Search

Background: Closure of the appendiceal stump is a crucial step during laparoscopic appendectomy. Multiple techniques have been described to close the appendiceal stump, with no clear consensus on which one offers the best results. In addition, most comparative results included patients with uncomplicated appendicitis. In this study, the intracorporeal sutures and metallic endoclips were compared in appendiceal stump closure in cases with complicated appendicitis. Methodology: One hundred patients were enrolled in this prospective randomized trial and divided into two groups: The endoclip group (n = 50) and the Suture group (n = 50). Postoperative outcomes were compared between the two groups. Results: Both preoperative and intraoperative findings were statistically comparable between the two approaches. Nonetheless, the application of metallic clips was associated with a significant shortening in the operative time (75 vs. 95 minutes with sutures). All patients were discharged within 24 hours after the operation. Only one patient (2%) required readmission in the suturing group. That patient presented with ileus, and radiological assessment revealed the presence of a postoperative intraabdominal abscess that needed reoperation via laparoscopy (for evacuation and drainage) that was the only patient who required readmission and reoperation in the current study. No patients developed fecal fistula, whereas port site infection occurred in 8% of cases in each group. Conclusion: Both metallic endoclips and intracorporeal sutures are available safe options for appendiceal stump closure during laparoscopic appendectomy for patients with complicated appendicitis. However, the former could provide a benefit over the latter, manifested in the decreased operative time. [ABSTRACT FROM AUTHOR]

Psuedomyxoma peritonei is an uncommon disease characterized by the presence and accumulation of gelatinous material in the pelvis and abdominal cavity. It is an unusual manifestation of mucinous ascites of controversial origin, though often associated with a primary tumour of the appendix. Diagnosis of pseudomyxoma peritonei is often incidental during exploratory laparotomy because there are no specific diagnostic clinical symptoms. We report three females with gynaecological diseases with incidental finding of pseudomyxoma peritonei in the absence of appendiceal or gastrointestinal tumour. Tissue biopsies were fixed in 10% formalin and processed in paraffin wax. Representative sections were stained with haematoxylin & eosin, periodic acid Schiff, diastase and mucicarmine. Three females aged 25years, 42years and 50years presented respectively with a year, 5years and 12years history of abdominal swelling and abdominal mass. The older female also complained of vaginal protrusion with significant weight loss. Clinical diagnosis in the two younger females was advanced ovarian carcinoma, while the older female was diagnosed with third degree utero vaginal prolapse. All three had exploratory laparotomy which revealed unilateral multi lobulated left ovarian masses, with extensive mucinous peritoneal and omental deposits. There were no obvious gastrointestinal lesions and the appendices had no gross pathology. Two of the patients had oophorectomy with peritoneal and omental clearance of mucinous materials while the third patient had vaginal hysterectomy and peritoneal clearance of gelatinous deposits. The gelatinous materials showed papillary and multi locular cystic masses containing gelatinous fluid. Histopathological diagnosis of pseudomyxoma peritonei in a background of mucinous ovarian cystadenoma, and utero vaginal prolapse with epidermialization of the cervical lining epithelium was made. Pseudomyxoma peritonei occurs in the absence of a primary appendiceal disease and there are no specific diagnostic clinical symptoms. Definitive diagnosis requires histopathological analysis however, clinicians should entertain a high index of suspicion during laparotomy when mucin pools are present in the absence of gross pathology particularly in females with benign gynaecological diseases. Our cases were classed histologically into the benign disseminated peritoneal adenomucinosis type. [ABSTRACT FROM AUTHOR]

Copyright of Romanian Journal of Family Medicine / Revista Română de Medicina Familiei is the property of Media DOM Express and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Amyand's hernia is the presence of a vermiform appendix in an inguinal hernia sac. It is a rare condition found approximately 1% of the reported cases and even more infrequently about 0.1% reported cases associated with acute or perforated appendicitis. Pre-operative diagnosis is very difficult and most of the cases are encountered during hernia repair. Case presentation: We presented a 1 month old child who was diagnosed to have right reducible inguinal hernia since birth. At his elective right herniotomy we inadvertently found a mildly inflammed tip of vermiform appendix in the inguinal sac. The body and base of appendix was healthy and there was no fluid collection seen. We decided not to remove the appendix and only performed herniotomy for this child. Antibiotics were completed for 1 week, post operatively was uneventful and no complications noted during follow up. Discussion: Amyand's hernia is a very rare disease. In the pediatric age group, computed tomography scan and ultrasound is not commonly practise before the operation, thus its pre-operative clinical diagnosis is very challenging. Treatment includes herniotomy with or without appendectomy depending on the level of inflammation and patient's general condition. Surgeons should be prepared if they encounter an Amyand's hernia especially in the symptomatic inguinal hernia over the right side to ensure that no complications and recurrence occur post operatively. [ABSTRACT FROM AUTHOR]

Copyright of BJS Open is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim. Our objective was to demonstrate the impact of appendix removal on the obstetric outcome of the next pregnancy. Materials and method. A questionnaire for the survey of the impact of appendix removal on the obstetric outcome of subsequent pregnancy was applied in 52 and 79 women, who were the study and the control cases, respectively. Prepregnancy complaints, such as pelvic or abdominal discomfort and back pain, were recorded together with the pregnancy outcome, delivery findings and the maternal risk factors for adverse gestational outcome. Results. The rate of pelvic complaints was 67.3% (35/52) and 32.9% (26/79) in patients who were appendectomized or not, respectively. The gestational week at delivery and birth weight were lower in the patients who were appendectomized (p=0.240; p=0.003). The patients with an interval less than two years between appendix removal and pregnancy had lower birth weight and gestational week at delivery compared to the remainders (p=0.003; p=0.068). Moreover, patients who experienced pelvic complaints had lower birth weight and gestational week at delivery compared to the ones who did not experience pelvic complaint, despite the lack of statistical significance (p=0.238; p=0.238). Additionally, further analysis regarding the autoimmune diseases revealed that the rates of autoimmune diseases were 2.5% (2/79) and 32.6% (17/52) in patients without a history of appendectomy and in those with appendix removal, respectively. Conclusions. The long-term complications of appendix removal, such as adhesions and peritoneal irritations, must be considered, especially in the antenatal care of the next pregnancies. Appendectomized pregnancies should be evaluated for the presence of immune system problems. [ABSTRACT FROM AUTHOR]

