined to be lodged in the distal vermiform appendix. Throughout his clinical course, the patient remained asymptomatic but was monitored closely for signs of complications of a retained foreign body in the appendix. Gastroenterology and general surgery were consulted on the case but ultimately non-surgical approaches prevailed and the drill bit passed in the stool. This patient's case highlights the success of noninvasive measures for appendiceal foreign body removal. [ABSTRACT FROM AUTHOR]

Mucinous Appendiceal Neoplasms (MANs) are rare tumours where more than 50% of the tumour volume is composed of extracellular mucin. Low-grade Appendiceal Mucinous Neoplasm (LAMN) is a rare condition with symptoms that vary depending on clinical manifestations. It can manifest as an unruptured mucin-filled appendix, transmural invasion of the primary tumour, or present with peritoneal metastases post-rupture. The prognosis of LAMN depends on the presence or absence of neoplastic epithelium outside the appendix. Here, the authors describe a case of 35-year-old female who visited the OPD of Emergency Medicine with only complain of pain in abdomen for three days. She exhibited right iliac fossa tenderness with no guarding during the abdominal examination. She underwent an open appendectomy and was diagnosed with LAMN upon histopathological examination. She was advised to follow up after six months post-discharge to monitor for any metastatic spread. Due to its malignant potential, mucinous lesions of the appendix are uncommon yet significant entities. They are more prevalent in women and can range from mucinous adenocarcinomas to straightforward retention cysts. This case illustrates the need for extreme caution when dealing with appendiceal tumours and the importance of selecting the appropriate course of action, be it surgical or medical. [ABSTRACT FROM AUTHOR]

Background: Appendiceal tumors represent a range of histologies that vary in behavior. Recommendations for treatment with appendectomy versus right hemicolectomy (RHC) for different tumor types are evolving and sometimes conflicting. This study sought to characterize variation in the United States around surgical treatment of major appendiceal tumor types over time and describe differences in outcomes based on procedure. Methods: Patients diagnosed with appendiceal goblet cell adenocarcinoma (GCA), mucinous adenocarcinoma, neuroendocrine neoplasm (NEN), or non-mucinous adenocarcinoma from 2004–2017 were identified in the National Cancer Database. Trends in RHC over time and predictors of RHC were identified. Surgical outcomes for each histologic type and stage were compared. Results: Of 18,216 patients, 11% had GCAs, 34% mucinous adenocarcinoma, 31% NENs, and 24% non-mucinous adenocarcinoma. Rate of RHC for NEN decreased from 68% in 2004 to 40% in 2017 (p = 0.008) but remained constant around 60–75% for other tumor types. Higher stage was associated with increased odds of RHC for all tumor types. RHC was associated with higher rate of unplanned readmission (5% vs. 3%, p < 0.001) and longer postoperative hospital stay (median 5 days vs. 3 days, p < 0.001). On risk-adjusted analysis, RHC was significantly associated with increased survival versus appendectomy for stage 2 disease of all tumor types (HRs 0.43 to 0.63) and for stage 1 non-mucinous adenocarcinoma (HR = 0.56). Conclusions: Most patients with appendiceal tumors undergo RHC, which is associated with increased readmission, longer length of stay, and improved survival for stage 2 disease of all types. RHC should be offered selectively for appendiceal tumors. [ABSTRACT FROM AUTHOR]

