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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]

Emerging evidence suggests that the human vermiform appendix is not a vestigial organ but rather an immunological organ of biological relevance. It is hypothesised that the appendix acts as a bacterial 'safe house' for commensal gut bacteria and facilitates re-inoculation of the colon after disruption through the release of biofilms. To date, no studies have attempted to explore this potential mechanistic function of the appendix. We conducted a pre-post intervention study in adults (n = 59) exploring re-establishment of the gut microbiota in those with and without an appendix after colonic disruption via bowel preparation and colonoscopy. Gut microbiota composition was measured one week before and one month after bowel preparation and colonoscopy using 16S rRNA sequencing. We observed between group differences in gut microbiota composition between those with (n = 45) and without (n = 13) an appendix at baseline. These differences were no longer evident one-month post-procedure, suggesting that this procedure may have 'reset' any potential appendix-related differences between groups. Both groups experienced reductions in gut microbiota richness and shifts in beta diversity post-procedure, with greater changes in those without an appendix, and there were five bacterial genera whose re-establishment post-procedure appeared to be moderated by appendicectomy status. This small experimental study provides preliminary evidence of a potential differential re-establishment of the gut microbiota after disruption in those with and without an appendix, warranting further investigation into the potential role of the appendix as a microbial safe house. [ABSTRACT FROM AUTHOR]

Abstract 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.

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]

Background: Appendiceal goblet cell adenocarcinoma (GCA) is a rare subtype of primary appendiceal adenocarcinoma with an incidence of 1–5 per 10,000,000 people per year. Appendiceal tumors are often diagnosed after appendectomy for acute appendicitis. Notably, however, there is currently no standard treatment strategy for GCA, including additional resection. We report a case of appendiceal GCA with perineural extension into the cecum, in which ileal resection was considered effective. Case presentation: A 41-year-old man was diagnosed with acute appendicitis and underwent appendectomy. Histopathological findings revealed GCA (T3, Pn1). He was referred to our hospital for additional resection. Preoperative examination indicated a diagnosis of GCA cT3N0M0. Laparoscopic ileocecal resection and D3 lymph node dissection were performed 2 months after initial appendectomy. The patient had a good postoperative course and was discharged 8 days after surgery. Histopathological findings showed a GCA invading the cecum, despite an intact appendiceal stump, no lymph node metastasis, no vascular invasion, and no horizontal extension into the submucosa. Direct invasion of the tumor through the serosa was not observed, but perineural extension was conspicuous in the cecum, suggesting that the GCA extended into the cecum via perineural invasion. The resection margins were negative. The patient has survived free of recurrence for a year after ileocecal resection. Conclusions: The current patient was diagnosed with appendiceal GCA following appendectomy for acute appendicitis. Despite intact of appendiceal stump and no evidence of lymph node or distant metastasis, he underwent laparoscopic ileocecal resection and D3 lymph node dissection 2 months after initial appendectomy, with a favorable outcome. Despite the detection of perineural invasion, the patient declined adjuvant therapy. This case suggests that extensive resection may be required in patients with appendiceal GCA, but the role of adjuvant therapy remains unclear. [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]

Copyright of Online Turkish Journal of Health Sciences (OTJHS) / Online Türk Sağlık Bilimleri Dergisi is the property of Oguz KARABAY 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.)

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]