The isolated appendiceal Crohn's disease without preceding bowel symptoms is a rare phenomenon, especially in older patients. In this case report, we present a 60-year-old female with isolated appendiceal Crohn's disease presenting with acute appendicitis. She presented with classical features of appendicitis with elevated inflammatory markers. She underwent an appendectomy which showed an excessively swollen, oedematous, and reddish appendix with swelling extending to the base of the caecum. Histological evaluation was suggestive of Crohn's disease, and subsequent colonoscopy was unremarkable. Following appendectomy, she was asymptomatic without any recurrence of disease. The atypical morphological appearance of the appendix should raise suspicion of Crohn's disease. This case highlights the importance of histopathological analysis of the specimen, especially in abnormal clinical findings. The prognosis of such patients seems to be good, and additional treatment is rarely needed. [ABSTRACT FROM AUTHOR]

Objectives: To understand the histopathology of various diseases of vermiform appendix, the knowledge of normal histology of the organ at different age group is mandatory. Study Design: Comparative study. Setting: Islamic International Medical College Rawalpindi. Period: January 2014 to March 2015. Material and Methods: Total forty negative appendectomy/normal appendices specimens removed along with other abdominal operations were included in this study. Four equal groups (10 specimens in each) were made, spacing 15 years between each group. The last group had no upper age limit due to less availability of the specimens. The middle parts of specimens were included in this study the various parameters i.e. wall thickness, lymphoid nodules and lumen sizes were measured under microscope after calibration in micrometers after staining. Results: The lumen size decreases with advancing age. There was inverse relationship between lumen size and wall thickness. Surprisingly sum of mean lumen size and mean wall thickness of all age groups had no much difference. The number and size of lymphoid nodules decreases with advancing age. Conclusion: Although lumen size decreased as age advances but did not obliterate completely till 74 years age. The number and size of lymphoid nodule decreased but wall thickness size remained same and they are observed even at the age of 74 years. [ABSTRACT FROM AUTHOR]

Aims: To research and identify how often complicated diverticular disease of the appendix [appendiceal diverticular disease (ADD)] shows histological mimicry of low‐grade appendiceal mucinous neoplasms (LAMNs) and to provide guidance on the useful histopathological features that allow the appropriate diagnosis to be made. Methods and results: Seventy‐four cases of complicated appendiceal diverticular disease were identified from two specialist centres. Of the second opinion/consultation cases, 71% of the ADD cases had been diagnosed by referring pathologists as LAMNs. Salient pathological features were identified and agreed upon to reach the applicable diagnosis. For a diagnosis of complicated diverticulosis, particularly when associated with mucus cysts, the following morphological features were regarded as important: relative retention of the normal mucosal architecture with lamina propria and a maintained crypt architecture, crypts arranged in regular array, epithelial hyperplasia and a lack of nuclear abnormalities extending the length of the crypts. In a formal case–control study undertaken on 30 cases with each diagnosis, ADD and LAMN, loss of lamina propria, a filiform architecture and hypermucinosis were significantly associated with low‐grade appendiceal mucinous neoplasms. Mucosal neuromas were significantly associated with diverticular disease of the appendix. Conclusions: To our knowledge, this study represents the largest series in the world literature and serves to highlight the important pathological features to distinguish complicated diverticular disease of the appendix from LAMNs, and emphasises the difficulties experienced by diagnostic pathologists in diagnosing complicated appendiceal diverticulosis. This is important, as LAMNs have a significant risk of transcoelomic spread, while complicated appendiceal diverticulosis has no such risk. [ABSTRACT FROM AUTHOR]

Appendicorectal fistula can be a cause of chronic abdominal pain, forming years after an occult episode of appendicitis. It can be diagnosed with Colonoscopy and Magnetic Resonance Imaging, and successfully treated surgically with laparoscopic appendicectomy and stapled segmental cuff resection of the rectum. [ABSTRACT FROM AUTHOR]

Objective: Appendectomy is one of the most commonly performed surgeries with the indication of acute appendicitis. Diseases and tumors of the appendix are rarely seen except for acute appendicitis. The aim of this study was to investigate the histopathological findings of the cases appendectomized with the indication acute appendicitis retrospectively as for incidental findings. Methods: In this study appendectomy specimens of children aged 0-18 years who underwent appendectomy with the diagnosis of acute appendicitis between January 2007 and June 2019 were retrospectively investigated. Patients with malignancy were excluded from the study. Results: A total of 961 cases were accessible including 593 (61.7%) male patients. The mean age of the patients was 10.95±4.2 (0-18) years. The diagnosis of appendicitis was confirmed in 824 (85.7%) cases. There were 666 (69.3%) cases with periapendicitis. Perforation was observed in 200 (20.8%) cases. In 13 cases (1.4%) parasites (E. Vermicularis) were detected. In 197 (20.5%) cases phlegmonous appendicitis and in 15 (1.6%) cases omentum inflammation were detected. Other findings included carcinoid tumor, Meckel diverticulum, ovarian cyst, endometriosis, mucocele. Conclusion: In conclusion, while lymphoid and fecaloid hyperplasia are the most common causes of acute appendicitis, other etiologies should be kept in mind. If the samples are not evaluated histopathologically, these unusual causes can be ignored. There may be diseases among emergent indications that cannot be ruled out and may require treatment. [ABSTRACT FROM AUTHOR]

IgG4-related disease is a recent entity that has been described in a wide variety of organ systems. A 46-year-old female presented with acute appendicitis accompanied by a mass-forming lesion, raising a concern for neoplasm, and therefore, hemicolectomy was performed. The lesion revealed a dense lymphoplasmacytic infiltrate accompanied by storiform fibrosis and obliterative phlebitis. The IgG4/IgG plasma cell ratio was >50%, and the number of IgG4-positive plasma cells was >100/high-power field. In order to assess the IgG4/IgG plasma cell ratio, MUM1 was employed instead of IgG to successfully estimate the plasma cell concentration. There was also a concomitant hyperplasia of S100-positive cell, which could represent dendritic or Schwannian origin and possibly play a pathophysiologic role. The hyperplasia was significant by itself that it may mimic a mass-forming lesion. This newly described entity of the past decade deserves increased recognition due to clinical implication and surgical morbidity. This is the first case of IgG4-related disease in the appendix to our knowledge that fully satisfied all the pathological diagnostic criteria. We would like to also highlight our innovative approach of evaluating the IgG4/IgG plasma cell. [ABSTRACT FROM AUTHOR]