Appendiceal neuroendocrine tumours (aNETs) are rare neoplasms of the gastrointestinal tract often diagnosed incidentally at the time of appendicectomy. Appendicectomy is considered curative in the majority of cases but guidelines recommend right‐sided hemicolectomy (RHC) for those with specific high‐risk features despite no data supporting a survival benefit. We performed a retrospective search of multi‐disciplinary tumour board and pathology databases from 2012 to 2022 to identify cases of aNET treated at our centre. Follow‐up data were obtained from the electronic healthcare records. A total of 142 cases of aNET were included for analysis. Mean age at presentation was 34, of which 76% were female and 92% of aNETs were located in the tip/middle of the appendix; 90% were grade 1, and 93% had R0 resection. Tumour size was <1 cm in 54%, 1–2 cm in 36%, >2 cm in 9%. A total of 43 patients (30%) underwent RHC with lymph node metastases identified in 16 (37%). Lymph node metastases were associated with tumour size >2 cm (p =.008) and higher tumour grade (p =.041) on multivariate analysis. For aNET 1–2 cm, lymph node metastases were identified in 7/22 who had RHC (32%) with tumour grade the only significant risk factor (p =.046). Distant metastases were identified in 2 cases (1%), diagnosed synchronously and associated with grade 2 tumours. Overall survival for those with lymph node metastases was 100% after a median 4 years. Progression‐free survival was 93%, with a single case of disease progression associated with synchronous distant metastases at initial diagnosis. Lymph node metastases in aNET are associated with higher tumour grade and tumour size >2 cm. Disease progression in the setting of lymph node metastases is rare. The significance of lymph node metastases and need for completion RHC remains uncertain. [ABSTRACT FROM AUTHOR]

In recent studies, there has been an increasing focus on Nanoparticles Enhanced Oil Recovery (NPs EOR). NPs EOR is a method that was initially developed to improve microscopic and macroscopic displacement efficiency. In some recent applications, NPs have assisted the conventional EOR methods such as a polymer, surfactant, and Co2 flooding, with the purpose of increasing the oil recovery. In this literature, the abilities to use NPs in EOR are investigated. The function of different types of NPs, different types of Dispersing agents, availability of nanomaterials in the lab, the effect of NPs to change the properties, future challenges and concerns about the NPs, are reviewed. However, the stability of NPs suspensions is still the biggest barrier to use the NPs in EOR. Upcoming studies are necessary to focus on the outcome of the appropriate techniques of NPs to improve their stability under the worst conditions of reservoirs and investigate new types of NPs. [ABSTRACT FROM AUTHOR]

Retroperitoneal appendiceal perforation presents unique challenges in surgical management due to the complex nature of the retroperitoneal space. We present a case of a 57-year-old male with retroperitoneal appendiceal perforation, characterized by the presence of a large amount of gas in the retroperitoneal space. Emergent laparoscopic surgery was performed to address the retroperitoneal involvement. In retroperitoneal appendiceal perforation, surgical intervention and postoperative drainage are of great significance to prevent septic shock. The interconnectedness of the retroperitoneal space with other body regions is highlighted, underscoring the potential for severe complications. This case emphasizes the need for a tailored approach to managing retroperitoneal appendiceal perforation, preventing potential complications associated with this condition. [ABSTRACT FROM AUTHOR]

Background: The testicular appendix is a residual of the paramesonephric and mesonephric duct, most commonly found close to the superior pole of the epididymis as Morgagni’s cyst. Torsion of such cysts is a common event in children, and the patient usually presents with a palpable testis with a tender mass in its upper pole. The co-existence of two or more appendices is very rare. In addition to the fact that Morgagni’s cyst was the non-twisted one and vas aberrans was, made clinical and radiological diagnosis difficult. Case presentation: Our patient, a 15-year-old boy, presented with persistent pain in the right scrotum, a significant palpable mass accompanied by vomiting. Upon surgical exploration, a large dark cyst was found located on the right side of the right testicle with a 720-degree torsion. The cyst was straightened and excised along with a Morgagni’s cyst. The testis was fixed in the right hemiscrotum due to a “bell clapper” deformity that was also a finding. Conclusions: Pathological findings were consistent with a twisted cyst of a testicular appendix (vas aberrans). Co-existence of two or more appendices is very rare in addition to the fact that Morgagni’s cyst was the non-twisted one. Usually and in very few cases, a second appendix is found randomly, during surgical exploration for acute scrotum due to torsion of Morgagni’s cyst. [ABSTRACT FROM AUTHOR]