Appendiceal neuroendocrine tumors (NETs) are common and often are identified as incidental lesions at the time of appendectomy. The guidelines for management are based on tumor size, degree of invasion, and the Ki67 proliferation index. Most small bowel NETs are composed of serotonin-producing EC-cells, but there are multiple other neuroendocrine cell types. In the rectum, there are L-cell tumors that express peptide YY (PYY), glucagon-like peptides (GLPs), and pancreatic polypeptide (PP); they are thought to have a better prognosis than serotonin-producing tumors. We investigated whether the appendix has distinct neuroendocrine tumor types based on cell type and whether that distinction has clinical significance. We collected 135 appendiceal NETs from the pathology archives of UHN Toronto and UHCMC (Cleveland). We analyzed the expression of biomarkers including CDX2, SATB2, PSAP, serotonin, glucagon (that detects GLPs), PYY, and pancreatic polypeptide (PP) and correlated the results with clinicopathologic parameters. Immunohistochemistry identified three types of appendiceal NETs. There were 75 (56%) classified as EC-cell tumors and 37 (27%) classified as L-cell tumors; the remaining 23 (17%) expressed serotonin and one of the L-cell biomarkers and were classified as mixed. EC-cell tumors were significantly larger with more extensive invasion involving the muscularis propria, subserosa, and mesoappendix compared with L-cell tumors. Mixed tumors were intermediate in all of these parameters. Both EC-cell and mixed tumors had lymphatic and/or vascular invasion while L-cell tumors had none. Unlike EC-cell NETs, L-cell tumors were not associated with lymph node metastasis. Tumor type correlated with pT stage and the only patient with distant metastatic disease in this series had an EC-cell tumor. Our study confirms that appendiceal NETs are not a homogeneous tumor population. There are at least three types of appendiceal NET, including EC-cell, L-cell, and mixed tumors. This information is important for surveillance of patients, as monitoring urinary 5HIAA levels is only appropriate for patients with serotonin-producing tumors, whereas measurement of GLPs and/or PP is more appropriate for patients with L-cell tumors. Our data also show that tumor type is of significance with EC-cell tumors exhibiting the most aggressive behavior. [ABSTRACT FROM AUTHOR]

Background: Lower gastrointestinal bleeding accounts for 20 to 25% of all gastrointestinal bleedings. Appendiceal bleeding is a rare, yet important cause of lower gastrointestinal bleed; in many cases, it can be misdiagnosed as obscure gastrointestinal bleeding. Here, we present a case of appendiceal bleeding in an elderly female. Case description: A 79-year-old female presented with acute onset of gastrointestinal bleeding of same-day duration. Investigations showed that she had an appendiceal bleed originating from an ulcer secondary to a small appendicolith, which has passed through the appendiceal orifice, combined with her aspirin use. Within 12 hours, a laparoscopic appendectomy was performed. No evidence of malignancy or vascular malformation was detected, and the post-operative course was smooth, with resultant discharge at day 3 after her surgery. Discussion: For lower gastrointestinal bleeding, it is crucial for the endoscopist to reach the terminal ileum during the colonoscopy, and thoroughly inspect the orifice of the appendix to assess any source of bleed including but not limited to Dieulafoy’s lesion, angiodysplasia or any vascular malformation. An effective treatment option for appendiceal bleeding is surgical management with appendectomy. Alternative approaches such as vessel embolization and endoscopic treatment have been reported to successfully control bleeding; nevertheless, the risk of acute appendicitis and recurrent bleeding following these procedures can be challenging to manage, potentially leading the patient to still need a surgical treatment with an appendectomy.

Aim To evaluate diagnostic reliability of accessible laboratory findings in recognition of acute appendicitis (AA). Methods A retrospective study included children aged 0-15 years with abdominal pain that lasted less than 5 days with at least two of the signs/symptoms - abdominal pain, tenderness of the lower right quadrant of the abdomen, "return" sensitivity of the abdomen to palpation, loss of appetite, nausea, vomiting, body temperature>37.2°C. Values of procalcitonin (PCT), C-reactive protein (CRP) and the leukocyte count were analyzed in the peripheral blood. Results Among 114 children, 63 (58.2%) were boys and 50 (41.8%) girls; median age of 9.5 years. Elevated values of PCT were found in 74 (65.5%), CRP in 94 (83.1%), and leukocytes in 78 (69%) (65%) children. Almost uniform significance in the recognition of AA was found for pathological values of PCT and CRP with sensitivity of 65% and 83% and diagnostic accuracy of 63% and 59%, respectively, but somewhat lower sensitivity for leukocytes, 61%. A very high predictive value of 98% for PCT and CRP, and PCT with leukocytes was found; CRP with leukocytes had a negative predictive value of 100%. Conclusion PCT values have significant sensitivity, specificity and diagnostic accuracy in recognizing AA, while CRP and leukocytes, with high sensitivity, as non-specific markers can be a significant support for clinical assessment in the timely diagnosis of AA.