Aims: Inverted appendices are rare, but have the potential to cause diagnostic confusion among endoscopists and pathologists. The aim of this study was to describe the clinicopathological features of inverted appendices seen at our institution over the last 30 years. Methods and results: Twenty‐one inverted appendices were identified and the clinical and pathological features reviewed. Patients were predominantly middle‐aged women. Most cases were detected incidentally on colonoscopy. Endoscopically, inverted appendices appeared polypoid in the proximal caecum. All resections featured associated pathological processes, including endometriosis (n = 3), inflammatory mucocoele (n = 1), low‐grade appendiceal mucinous neoplasm (n = 2), traditional serrated adenoma (n = 1) and inflammatory fibroid polyp (n = 1). Five cases were endoscopically mischaracterised as caecal polyps and removed via polypectomy; initial pathological impressions were erroneous in most cases. All polypectomies featured a dome‐like configuration covered by mucosa on the convex surface; the majority had aggregates of ganglion cells and neural plexi embedded in muscularis propria. The vast majority of cases, regardless of the procedure, showed lymphoid aggregates. Among post‐polypectomy patients with follow‐up, none experienced perforation‐associated morbidity despite the histological presence of muscularis propria. Conclusions: The diagnosis of an inverted appendix should be considered in polypectomy specimens from the caecum or appendiceal orifice with (i) dome‐like tissue configuration covered by mucosa on the convex surface, (ii) a deep, robust smooth muscle component with ganglion cells (muscularis propria) and (iii) associated lymphoid aggregates. Prompt recognition on H&E will avoid unnecessary time and resource investment. [ABSTRACT FROM AUTHOR]

Recent advances, specifically cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), offer advantages compared to the traditional therapeutic approach of systemic chemotherapy in the treatment of peritoneal carcinomatosis from mucinous appendiceal neoplasms (MAN). This review provides an up-to-date, comprehensive summary of the histologic classification of MAN, reviews common imaging findings of mucoceles and pseudomyxoma peritonei, and describes the radiologist's role in the multidisciplinary care team in quantifying disease and in helping select patients for definitive surgery. [ABSTRACT FROM AUTHOR]

Appendiceal neoplasms are rare and often only discovered incidentally during surgery performed for acute appendicitis. Computed tomography (CT) has been demonstrated to be a reliable technique for accurately establishing the preoperative diagnosis of appendiceal neoplasms that manifest as acute appendicitis through the presence of certain imaging findings. Other manifestations of appendiceal neoplasms include appendiceal mass, mucocoele, localised abscess formation, ileus, increasing abdominal girth from pseudomyxoma peritonei, and intussusception. This pictorial essay illustrates varied CT findings of neoplasms of the appendix, with emphasis on the more commonly encountered manifestations of these tumours. [ABSTRACT FROM AUTHOR]

Background: Our aim is to compare the management approaches and clinical outcomes of acute appendicitis according to annual Gross National Income per Capita (GNI/Capita) of countries.Methods: Consecutive patients who were diagnosed to have acute appendicitis from 116 centers of 44 countries were prospectively studied over a 6-month period (April-September 2016). Studied variables included demography, Alvarado score, comorbidities, radiological and surgical management, histopathology, and clinical outcome. Data were divided into three groups depending on the GNI/Capita.Results: A total of 4271 patients having a mean (SD) age of 33.4 (17.3) years were studied. Fifty-five percent were males. Two hundred and eighty patients were from lower-middle-income (LMI) countries, 1756 were from upper-middle-income (UMI) countries, and 2235 were from high-income (HI) countries. Patients in LMI countries were significantly younger (p < 0.0001) and included more males (p < 0.0001). CT scan was done in less than 8% of cases in LMI countries, 23% in UMI countries, and 38% in HI countries. Laparoscopy was performed in 73% of the cases in the HI countries, while open appendectomy was done in more than 60% of cases in both LMI and UMI countries (p < 0.0001). The longest mean hospital stay was in the UMI group (4.84 days). There was no significant difference in the complication or death rates between the three groups. The overall death rate was 3 per 1000 patients.Conclusions: There is great variation in the presentation, severity of disease, radiological workup, and surgical management of patients having acute appendicitis that is related to country income. A global effort is needed to address this variation. Individual socioeconomic status could be more important than global country socioeconomic status in predicting clinical outcome. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the accuracy of magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis in pregnant patients and the value of additional diffusion-weighted MRI (DWI).Methods: A total of 125 pregnant patients with clinically suspected appendicitis who underwent 1.5 T MRI were enrolled between May 2011 and January 2016. During this period, two radiologists prospectively predicted acute appendicitis on MRI during daily interpretation. We retrospectively reviewed clinical records, and radiological results were correlated with surgical pathology and clinical outcomes. We calculated the sensitivity, specificity, and accuracy of MRI for diagnosing acute appendicitis. We performed additional DWI between August 2014 and January 2016, and we calculated sensitivity, specificity, and accuracy of MRI with or without DWI.Results: The sensitivity, specificity, and accuracy of MRI for acute appendicitis were 100%, 95%, and 96%, respectively. The sensitivity, specificity, and accuracy of MRI without DWI (n = 72) vs. with DWI (n = 53) were 100%, 94.7%, and 95.8% versus 100%, 95%, and 96%, respectively.Conclusions: MRI has high accuracy for the diagnosis of acute appendicitis in pregnant patients. Therefore, MRI is recommended for use as a first-line diagnostic test for pregnant patients with clinically suspected appendicitis. [ABSTRACT FROM AUTHOR]

Mucinous appendiceal neoplasms are uncommon, but important to recognize with imaging due to malignant potential. Peritoneal seeding and pseudomyxoma peritonei can occur with both frankly malignant as well as low-grade appendiceal neoplasms. Prospective imaging identification of potential appendiceal neoplasm is paramount to clinical/surgical management. When a mucinous appendiceal neoplasm is suspected, a right hemicolectomy with lymph node dissection is the preferred surgical management. Unfortunately, accurate preoperative diagnosis can be challenging due to a wide range of clinical presentations and overlapping imaging appearances of appendiceal neoplasms with benign entities. Using the 2010 World Health Organization (WHO) pathologic classification as a framework, we provide a comprehensive multi-modality pictorial essay detailing the broad array of imaging findings of mucinous appendiceal neoplasms and common imaging mimics. [ABSTRACT FROM AUTHOR]