Appendiceal mucinous neoplasms are relatively rare. Following rupture of a mucinous neoplasms of the appendix, mucus can implant into the scrotum along the congenital or acquired inguinal space. We report a case of a testicular mucinous neoplasm with no preoperative abdominal lesions. Scrotal ultrasound showed an irregular mass in the right testis and inguinal area, with uneven echogenicity (stripe hyperechoic layered distribution) and no obvious blood flow signals. Ultrasound diagnosis was suspected as mucinous neoplasm. Postoperative pathology was confirmed to be low-grade mucinous neoplasm of the testis. Subsequently, the surgeon performed laparoscopic exploration and found that the appendix tumor had ruptured and the peritoneal cavity was implanted, and an appendectomy was performed. Postoperative pathology confirmed a low-grade appendix mucinous neoplasm. The evaluation and discovery of a scrotal mucinous neoplasm requires exploration of the appendix with ultrasound imaging. Even if the inner diameter of the appendix is normal but the presence of ascites, appendiceal mucinous neoplasms need to be considered. [ABSTRACT FROM AUTHOR]

Purpose: Incidental appendiceal neoplasms are identified in approximately 1% of the specimens of suspected appendicitis. The current institutional policy is to perform en bloc mesoappendix resection during routine laparoscopic appendicectomy allowing for staging, reducing the need for oncological right hemicolectomy (ORH). Herein, we review en bloc mesoappendicectomy in clinical practice and its effects on the rate of ORH. Methods: We reviewed all cases of appendicectomy performed at the Auckland City Hospital between 1 May 2014 and 31 May 2019. Clinical notes and histopathological reports were reviewed. All neoplasms, surgical techniques and the need for further surgery were analysed. Results: A total of 2455 appendicectomies were performed with an approximately similar number of procedures between the sexes and an overall median age of 31 years. Overall, 86% (n = 2098) of the specimens included resection of the mesoappendix, and 58 (2.4%) appendiceal neoplasms were identified. Of them, 33 (1.3%) specimens included neuroendocrine appendiceal neoplasms. Eleven (33%) patients with appendiceal neuroendocrine neoplasms were recommended ORH. One of these patients may have avoided additional surgery, whereas 3 (9.1%) patients with tumours of 10–20 mm avoided ORH because their mesoappendix was resected. Conclusion: At our centre, there has been a significant change in the practice of mesoappendix resection, and we support resection of the mesoappendix during appendicectomy. The procedure is technically straightforward and safe, incurs no increases in costs or time, allows for accurate tumour staging and guides decisions regarding further surgical interventions. [ABSTRACT FROM AUTHOR]

While the debate on the association between Enterobius vermicularis (E. vermicularis) and acute appendicitis has not been settled, a few case reports of this very rare encounter are beginning to come to light. E. vermicularis is one of the most common parasitic infections around the world, and acute appendicitis, on the other hand, is also a commonly encountered condition in general surgery. However, the association between these two conditions remains controversial. Here we present a case report of a young woman with appendicitis associated with E. vermicularis. [ABSTRACT FROM AUTHOR]

Appendiceal signet ring cell carcinoma (ASRCC) is a rare and aggressive form of appendiceal cancer, often presenting with nonspecific symptoms that overlap with acute appendicitis. Early diagnosis and appropriate management are crucial for improving patient outcomes in these rare malignancies. This case report and literature review aims to raise awareness among clinicians about ASRCC of the appendix as a cause of acute appendicitis and highlight the importance of considering this diagnosis in patients with atypical presentations or unexpected histopathological findings. We present a 65-year-old female patient with ASRCC who underwent successful surgical treatment and remains disease-free at the one-year follow-up. It also highlights the necessity of early detection and appropriate treatment in order to improve patient outcomes. In addition, a comprehensive literature review is provided, discussing the clinical presentation, histopathological characteristics, potential pathogenesis, treatment options, and prognosis of ASRCC. [ABSTRACT FROM AUTHOR]

Colorectal cancers represent the predominant malignancies affecting the gastrointestinal tract. In contrast, appendiceal tumors occur less frequently. Among them, appendiceal neuroendocrine tumors (ANETs) account for approximately 50 % of cases and are often detected incidentally during unrelated procedures. We present an extremely rare case of an incidental neuroendocrine tumor of the appendix discovered during surgery for rectal adenocarcinoma and provide a review of the relevant literature. A 70-year-old patient with radiologically and endoscopically diagnosed rectal cancer underwent a low anterior resection with total mesorectal excision and a temporary diverting ileostomy following preoperative chemotherapy and radiation therapy. Intraoperatively, a small appendiceal mass was discovered and excised. Histopathological examination confirmed a well-differentiated NET of the appendix measuring 0.4 cm in diameter. This case report emphasizes the importance of thorough intraoperative examination during colorectal surgeries and highlights the need for increased awareness of appendiceal NETs among surgeons. [ABSTRACT FROM AUTHOR]