Background: Small bowel and omentum are the most common structure seen in an inguinal hernia sac. Appendix as a content of an inguinal hernia sac is extremely rare. We report this clinical entity due to its rarity. Case report: We report a 56 year old man who was seen at the surgical outpatient department of our center with a history of simple symptomatic right inguinal hernia. He had an elective inguinal hernia repair. A clinically normal appendix was seen in the hernia sac. It was reduced during the surgery. He was discharged satisfactorily. Conclusion: A clinically normal appendix may be a content of an inguinal hernia sac.

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]

Appendiceal mucinous neoplasms, particularly Low-grade Appendiceal Mucinous Neoplasms (LAMN), are rare but important diagnostic entities as they are potential causes of a surgical abdomen. The clinical manifestations of this lesion are obscure and ill-defined, and these lesions are commonly misdiagnosed as acute appendicitis, adnexal masses, or retroperitoneal tumours. This lesion can rupture and seed mucin and neoplastic epithelium into the peritoneum, leading to Pseudomyxoma Peritonei (PMP), a serious complication with a high morbidity and mortality rate. Therefore, timely identification and treatment of LAMN are crucial for reducing the risk of PMP and improving prognosis and outcomes. Ultrasonography (USG) and Computed Tomography (CT) scans are useful methods for diagnosis; however, the diagnosis is often incidental or found intraoperatively during resection for suspected acute appendicitis. Clinical awareness of the misleading presentations of LAMN should be present in cases of a surgical acute abdomen to prevent performing a dissimilar treatment intervention. Considering the rarity of this lesion and its varied presentation, it is important to study and document this type of neoplasia in the literature. Hereby, authors report a rare case of LAMN in a 33-year-old male patient with a primary diagnosis of acute appendicitis. This case highlights the importance of having a high index of clinical suspicion of appendiceal malignancy and mucocele rupture in patients planned for appendectomy. This also emphasises the fact that all excised appendicectomy tissues should be sent for histopathological examination as they can harbor pathological changes like LAMN.

Abstract Background Amyand’s hernia is characterized as an inguinal hernia in which the hernia sac contains the appendix. It is highly atypical for the appendix structure to be contained within the hernia sac. Patients with Amyand’s hernia are typically asymptomatic and are frequently identified intraoperatively. Rarely seen in medical literature, this case report details the incidental finding of Amyand’s hernia and the successful preoperative diagnosis. Case presentation A 61-year-old male presented to the urology clinic for his urinary tract complaint. An incidental finding of Amyand’s hernia was found in a non-contrast computerized tomography of the abdomen. Following the evaluation of computed tomography scan images showing the condition of the appendix and radiological findings regarding Amyand’s hernia, the surgeon planned the patient’s herniorrhaphy with mesh. Conclusions Amyand’s hernia is often overlooked; therefore, radiologic examination can help to confirm this diagnosis.