Background: appendicitis is defined as an inflammation of the inner lining of the vermiform appendix that spreads to its other parts. Despite diagnostic and therapeutic advancement in medicine, appendicitis remains a clinical emergency and is one of the most common causes of acute abdominal pain and one of the most frequent surgical complains in the emergency room. Aim of the Work: the aim of this work was to compare the Appendicitis Inflammatory Response Score to the traditional Alvarado score to determine which is more accurate in the diagnosis of acute appendicitis. Patients and Methods: this descriptive prospective study was carried on 50 patients admitted to the surgical ER of Rashid General Hospital from December 2017 to April 2018 complaining from right lower quadrant pain between the age of 5 years old and 70 years old. All 50 patients had lower quadrant abdominal pain with suspicion of having acute appendicitis, all of them were thoroughly examined and both Alvarado Score and Appendicitis Inflammatory Response Score were applied to all of them, patients with moderate to high probability of having appendicitis(Alvarado Score = 7 or higher, AIR = 8 or higher) underwent open appendectomy and then the resected appendices were sent for histopathology to confirm the diagnosis. Results: the total number of cases with confirmed diagnosis of acute appendicitis by means of post-operative histopathology in our study was 46 out of 50 patients, the AIR score had sensitivity of 95.65% while the Alvarado score had sensitivity of 91.3%. Conclusion: this study demonstrates that the Appendicitis Inflammatory Response Score (AIR) appears to be more accurate than the Alvarado score, easy-to-use and reliable when dealing with a case of right lower quadrant pain with the suspicion of acute appendicitis and can help reduce the negative appendectomy rate. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Pseudomyxoma peritonei (PMP) is a rare neoplasm of the appendix, which if untreated disseminates throughout the abdominal cavity and generates considerable morbidity. Since 2002 in the UK, patients with PMP have been managed via two nationally commissioned centres. We evaluated referrals and treatment pathways over time at the Manchester centre. Method: Data from all patients referred with suspected PMP were prospectively collected (2002–2015). Definitive treatment was cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy. Disease burden was quantified using the Peritoneal Cancer Index (PCI) (score 0–39) and complete cytoreduction (CC) defined by scores of 0/1. Novel treatment algorithms were developed for patients with low grade appendiceal mucinous neoplasm (LAMN) localized to the peri‐appendiceal tissue. Results: In all, 817 patients with confirmed PMP were referred increasing from 11 in 2002 to 103 in 2015. Disease burden was high with a mean PCI of 31 in the first quartile (Q1), levelling off to 15, 15, 17 thereafter (P = 0.002). The proportion of CC0/1 increased from 67% in Q1 to 77% Q2 and 74% Q3/4. Where complete cytoreduction was achieved, 5‐ and 10‐year overall survival was 77% and 66%. The proportion of patients referred with localized LAMN increased over time reaching 25% each year since 2010 (Ptrend < 0.0001). Two‐thirds of localized LAMN now undergo laparoscopically assisted risk‐reducing CRS. Conclusion: The establishment of a national treatment centre was associated with an initial presentation of patients with advanced disease. The programme has demonstrated a clear trend over time towards earlier referral and adoption of minimally invasive techniques for localized disease. [ABSTRACT FROM AUTHOR]

Objective: To validate diagnosis of acute appendicitis using grey scale ultrasound. Study Design: Cross sectional validation. Place and Duration of Study: The study was conducted at Radiology Department, Armed Forces Institute of Radiology and Imaging (AFIRI) Rawalpindi, from Mar 2013 to Aug 2013. Material and Methods: All the patients were referred to the sonography section of Emergency Radiology Department for suspected diagnosis of acute appendicitis. All patients of suspected appendicitis had ultrasound of abdomen. Indication of any above stated criteria resulted in appendicectomy of the patient. Patients were operated by conventional method of appendicectomy. Results regarding appendix by ultrasonography and surgical outcome were recorded on the proforma. Data entry and analysis were done by using SPSS 21. Results: Mean age of patients was 21.39 ± 4.332 years. There were 77 (48.1%) male and 83 (51.9%) female patients. Clinically, there were 126 (79%) patients positive for appendicitis and on ultrasound findings 121 (76%) patients had appendicitis. Surgical outcome showed 125 (78%) patients as positive. Sensitivity and specificity of ultrasound for the diagnosis of appendix was 87.20% and 65.71%. While positive predictive value (PPV) and negative predictive value (NPV) of ultrasonography was 90.80% and 58.97% respectively. Overall diagnostic accuracy of ultrasound was 82.5%. Conclusion: In patients who present with clinically suspected acute appendicitis, imaging with ultrasound was effective technique to confirm the clinical diagnosis. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is a common problem in children and early adult life. Appendicectomycan significantly reduce morbidity and mortality. The present study was conducted to find out demographic profile of appendicitis and also distribution of position of appendix as found during surgery. Materials and methods:A total of 127 cases were studied,Sixty cases are from the prospective study over a period of one and half years between May 1991 to October 1992 and sixty seven cases are from retrospective study of cases prior to this period. Results:The most common age group of appendicitis is third decade with male predominance in our study. The position of appendix found during surgery in our cases were mostly retrocaecal. Conclusion: In a young patient with abdominal emergency,appendicitis has to be ruled out. [ABSTRACT FROM AUTHOR]

While appendicectomy has been considered the mainstay of treatment for children with acute appendicitis for many decades, there has been a great deal of recent interest in non-operative treatment (NOT) with antibiotics alone. Initial results suggest that many children with appendicitis can indeed be safely treated with NOT and can be spared the surgeon's knife. Many as yet unanswered questions remain, however, before NOT can be considered a realistic and reliable alternative to surgery. This review summaries current knowledge and understanding of the role of NOT in children with appendicitis and outlines and discusses the outstanding knowledge gaps. [ABSTRACT FROM AUTHOR]

Objective: Low-grade appendiceal mucinous neoplasms (LAMN) are debated about their potential to cause invasion and pseudomyxoma peritoneii (PMxP). Our aim was to examine these neoplasms by two invasion markers: matrix metalloproteinases- 2 and -9 (MMP). Methods: Twenty-eight cases of mucinous adenomas, LAMNs and adenocarcinomas were included. Immunohistochemistry of MMP-2 and -9 were applied and scored. Results: Overall, the majority of LAMNs were negative by these two markers. Conclusion: LAMNs may not actually have an invasive nature but still they can cause PMxP. These patients should be followed. [ABSTRACT FROM AUTHOR]