Objectives: To perform a systematic review on the use of magnetic resonance imaging (MRI) of the abdomen to evaluate clinically suspected appendicitis in the general adult population. We examined the diagnostic accuracy, the reported trends of MRI use, and the factors that affect the utility of MRI abdomen, including study duration and cost-benefits. Methods: We conducted a systematic literature search on PubMed, MEDLINE, Embase, Web of Science, and Cochrane Library databases. We enrolled primary studies investigating the use of MRI in diagnosing appendicitis in the general adult population, excluding studies that predominantly reported on populations not representative of typical adult appendicitis presentations, such as those focusing on paediatric or pregnant populations. Results: Twenty-seven eligible primary studies and 6 secondary studies were included, totaling 2,044 patients from eight countries. The sensitivity and specificity of MRI for diagnosing appendicitis were 96% (95% CI: 93–97%) and 93% (95% CI: 80–98%), respectively. MRI can identify complicated appendicitis and accurately propose alternative diagnoses. The duration of MRI protocols in each primary study ranged between 2.26 and 30 minutes, and only one study used intravenous contrast agents in addition to the non-contrast sequences. Decision analysis suggests significant benefits for replacing computed tomography (CT) with MRI and a potential for cost reduction. Reported trends in MRI usage showed minimal utilisation in diagnostic settings even when MRI was available. Conclusions: MRI accurately diagnoses appendicitis in the general adult population and improves the identification of complicated appendicitis or alternative diagnoses compared to other modalities using a single, rapid investigation. [ABSTRACT FROM AUTHOR]

Aims. To evaluate scope of diagnosing tools-Alvarado score, CRP, USG, and CT in acute appendicitis. Method. Conducted observational study of 152 patients in Department of Emergency Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, India between January to December 2022. The diagnostic tool’s (Alvarado score, CRP, USG, CT (abdomen), sensitivity, specificity, accuracy, and ROC were analyzed to diagnose acute appendicitis. Results. Among 152 study patients, males - 86, females - 66, higher number of age group was <30 years, abnormal variables in study patients are BP - 79%, HR - 80%, RFP pain - 57%, anoxia - 78%, nausea/ vomiting - 68%, RIF tenderness - 69%, rebound tenderness - 63.8%, elevated temperature - 62%, pain - 44.7%, leukocytosis - 70.7%, and left shift - 38.2%. In comparison, Alvarado scores-identified 98% patients, (<5 score - 8.2%, 5-6 score - 30.6%, >7-61.2%) (0.0271), CRP - identified 95.1% (<0.001), USG identified (group 1-33%, group 2-12.2%, group 3-11.3%, and group 4-43.5%, and CT identified 152/152 (100%) patients with acute appendicitis. The odds ratio/95% CI of diagnostic tools (USG - 0.878, 0.66, CRP - 7.337, 2.623, Alvarado score - 0.81, 0.687). Sensitivity (Alvarado's score - 84.74%, USG - 83.33%, CRP - 76.43%), and specificity was (Alvarado's score - 84.32, USG - 72.97%, CRP-83.86%. The PPV (Alvarado's score - 74.56%, USG - 75.5%, CRP - 33.16%), NPV (Alvarado's score - 32.5%, USG - 79.1%, CRP - 81.03%), and diagnostic accuracy (Alvarado's score - 72.01%, USG - 73.05%, CRP - 68.81%). ROC in individual tools-Alvarado score was specific than USG, and CRP. ROC in combination toolsAlvarado score and USG was specific than USG, and CRP. Conclusion. Among the diagnostic tools tested, as individual tool-Alvarado score was specific, in combination, and Alvarado score and USG were accurate, specific, sensitive, hence combination of tools will identify acute appendicitis early to reduce mortality by undiagnosed or late diagnosed. [ABSTRACT FROM AUTHOR]