Abstract Introduction Neuroendocrine tumors (NETs) of the appendix are rare and are often discovered incidentally during surgery for acute appendicitis or other unrelated conditions (Modlin et al. in Gastroenterology 128:1717–1751, 2005, Alsaad et al. in Oncol Rep 16:1105–1109, 2006, Frilling et al. in Lancet Oncol 15:e8–e21, 2014). These tumors can range from asymptomatic incidental findings to clinically significant tumors with metastases (Alsaad et al. in Oncol Rep 16:1105–1109, 2006, Gomes et al. in World J Emerg Surg 10:60, 2015, Paiva et al. in Eur J Cancer 38:702–705, 2002, Burke et al. in Am J Surg Pathol. 9:661–674, 1985). This case report presents a rare case of a NET of the appendix presenting as acute appendicitis. Case description A 23-year-old male presented with right lower quadrant abdominal pain, nausea, and vomiting for 2 days. A CT scan revealed a mucocoele of the appendix. The patient underwent laparoscopic appendectomy, and the appendix was sent for histopathological examination. The final pathological report confirmed a NET of the appendix with a Ki-67 index of 1% and no lymphovascular invasion. Due to tumor invasion to the cecum and its large size (3–4 cm), the patient underwent right hemicolectomy. The final histopathology report of the resected specimen confirmed the diagnosis of NET of the appendix. Discussion The clinical diagnosis of NETs of the appendix can be challenging due to their rarity and non-specific presentation. Symptoms of NETs of the appendix can mimic those of acute appendicitis, making it difficult to differentiate between the two conditions. Imaging studies, such as CT scans, can provide valuable information about the size and location of the tumor (Gomes et al. in World J Emerg Surg 10:60, 2015, Maggard et al. in Ann Surg 240:117–122, 2004, Burke et al. in Am J Surg Pathol. 9:661–674, 1985, Frilling et al. in Lancet Oncol 15:e8–e21, 2014). However, the definitive diagnosis is made through histopathological examination of the resected specimen. The treatment of NETs of the appendix depends on factors such as the size, location, and grade of the tumor. Small tumors confined to the appendix with no lymph-vascular invasion can be treated with appendectomy alone, while larger tumors or those that have spread beyond the appendix may require more extensive surgery, such as right hemicolectomy (Gomes et al. in World J Emerg Surg 10:60, 2015, Mestier et al. in Dig Liver Dis 52:899–911, 2020, Maggard et al. in Ann Surg 240:117–122, 2004, Burke et al. in Am J Surg Pathol. 9:661–674, 1985, Frilling et al. in Lancet Oncol 15:e8–e21, 2014, Pavel et al. in Neuroendocrinology 103:172–185, 2016). In some cases, additional treatments such as chemotherapy or radiation therapy may be recommended. Conclusion This case report emphasizes the importance of considering NETs of the appendix in the differential diagnosis of acute appendicitis. Imaging studies can provide valuable information, but the definitive diagnosis is made through histopathological examination. The treatment approach for NETs of the appendix depends on various factors and requires a multidisciplinary approach for optimal management.

We report a patient with a mucocele with diffuse wall thickening diagnosed by transabdominal ultrasonography and contrast-enhanced ultrasonography. Transabdominal ultrasonography showed diffuse thickening of the entire appendix wall and an anechoic area that appeared to be fluid collected throughout the appendix lumen. However, the “onion skin sign” was not detected. Contrast-enhanced ultrasonography combined with superb microvascular imaging revealed abundant mucosal blood flow and no abnormal vascular network within the mucosa of the appendix wall. We preoperatively diagnosed a mucocele complicated by acute and chronic appendicitis, and ileocecal resection was performed. Macroscopic and microscopic findings of the resected specimens demonstrated that the appendiceal wall was diffusely thickened, with fibrosis and inflammatory cell infiltration, and that the appendiceal root rumen was narrowed with epithelial hyperplasia. No neoplastic changes were observed. The cause of the appendiceal mucocele was likely fibrosis and stenosis at the root of the appendix due to initial acute appendicitis.