This study evaluated nonoperative treatment for mild appendicitis and reviewed selection criteria to be used in introducing this option into clinical practice. A retrospective review of 73 consecutive cases of appendicitis treated by a single surgeon from 2011 to 2013 was completed. Patients who were diagnosed with mild appendicitis meeting the criteria of an APPENDICITIS scoring algorithm proposed in this manuscript were considered for nonoperative management. An additional 17 patients with mild appendicitis were offered and successfully treated nonoperatively between 2014 and 2016 and reviewed. Of these original 73 patients, 37 had moderate to severe appendicitis and directly underwent appendectomy. The remaining patients were diagnosed with mild appendicitis and considered eligible for nonoperative management. Of these, 14 patients were offered nonoperative therapy. Thirteen responded successfully; one patient responded partially, but later opted for surgery. In 2014, this scoring system and preliminary results were shared with the other surgeons in our department. Nonoperative management was then selectively adopted by a few of the surgeons from 2014 to 2016 with another 17 patients (APPENDICITIS score of 0 or 1) being offered and successfully managed nonoperatively. Patients with mild or early appendicitis can be successfully managed nonoperatively. A proposed APPENDICITIS scoring system may provide a helpful mnemonic for successfully selecting patients for this option. [ABSTRACT FROM AUTHOR]

Background: Duplex appendix is very rare (incidence 0.004%) but has clinical relevance given the frequency of appendicectomies performed. Failure to recognise duplication can result in failure of treatment and medico-legal consequences. A review of published cases was undertaken to identify factors that may help in managing this rare condition. Methods: All English and non-English publications were identified in PubMed, Embase and Cochrane databases. Patient demographics, intraoperative findings, anatomical details and histopathology were analysed. Results: A total of 141 cases were identified [male/female ratio 1.4:1, median age 20 years (range foetus to 69 years)]. Duplication of the appendix ranges from branching of the appendix trunk to a fully matured appendix located elsewhere along the colon. Most can be categorised by the Cave-Wallbridge classification. There were 22 Type A, 8 Type B1, 46 Type B2 and 10 Type C cases (Cave-Wallbridge). There were six cases of horseshoe and two cases of triple appendix. Six reports gave anatomical descriptions that could not be classified by Cave-Wallbridge categories and in 11 cases there were no anatomical descriptions. Conclusions: An anteriorly placed appendix, away from the convergence of the taenia, or a normal appendix in the presence of convincing clinical or radiological signs of appendicitis should instigate a careful examination of the caecal pole and possible exploration of the retrocaecal space for appendiceal duplication. If the patient had previous surgery for congenital abnormalities, Type B1 or Type C duplication should be considered. [ABSTRACT FROM AUTHOR]

The article focuses on a study based on routine appendix diagnostics which is considered as seeds in the appendiceal lumen, their histological aspects and their differential diagnosis from parasites. It mentions real importance of identifying seed type in histological sections is in forensic botany and forsensic pathology. It also mentions incidental presence of seeds within the appendix lumen can be challenging to interpret for inexperienced pathologists.

Objective: To evaluate the diagnostic value of the T1 bright appendix sign for the diagnosis of acute appendicitis in pregnant women.Material and Methods: This retrospective study included 125 pregnant women with suspected appendicitis who underwent magnetic resonance (MR) imaging. The T1 bright appendix sign was defined as a high intensity signal filling more than half length of the appendix on T1-weighted imaging. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the T1 bright appendix sign for normal appendix identification were calculated in all patients and in those with borderline-sized appendices (6-7 mm).Results: The T1 bright appendix sign was seen in 51% of patients with normal appendices, but only in 4.5% of patients with acute appendicitis. The overall sensitivity, specificity, PPV, and NPV of the T1 bright appendix sign for normal appendix diagnosis were 44.9%, 95.5%, 97.6%, and 30.0%, respectively. All four patients with borderline sized appendix with appendicitis showed negative T1 bright appendix sign.Conclusion: The T1 bright appendix sign is a specific finding for the diagnosis of a normal appendix in pregnant women with suspected acute appendicitis.Key Points: • Magnetic resonance imaging is increasingly used in emergency settings. • Acute appendicitis is the most common cause of acute abdomen. • Magnetic resonance imaging is widely used in pregnant population. • T1 bright appendix sign can be a specific sign representing normal appendix. [ABSTRACT FROM AUTHOR]

Introduction:Pseudomyxoma peritonei (PMP) is a rare condition caused by mucinous adenocarcinoma cancerous cells that produce abundance of mucin or gelatinous ascites. This cancer can cause tissue fibrosis and can impair normal organ function. Diagnosis can involve multiple imaging modalities including CT scan. There have been few cases of endoscopic ultrasound (EUS) being used as a means for diagnosis of this condition. Here we report a second case of PMP with a previous history of appendectomy diagnosed with EUS guided fine needle aspiration (FNA) biopsy. Case study:A 66-year-old male with a history of an appendectomy presented with intermittent abdominal pain for two years and weight loss of 40 pounds over two months. EGD and colonoscopy performed at an outside hospital was unremarkable. CT abdomen revealed perigastric ascities and lesions of the liver. ESR was elevated at 75. At our facility, EUS was performed revealing a peri-gastric and omental mass measuring 36.6 mm × 25.5 mm. FNA performed of both mass and ascetic fluid revealed low grade mucinous adenocarcinoma with mucinous deposits in the peritoneum consistent with PMP. Conclusions:Endoscopic ultrasound guided FNA, although very rarely used, can be a reliable and safe technique in diagnosis of PMP. [ABSTRACT FROM PUBLISHER]

Background Acute appendicitis is one of the most common emergency requiring operation. As the first discovered coagulation factor, plasma fibrinogen frequently increases with inflammation due to the activation of coagulation. The aim of this retrospective study was to investigate the diagnostic value of hyperfibrinogenemia as a preoperative laboratory marker for appendiceal perforation in patients with acute appendicitis. Materials and methods We identified 455 patients (202 females, 253 males; mean age, 31.7 years) with histologically confirmed acute appendicitis who underwent laparoscopic or open appendectomy. Results of preoperative laboratory values and post-operative histologic results were analysed retrospectively. A multivariate logistic regression model was performed to determine patient's age and laboratory tests associated with perforated appendicitis. Result Mean plasma fibrinogen level of all patients was 3.99 g/L (1.41 SD; range, 1.73-10.6 g/L; median, 3.69 g/L). Patients with appendiceal perforation had a mean fibrinogen level of 5.72 g/L (1.52 SD; range, 3.38-10.04 g/L; median, 5.28 g/L), which was significantly higher than those with nonperforated groups ( P = 0.001). Multivariate analysis showed fibrinogen and D-dimer were associated with perforation ( P = 0.001, P = 0.014, respectively). Areas under the receiver operating characteristic curve of fibrinogen for discriminating acute perforated appendicitis from non-perforated groups were larger than white blood cell and D-dimer. Conclusions Hyperfibrinogenemia was common in patients with acute appendicitis and fibrinogen may be useful as a predictive factor for appendiceal perforation. [ABSTRACT FROM AUTHOR]