Background: Stump appendicitis is a rare complication after primary appendectomy and is often not considered in the differential diagnosis of patients who have undergone an appendectomy. With this systematic review, the aim was to identify all cases of stump appendicitis in children in order to gain a better insight into the risk factors, clinical presentation, diagnostics, and treatment. Methods: Scopus and PubMed databases were searched. The search combinations used the following MeSH and free text terms: [(stump) OR (residual) OR (remaining) OR (retained) OR (recurrent)] AND (append*). Neither search filters nor text analysis tools were used. To be included, the report had to contain information about a patient between the age of 0 and 18 who was treated for stump appendicitis as a result of an inadequately performed appendectomy. Results: Out of the 19,976 articles, 29 of them, with a total of 34 cases, met the inclusion criteria. The mean age at the time of stump appendectomy was 13.32 ± 3.57 years, while the median time between primary and stump appendectomy was 7.5 (2.3 – 24.0) months. The ratio between boys and girls was 3.2: 1. Primary appendectomy was performed laparoscopically in a greater number of cases compared to the open approach (1.5: 1), and according to the available data, no higher proportion of complicated appendicitis was recorded during a primary appendectomy. The median duration of symptoms during stump appendicitis was 2 days, and in most cases, the pain was localized. Stump appendectomy in most cases was performed with an open approach, and in relation to the type of appendicitis, most of them were complicated. The mean value of the length of the stump was 2.79 ± 1.22 cm, and the smallest recorded length was 0.6 cm. Conclusions: A non-specific clinical presentation with a history of appendectomy usually makes the diagnosis of stump appendicitis challenging for uninformed physicians, and due to untimely treatment, it usually results in complicated forms of stump appendicitis. Complete appendectomy remains the gold standard in the treatment of stump appendicitis. [ABSTRACT FROM AUTHOR]

Background: Stump appendicitis is a rare complication after primary appendectomy and is often not considered in the differential diagnosis of patients who have undergone an appendectomy. With this systematic review, the aim was to identify all cases of stump appendicitis in children in order to gain a better insight into the risk factors, clinical presentation, diagnostics, and treatment. Methods: Scopus and PubMed databases were searched. The search combinations used the following MeSH and free text terms: [(stump) OR (residual) OR (remaining) OR (retained) OR (recurrent)] AND (append*). Neither search filters nor text analysis tools were used. To be included, the report had to contain information about a patient between the age of 0 and 18 who was treated for stump appendicitis as a result of an inadequately performed appendectomy. Results: Out of the 19,976 articles, 29 of them, with a total of 34 cases, met the inclusion criteria. The mean age at the time of stump appendectomy was 13.32 ± 3.57 years, while the median time between primary and stump appendectomy was 7.5 (2.3 – 24.0) months. The ratio between boys and girls was 3.2: 1. Primary appendectomy was performed laparoscopically in a greater number of cases compared to the open approach (1.5: 1), and according to the available data, no higher proportion of complicated appendicitis was recorded during a primary appendectomy. The median duration of symptoms during stump appendicitis was 2 days, and in most cases, the pain was localized. Stump appendectomy in most cases was performed with an open approach, and in relation to the type of appendicitis, most of them were complicated. The mean value of the length of the stump was 2.79 ± 1.22 cm, and the smallest recorded length was 0.6 cm. Conclusions: A non-specific clinical presentation with a history of appendectomy usually makes the diagnosis of stump appendicitis challenging for uninformed physicians, and due to untimely treatment, it usually results in complicated forms of stump appendicitis. Complete appendectomy remains the gold standard in the treatment of stump appendicitis. [ABSTRACT FROM AUTHOR]