Introduction: Hydatidosis is the formation of cysts caused by the parasitic infection of Echinococcus granulosus. This disease predominantly affects the liver and lungs. The involvement of other organs is quite rare. Case presentation: A 5-year-old Iranian boy presented with abdominal pain, anorexia, and hepatomegaly. The pain had been present for about 1 year. He had developed low-grade fever during the previous two months. On physical exam he had abdominal distention and a palpable mass on the right lower quadrant. Basic blood work revealed leukocytosis and eosinophilia. An abdominal ultrasound revealed a 5 × 6 × 8 cm cystic lesion in the pelvis, and two cystic lesions located in the right lobe of the liver. A computerized tomography (CT) scan of the abdomen confirmed the findings. CT of the chest and brain ruled out further cystic lesions. The patient had a positive Indirect hemagglutination assay (IHA), confirming the diagnosis of hydatidosis. A regimen of an albendazole was initiated. He was taken to the operating room for the resection of all cysts. The hepatic cysts were drained and re-filled with hypertonic saline solution, which was left in place for several minutes. Next, the hypertonic solution was drained and all hepatic cysts removed. We turned our attention to the pelvic cyst. It had a thick wall and was indistinguishable from the surrounding tissues. After dissecting it we found that it was arising from the wall of the appendix. We surrounded it with gauze embedded in hypertonic solution and resected the majority of it, leaving a small aspect of the external layer that was densely adherent to the bowel. He recovered well from the operation, remained on albendazole for 6 months, and has had no recurrences this far. Conclusion: Appendiceal hydatid cysts should be included in the differential diagnosis of patients with hydatid disease and pelvic cysts.

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]

Background. Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare in children and adolescents. Standard management of these tumors has not been well established due to their rarity in this age group. We aimed to report the clinical and pathological characteristics of patients with this rare disease followed and treated between the years 1993-2022. Materials and methods. The medical records of patients with GEP-NETs were reviewed. Results. Fourteen patients (11 girls, 3 boys) were diagnosed with GEP-NET. The median age was 13 (9-18) years. Tumor localization was the appendix in 12, stomach in one and pancreas in one patient. Mesoappendix invasion was detected in four patients two of whom underwent right hemicolectomy (RHC) and lymph node dissection (LND). Of those, one patient had lymph node involvement. The other two had not further operations. Somatostatin was used in one with pancreatic metastatic disease and the other with gastric disease after surgery. No additional treatment was given in other patients. All patients are under follow-up without evidence of disease at a median follow-up of 85 months (7-226 months). Conclusion. GEP-NETs should be considered in the differential diagnosis of acute appendicitis and in cases with persistent abdominal pain. In children, there is invariably a favorable prognosis, and additional surgical interventions other than simple appendectomies generally do not provide benefits. Mesoappendix invasion may not necessitate RHC and LND. [ABSTRACT FROM AUTHOR]

Background: Appendiceal neuroendocrine tumors (NETs) rank as the third most frequent neoplasm affecting the appendix, originating from enterochromaffin cells. This study aims to evaluate the influence of various prognostic factors on the mortality rates of patients diagnosed with NETs of the appendix. Methods: Conducted retrospectively, the study involved 3346 patients, utilizing data sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Our analysis centered on investigating demographic characteristics, clinical features, overall mortality (OM), and cancer-specific mortality (CSM) among the cohort. Variables showing a p-value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox regression analysis. A Hazard Ratio (HR) > 1 indicated an unfavorable prognosis. Results: In the multivariate analysis, higher OM and CSM were observed in males, older age groups, tumors with distant metastasis, poorly differentiated tumors, and those who underwent chemotherapy. Non-Hispanic Black individuals showed elevated mortality rates. Conclusion: Delayed diagnosis may contribute to the increased mortality in this community. Improved access to healthcare and treatment is crucial for addressing these disparities. Larger prospective studies are needed to pinpoint the underlying causes of elevated mortality in non-Hispanic Black populations, and randomized controlled trials (RCTs) are warranted to evaluate therapies for advanced-stage appendix NETs. [ABSTRACT FROM AUTHOR]