We present the case of an 81-year-old man with a known appendicular mucocele who presented to the emergency department with acute abdominal pain. A CT scan showed a change in orientation of the previously seen ovoid mass with surrounding fat stranding suggesting torsion. An emergency laparotomy with appendicectomy and resection of the caecal pole was performed. We discuss the findings and histopathology. [ABSTRACT FROM AUTHOR]

In this study, we aimed to determine factors that cause appendix perforations and to identify the role of physicians and patients in contributing to the cause of these perforations. This study was conducted between April 2010 and May 2015 and included 64 patients with perforated appendicitis. Patients' medical records were examined for factors that might have contributed to perforation, and the roles of patients and physicians in perforation appendicitis were evaluated. The perforation rate of patients with appendicitis was 16.0 per cent. The average duration from symptom onset to hospital admission was 4.4 days (29 patients were admitted to hospital within two days, 35 were admitted later). In total, 38 patients had visited a different hospital before admission. Furthermore, six out of 26 patients who had not visited any other hospital had consumed analgesics. Factors contributing to appendix perforation included misdiagnosis at the patient's initial visit (56.0%), delayed admission to hospital (11.0%), and use of analgesics (9.0%). The cause of perforation was mostly physician-related in children and adults, and patient-related in older adults. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is the most common surgical emergency and can represent a challenging diagnosis, with a negative appendectomy rate as high as 20 %. This review aimed to evaluate the clinical utility of individual biomarkers in the diagnosis of appendicitis and appraise the quality of these studies.Methods: A systematic review of the literature between January 2000 and September 2015 using of PubMed, OvidMedline, EMBASE and Google Scholar was conducted. Studies in which the diagnostic accuracy, statistical heterogeneity and predictive ability for severity of several biomarkers could be elicited were included. Information regarding costs and process times was retrieved from the regional laboratory. European surgeons blinded to these reviews were independently asked to rank which characteristics of biomarkers were most important in acute appendicitis to inform a cost-benefit trade-off. Sensitivity testing and the QUADAS-2 tool were used to assess the robustness of the analysis and study quality, respectively.Results: Sixty-two studies met the inclusion criteria and were assessed. Traditional biomarkers (such as white cell count) were found to have a moderate diagnostic accuracy (0.75) but lower costs in the diagnosis of acute appendicitis. Conversely, novel markers (pro-calcitonin, IL 6 and urinary 5-HIAA) were found to have high process-related costs including analytical times, but improved diagnostic accuracy. QUADAS-2 analysis revealed significant potential biases in the literature.Conclusion: When assessing biomarkers, an appreciation of the trade-offs between the costs and benefits of individual biomarkers is needed. Further studies should seek to investigate new biomarkers and address concerns over bias, in order to improve the diagnosis of acute appendicitis. [ABSTRACT FROM AUTHOR]

Background: To determine the diagnostic accuracy of abdominal ultrasound (US) for the diagnosis of acute appendicitis (AA), in terms of sensitivity, specificity and post-test probabilities for positive and negative result. Methods: A systematic search of MEDLINE, Embase, The Cochrane library and Science Citation Index Expanded from January 1994 to October 2014 was performed. Two authors independently evaluated studies for inclusion, extracted data and performed analyses. The reference standard for evaluation of final diagnosis was pathohistological report on tissue obtained at appendectomy. Summary sensitivity, specificity and post-test probability of AA after positive and negative result of US with corresponding 95% confidence intervals (CI) were calculated. Results: Out of 3306 references identified through electronic searches, 17 reports met the inclusion criteria, with 2841 included participants. The summary sensitivity and specificity of US for diagnosis of AA were 69% (95% CI 59-78%) and 81% (95% CI 73-88%), respectively. At the median pretest probability of AA of 76.4%, the post-test probability for a positive and negative result of US was 92% (95% CI 88-95%) and 55% (95% CI 46-63%), respectively. Conclusions: Abdominal ultrasound does not seem to have a role in the diagnostic pathway for diagnosis of AA in suspected patients. The summary sensitivity and specificity of US do not exceed that of physical examination. Patients that require additional diagnostic workup should be referred to more sensitive and specific diagnostic procedures, such as computed tomography. [ABSTRACT FROM AUTHOR]

Mucocele of the appendix is a rare entity in pediatrics, with few case reports in the literature. We present a case of a 17-year-old male with right lower quadrant pain who was found to have an appendiceal mucocele while being evaluated for appendicitis. Laparoscopic-assisted resection was performed, with pathology confirming a low-grade mucinous neoplasm of the appendix, a tumor scarcely described in the pediatric population. He underwent complete resection with negative margins, rendering him cured without the need for any further resection or treatment. We review the literature on this topic. [ABSTRACT FROM AUTHOR]

Background: Abdomen is considered a magic box or a Pandora box where you will get different, unexpected pathologies along with rare entities. Appendicitis is the commonest emergency in surgery which presents challenges to surgeons because of a myriad list of differential diagnosis including both medical and gynaecological pathologies. Preoperative imaging plays an important role in diagnosis and management. Aims and objectives: To study the rare atypical anatomical and surgical presentations of appendix in patients with clinical features of appendicitis. We focus on the clinical features and the role of investigations for the radiological part and management. Material and methods: This study was done in M.M. Institute of Medical Sciences and Research, Mullana, Ambala, from November 2014 to July 2016. This was a retrospective study. We found 168 cases with the diagnosis of appendicitis, out of which 19 were with rare entities. Results: Subjects of both genders were aged between 20 and 60 years. Out of 19, 15 were males and 4 females. Four patients were operated for inguinal hernia but incidentally we found appendix in the hernial sac termed as Amyand's hernia. Another patient presented with obstruction and appendix was forming a band diagnosed as torsion of appendix. Two most interesting cases were diagnosed as appendicular neuralgia and relieved by appendectomy. Out of 19 cases, 7 cases were operated for appendicitis diagnosed as appendicolith. In all the cases appendectomy was done without encountering any complications. Symptom free patients were operated for appendicular neuralgia. No malignancy was found in mucocele appendix at follow up. There were no complications by the 6-month follow-up. Conclusion: As we came across with different entities of appendix presented with appendicitis, patients should be investigated before proceeding for surgery. In our study, there were incidental findings for which surgeons were not aware of the diagnosis and even for the patient. In inguinal hernia, ultrasonography was not done, diagnosis being made on clinical basis. Clinical and radiological investigations play an important part in early diagnosis and management. [ABSTRACT FROM AUTHOR]