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

Background: The distinction between complicated and uncomplicated appendicitis is very important for the selection of the treatment method. Purpose: To investigate the sensitivity and specificity of computed tomography (CT) in differentiating between complicated and uncomplicated appendicitis to demonstrate that false negativity in differentiating these cases can be reduced when CT findings are incorporated into the clinical evaluation of patients. Material and Methods: All patients aged ≥18 years who underwent appendectomy at Malatya Training and Research Hospital in 2020 and 2021 were retrospectively screened. Of them, 283 patients were included in the study who had undergone CT before the operation. Patients with appendicitis were divided into two groups: complicated and uncomplicated, according to the results of their pathology tests. Demographic data, laboratory results, and CT images of the patients were evaluated. Results: The patients with complicated appendicitis had a significantly higher mean age (P <0.001). The most common CT findings in patients with complicated appendicitis were moderate or severe peri-appendiceal fat stranding (PFS) and appendix wall enhancement defect (AWD). The findings with the highest sensitivity were PFS (77.9%) and AWD (69.4%). Although abscess, phlegmon, and peri-appendiceal air had the highest specificity (100%), these findings were the ones with the lowest sensitivity. According to the scoring system was developed for the differential diagnosis, CT had a sensitivity of 83.3% and a specificity of 79.2%. Conclusion: Based on the sensitivity and specificity values measured for CT according to the findings of our study, the scoring system may be useful for the differential diagnosis of complicated appendicitis. [ABSTRACT FROM AUTHOR]

Background: There have been debates about the human appendix function, and while previous research suggested it might be a vestigial organ with no functional significance, recent studies have pointed out that it might have an important role in the immune system. Acute appendicitis (AA) is a common cause of emergency abdominal surgery in the world. Some epidemiologic investigations have found an association between appendicitis and viral infections. In this study, we have reviewed systematically articles to discover viral infections that cause appendicitis and find any possible correlations between the two. Methods: This systematic review was performed by searching among electronic databases including Web of Science, PubMed, Scopus, and EMBASE on viruses and appendicitis topics. Results: Conducted search leads to 983 results in all databases after the duplicate removal and screening by title, abstract, and full-text based on inclusion criteria lead to 19 studies. There were several assays to detect the viruses, which are thought to be AA causative agents. RT-PCR and immunoassays were the mainstay methods to detect the probable cause. Conclusion: Investigations suggested that some viruses including measles virus (MV), influenza virus, dengue fever virus (DFV), human immunodeficiency virus (HIV), human herpesviruses, rotavirus, and adenovirus are associated with acute appendicitis. Despite the available reports, the specific mechanisms behind the relationship between acute appendicitis and viral infections are yet to be understood. Therefore, further investigations are necessary to find out the pathogenesis and pathophysiology of viral complications in appendicitis. [ABSTRACT FROM AUTHOR]

Introduction: Primary lymphoma of the appendix occurs in 0.015% of all malignant neoplasms of the appendix. The most frequent clinical manifestation is acute appendicitis, and pathological analysis is very important. Case report: Primary lymphoma of the cecal appendix, a 38-year-old man was admitted with acute appendicitis. Macroscopic histopathological study shows diffusely thickened white appendage wall. Microscopically: high-grade Burkitt lymphoma, ACL, CD20, CD10 positive, KI 67 positive 95%, CD3, BCL2, EBV negative. Postoperative: thoracic abdominal tomography showed a tumor in the right iliac fossa without lesions or adenopathies in the abdomen and thorax. The patient was treated with two courses of chemotherapy and a control abdominal CT was performed at 6 months, which showed the initial tumor. At 6 months the patient is stable and controlled. Conclusion: The value of the histopathological study in cecal appendages is emphasized in the presence of primary cecal lymphomas. [ABSTRACT FROM AUTHOR]

A 26-year-old female patient presented to the family medicine outpatient clinic with complaints of diarrhea, widespread abdominal pain, nausea, and vomiting, which had been going on for five days. In the first physical examination findings of the patient, there was widespread sensitivity in the abdomen, but there were no findings of defense or rebound. The patient was re-evaluated with the results of conducted tests, her abdominal examination was repeated, and rebound positivity was detected in the right lower quadrant. The patient was referred to the Emergency Department, and she was taken into operation by the general surgery team with the diagnosis of acute appendicitis. The most important factor in delaying the diagnosis of acute appendicitis is the presence of gastroenteritis. Cases of acute appendicitis presenting with diarrhea have been reported in the medical literature. Since acute pathologies should always be kept in mind in the differential diagnosis of patients who present to primary care with abdominal pain and diarrhea, it is deemed appropriate to present the case with literature. [ABSTRACT FROM AUTHOR]