Background: The unexpected observation of calretinin immunoreactivity in smooth muscle cells in the muscularis propria of the cecum led to a more detailed examination of calretinin expression and its possible relationship to propulsive contractile activity around the vermiform appendix. Methods: Immunohistochemistry and RNA in situ hybridization were performed to analyze calretinin expression in intestinal samples from 33 patients at ages ranging from mid-gestation fetuses to adults, as well as in some potentially relevant animal models. Dual immunolabeling was done to compare calretinin localization with markers of smooth muscle and interstitial cells of Cajal. Results: Calretinin expression was observed consistently in the innermost smooth muscle layers of the muscularis interna in the human cecum, appendiceal base, and proximal ascending colon, but not elsewhere in the intestinal tract. Calretinin-positive smooth muscle cells did not co-express markers located in adjacent interstitial cells of Cajal. Muscular calretinin immunoreactivity was not detected in the ceca of mice or macaques, species which lack appendices, nor in the rabbit cecum or appendix. Conclusions: Localized expression of calretinin in cecal smooth muscle cells may reduce the likelihood of retrograde, calcium-mediated propulsive contractions from the proximal colon and suppress pro-inflammatory fecal stasis in the appendix. [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: Neuroendocrine tumors (NETs) of the appendix are rare and are often discovered incidentally during surgery for acute appendicitis or other unrelated conditions (Modlin et al. in Gastroenterology 128:1717–1751, 2005, Alsaad et al. in Oncol Rep 16:1105–1109, 2006, Frilling et al. in Lancet Oncol 15:e8–e21, 2014). These tumors can range from asymptomatic incidental findings to clinically significant tumors with metastases (Alsaad et al. in Oncol Rep 16:1105–1109, 2006, Gomes et al. in World J Emerg Surg 10:60, 2015, Paiva et al. in Eur J Cancer 38:702–705, 2002, Burke et al. in Am J Surg Pathol. 9:661–674, 1985). This case report presents a rare case of a NET of the appendix presenting as acute appendicitis. Case description: A 23-year-old male presented with right lower quadrant abdominal pain, nausea, and vomiting for 2 days. A CT scan revealed a mucocoele of the appendix. The patient underwent laparoscopic appendectomy, and the appendix was sent for histopathological examination. The final pathological report confirmed a NET of the appendix with a Ki-67 index of 1% and no lymphovascular invasion. Due to tumor invasion to the cecum and its large size (3–4 cm), the patient underwent right hemicolectomy. The final histopathology report of the resected specimen confirmed the diagnosis of NET of the appendix. Discussion: The clinical diagnosis of NETs of the appendix can be challenging due to their rarity and non-specific presentation. Symptoms of NETs of the appendix can mimic those of acute appendicitis, making it difficult to differentiate between the two conditions. Imaging studies, such as CT scans, can provide valuable information about the size and location of the tumor (Gomes et al. in World J Emerg Surg 10:60, 2015, Maggard et al. in Ann Surg 240:117–122, 2004, Burke et al. in Am J Surg Pathol. 9:661–674, 1985, Frilling et al. in Lancet Oncol 15:e8–e21, 2014). However, the definitive diagnosis is made through histopathological examination of the resected specimen. The treatment of NETs of the appendix depends on factors such as the size, location, and grade of the tumor. Small tumors confined to the appendix with no lymph-vascular invasion can be treated with appendectomy alone, while larger tumors or those that have spread beyond the appendix may require more extensive surgery, such as right hemicolectomy (Gomes et al. in World J Emerg Surg 10:60, 2015, Mestier et al. in Dig Liver Dis 52:899–911, 2020, Maggard et al. in Ann Surg 240:117–122, 2004, Burke et al. in Am J Surg Pathol. 9:661–674, 1985, Frilling et al. in Lancet Oncol 15:e8–e21, 2014, Pavel et al. in Neuroendocrinology 103:172–185, 2016). In some cases, additional treatments such as chemotherapy or radiation therapy may be recommended. Conclusion: This case report emphasizes the importance of considering NETs of the appendix in the differential diagnosis of acute appendicitis. Imaging studies can provide valuable information, but the definitive diagnosis is made through histopathological examination. The treatment approach for NETs of the appendix depends on various factors and requires a multidisciplinary approach for optimal management. [ABSTRACT FROM AUTHOR]