Unusual locations of the appendix vermiformis can result in delay in appropriate diagnosis and treatment of appendicitis. So an inflamed appendix in a sub-hepatic caecum caused by caecal maldescent for example can mimic cholecystitis, the pain being localized in the right upper quadrant. Here, we present a case of perforated sub-hepatic appendicitis with peritonitis, requiring open ileocaecal resection. Review of the existing literature has demonstrated that this pathology is uncommon, yet not so rare as one might presume. In conclusion, surgeons should be aware of this possibility in the diagnostic and therapeutic management of acute abdomen. [ABSTRACT FROM AUTHOR]

Background/Objective Many pediatric emergency departments in the United States have adopted a staged ultrasound and CT pathway for the diagnosis of acute appendicitis. However, most algorithms only include radiology-performed ultrasound (BUS). Our objective was to determine if emergency physician-performed BUS provides sufficient diagnostic accuracy for acute appendicitis in a pediatric population, thereby limiting additional cost and/or delay in disposition. Methods This is a single-center prospective study of pediatric patients with concern for and requiring further work-up for acute appendicitis. Each patient had a focused bedside ultrasound (BUS) performed by an emergency physician with training in BUS. Diagnostic accuracy was compared with surgical pathology standard, as well as radiology-performed ultrasound (RUS), computed tomography (CT), and clinical follow-up. Results Among 46 enrolled patients, 12 were diagnosed with acute appendicitis (26%). There were no negative laparatomies in those who had surgery. There was one case of missed appendicitis at 4-week follow-up. BUS had a sensitivity of 100% (95% CI: 72% to 100%) and a specificity of 81% (61% to 93%) when the appendix was visualized (37). This resulted in positive likelihood ratio of 5.2 and negative likelihood ratio of 0. In the cases where the appendix was not visualized on BUS (9), 1 patient was diagnosed with appendicitis, and the other 8 patients were negative for appendicitis. In RUS both the sensitivity and specificity was 100% when the appendix was visualized. The sensitivity and specificity of CT in our study was 90% and 100% respectively. Conclusions Emergency physicians can perform bedside ultrasound with high accuracy for acute appendicitis in a pediatric population. When the appendix is not visualized by ultrasound, a staged ultrasound and CT pathway should be considered. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Surgery & Medicine (JOSAM) is the property of Journal of Surgery & Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Vermiform appendix is considered as a vestigial organ, and it has minimal or no role to play in the digestion and absorption of food. It is an enigma to the clinicians due to its variable positions and symptoms caused by its inflammation. In the available literature, there are many reports on various positions, size and disease of appendix. However, there is no report on an anteriorly located appendicular attachment to the caecum. During dissection classes for medical undergraduates, an appendix with its base attached to the anterior wall of the caecum was noted. The entire appendix was attached to the ileum through a mesoappendix and was readily visible when the anterior abdominal wall was reflected. This position could be a boon to the clinicians and radiologists during diagnosis and surgery of the appendix. [ABSTRACT FROM AUTHOR]

Enterobius vermicularis associated appendiceal colic and acute appendicitis are rarely encountered in the United States. The 9-year-old patient described in this case presented with right lower quadrant abdominal pain, nausea, and vomiting consistent with acute appendicitis and was brought to the operating room for an appendectomy. Intraoperatively a pinworm, E. vermicularis, was visualized and the presumptive diagnosis of acute appendicitis was revised to E. vermicularis associated appendiceal colic. Retrospective review of the preoperative imaging demonstrates the first reported ultrasonographic image of pinworm inhabitance within the appendiceal lumen. The patient was treated postoperatively with a course of albendazole and recovered appropriately. This article reviews the geographic epidemiology, pathophysiology, surgical, and medical treatment recommendations in the management of E. vermicularis diseases of the appendix. Through dissemination of this ultrasonographic imaging, the authors hope to inform other providers about E. vermicularis associated appendiceal colic and reduce the incidence of avoidable surgeries. [ABSTRACT FROM AUTHOR]

TULAA or Transumbilical Laparoscopic Assisted Appendicectomy is a minimally invasive technique described by Pelosi in 1992 for the removal of the inflamed appendix. Its main advantage is the possibility of exploring the peritoneal cavity and performing a simple and safe extracorporeal appendicectomy. Since its first description, different authors reported their experience with such technique. The aim of this review is to summarise the surgical outcomes currently reported in the literature for this minimally invasive surgical approach and compare it with standard open and laparoscopic appendicectomy. [ABSTRACT FROM AUTHOR]

Background: Appendectomy is the most frequent and urgent gastrointestinal surgery. Overtime, the surgical techniques have been improved upon, in order to reduce complications, get better cosmetic results, and limit the discomfort associated with this procedure, by its high impact in the surgery departments. The traditional skin closure is associated with a poor cosmetic result and it requires stitches removal, alongside the pain associated with this procedure, and no benefits were demonstrated in the literature regarding separated stitches over intradermic stitch. This is a randomized controlled trial, and our objective is to compare two different skin closure techniques in open appendectomy. Methods: A prospective randomized trial method was used, with a total number of 208 patients participating in the study, after acute appendicitis diagnosis in the emergency department. They were randomized into two groups: patients who would receive skin closure with a unique absorbable intradermic stitch (Group A) and another group that would receive the traditional closure technique, consistent in non-absorbable separated stitches (Group B). General characteristics like gender, age, Body Mass Index (BMI), comorbidities, and allergies were registered. Days of Evolution (DOE) until surgery, previous use of antibiotics, complicated or uncomplicated appendicitis, surgical time, and wound complications like skin infection, dehiscence, seroma or abscess were also registered in each case. Results: 8 patients were excluded due to negative appendicitis during surgery and lack of follow-up. Two groups, each containing 100 patients, were formed. General characteristics and parity were compared, and no statistically significant differences were observed. Difference in the surgical time (Group A: 47.35 min vs Group B: 54.13 min, p < .001) and cases with complicated appendicitis (Group A: 58 and Group B:38, p = .005) were found to be statistically significant. Four wound complications were reported, and the incidence of seroma (Group A:0 and Group B:5, p = .02) and abscess (Group A:2 and Group B:8, p = .05) were found to have some statistical significant difference. In a multivariate analysis, a relationship was observed between BMI > 25 kg/m and seroma ( p = .006), BMI > 25 kg/m and abscess ( p = .02), surgical time >50 min and seroma ( p < .001), >2 DOE and abscess ( p = .001), and complicated appendicitis with seroma development ( p = .03). Conclusion: Open appendectomy skin closure with a unique absorbable intradermic stitch is safe, with a reduced seroma and abscess incidence, compared to traditional closure, and an equivalent dehiscence and superficial infection incidence, allowing a lower hospital attention cost and length of hospital stay for treatment of complications. The relative risk of complications with traditional skin closure is 2.91 higher, compared to this new technique. [ABSTRACT FROM AUTHOR]

Acute appendicitis is a common surgical emergency. Appendix continues to be the major chunk of surgical specimens received in Pathology laboratory. However, pathogenesis of appendicitis remains poorly understood. Obstruction and inflammation is implied in pathogenesis of acute appendicitis. Presently there is increasing evidence of involvement of enteric nervous system in immune regulation and in inflammatory responses. The present study combines routine histopathology and immunohistochemistry to study the role of mast cells and enteric nervous system in pathophysiology of acute appendicitis. We have done a prospective study for a period of one and half years from January 2014 to July 2015. Appendicectomy specimens from patients who are clinically diagnosed as acute appendicitis were included in study group as cases. Appendix specimens removed at Forensic autopsies were used as controls. Study was conducted on total 138 appendix specimens of which 118 were surgically removed from patients with acute appendicitis, taken as study group. 20 specimens from Forensic autopsy, were used as comparison group (normal control group). We found a consistent increase in mast cell and neuronal counts along with prominence of ganglion cells in specimens with acute appendicitis compared to the control group. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to analyse 13 patients who were treated in our clinic due to acute appendicitis during pregnancy. Methods: Records of the patients who received appendectomy with appendicitis diagnosis in our Turgut Özal University Research and Application Hospital between January 2007 and December 2015 have been analyzed retrospectively. Results: Appendectomies were performed on 13 pregnant patients with an acute appendicitis diagnosis. Average age of the patients was 27.69 years (between 22-37 years). Most frequent complaint of the patients was abdominal pain and most frequent examination finding was tenderness at right lower quadrant. Ultrasonography was used in all cases for diagnosis. Surgery was decided with clinical diagnosis for five cases (38.5%) where appendix had not been identified with ultrasonography. While laparoscopic appendectomy was applied in one case (7.7%) and open appendectomy was applied using a McBurney incision in 12 cases (92.3%). Average hospitalization duration was 1.69 days. All patients were tracked together through the Gynaecology Department for two weeks after they had been discharged from the hospital. Preterm delivery, maternal and fetal loss did not occur. Conclusion: It is considered appropriate to apply ultrasonography routinely to all pregnant patients in whom acute appendicitis is suspected. Concern for maternal or fetal complication that may occur in consequence of an unnecessary surgery should not be at a level that will delay surgical treatment needed by the patient. [ABSTRACT FROM AUTHOR]

Background: To investigate the status of antibiotics use in acute appendicitis patients who undergo appendectomy in a Chinese tertiary care hospital. Methods: A retrospective analysis of 93 patients who underwent appendectomy from June 1, 2011 to May 30, 2012 and had recorded use of intravenous antibiotics. We defined simple appendicitis and suppurative appendicitis as mild appendicitis. Gangrenous appendicitis and perforated appendicitis were classified as advanced appendicitis. The occurrence of advanced appendicitis, postoperative complications and length of hospital stay were the three major end points for outcomes analysis. Results: 100 % of the patients received antibiotics therapy before and after operation. 45 patients received Fluoroquinolones (48.4 %), 41 patients received Cephalosporins (44.1 %) and 7 patients received Carbapenems (7.5 %). We found no statistical difference between antibiotics selection and the occurrence of advanced appendicitis (P = 0.3337). Both the monovariate analysis and multivariate analysis showed no statistical difference between antibiotics selection and the postoperative complications (P > 0.05). The average stay of patients receiving Fluoroquinolones was 2.6 days shorter than patients who received Cephalosporins (P = 0.0085). Conclusion: It is a lack of a standardized guideline for antibiotics selection in our hospital. All the antibiotics prescription were empirical. We tended to choose high levels of antibiotics, pay insufficient attention to the anaerobic bacteria and have a long duration of antibiotics therapy. We also found that antibiotics selection bore no relationship with the occurrence of advanced appendicitis and postoperative complications. Fluoroquinolones may lead to a shorter hospital stay, but this result may also be affected by the fewer underlying diseases and lower severity of the patients. [ABSTRACT FROM AUTHOR]

Appendicular knot/tie syndrome is a rare cause of mechanical intestinal obstruction. It is rarer still in the paediatric age group. We present the case of a 9-year-old boy admitted with clinical features and radiological evidence of acute intestinal obstruction, which at laparotomy revealed an inflamed/gangrenous knotted appendix, ileal volvulus and strangulation. This is a 'three in one' case of acute abdomen associated with appendicoileal knotting. In the presence of viable ileum, a retrograde appendectomy was performed. Postoperative period and follow-up were uneventful. Appendicular knot/ band syndrome should be considered a possible differential in acute intestinal obstruction. Computed tomographic scan as an investigative modality should be selective in the presence of acute intestinal obstruction with or without peritonitis, with emphasis on adequate resuscitation and surgery. [ABSTRACT FROM AUTHOR]

Background: Identification of the normal position of appendix is important because in appendicitis variable positions may produce symptoms and signs related to position and hence can mimic other diseases. Hence knowledge of these variations is essential for accurate diagnosis and treatment of the condition. Aims: It was undertaken to investigate certain anatomical features and different positions of the vermiform appendix and caecum in cadavers of Nandyal region. Method: This study was carried on 35 human cadavers irrespective of sex and age from the Department of Anatomy over a periods of 12 months. Results: In the present study the commonest position was retrocaecal(34%), followed by pelvic(28%), postileal(17%), subcaecal(11%) and midinguinal(8%). Preileal variety was not established. Average length of appendix, outer girth of appendix and distance of appendix from ileocaecal junction was 5.93 cm, 2.8 cm and 2.47 cm, respectively. Conclusion: A systematic knowledge of normal anatomy and variations in the position of vermiform appendix is of significant value during surgical and radiological procedure to avoid any catastrophical complication. [ABSTRACT FROM AUTHOR]