Background: Primary appendiceal tumors are rare. Low-grade appendiceal mucinous neoplasia (LAMN) and goblet cell adenocarcinoma (GCA) account for 20% and 14% of primary appendiceal tumors, respectively. The coexistence of LAMN and GCA is an extremely rare event. This report presents a case of an elderly male patient with an appendiceal tumor composed of LAMN and GCA in the same appendix. Case presentation: A 72-year-old male patient was admitted to our institution presenting with a history of abdominal pain localized to the right lower quadrant for two months. Abdominal computed tomography (CT) showed a large dilated thickened cystic mass in the appendix, along with a small duodenal diverticulum. Laboratory tests indicated elevated levels of serum carcinoembryonic antigen (CEA) and cancer antigen 199 (CA19-9) markers. The patient underwent a laparoscopic right hemicolectomy and exploration of the duodenal diverticulum, and there was no finding of perforation of the duodenal diverticulum. Focal positivity for chromogranin A (CgA) and synaptophysin (Syn) was observed in the tumor cells of GCA. The final pathological diagnosis revealed the coexistence of LAMN staged pT4a and grade 1 GCA staged pT3 in the appendix. Unfortunately, the patient died due to severe septic shock and circulatory failure secondary to a perforated duodenal diverticulum. Conclusions: The coexistence of LAMN and GCA are extremely rare in the appendix and may result from the proliferation of two independent cellular lines. The coexistence of distinct neoplasms poses diagnostic and management challenges. Multidisciplinary team discussion may be essential in the effective management of these patients. [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]

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.

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.

Background: When someone has appendicitis, the symptoms can be different depending on where the appendix is located. When someone has retrocaecal appendicitis, their symptoms are different from those of classical appendicitis in which the appendix is in the usual place. K-Sign show that the back wall of the abdomen is soft in people with paracolic appendicitis. As a sign of respect, the K-Sign is called the "Kashmir Sign" after the place where it forms, Kashmir. When the inflamed appendix crosses above the iliac crest on the back wall of the abdomen, it's a sign. The soreness is caused by irritation of the peritoneum on the back wall of the abdomen. Case Presentation: A group of five patients were studied and a K-Sign was used to find tenderness on the back wall of the abdomen. The tenderness was found in a specific area bounded by the 12th rib above, the spine below, the side edge of the back wall below, and the iliac crest above. All 5 of the cases had pain in this place on the back wall of the abdomen. They all wanted to have an appendectomy and had a report from a histopathological test that showed their appendix was inflamed. Conclusion: The K-Sign was looked at in a swollen appendix that was retrocephalic and paracolic. The K-Sign is important because it's hard to diagnose retrocaecal appendicitis and it can lead to other problems.

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]

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.

Due to the scarcity of low-grade appendiceal mucinous neoplasm (LAMN), there is an absence of systematized guidelines concerning its management, especially after incidental finding on an appendiceal specimen. In this study, we evaluate the active surveillance (AS) strategy adopted for a series of patients diagnosed with LAMN on resection specimens who were considered to have a low risk of pseudomyxoma progression.

Objective: To compare the immunohistochemical (IHC) characteristics of appendices removed from children with acute appendicitis and chronic pain syndrome (CP) in the right lower quadrant of the abdomen (RLQA), as well as to define clinical and morphological correlations. Methods: The structure of fifty-one appendices of children aged 5-14 years who underwent appendectomy for chronic appendicitis/CP in the RLQA (24 patients, Group 1) and acute appendicitis (27 patients, Group 2) was assessed. Image analysis of histological sections stained with hematoxylin-eosin and immunohistochemically for S100 protein and proliferating cell nuclear antigen (PCNA) was performed. Results: Image analysis showed the presence of a significantly higher volume density (VD) and numerical density (ND) (p

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]