BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)is an emerging technique.However,its efficacy remains uncertain,and postoperative complications often exacerbate inflammation,thereby increasing the difficult...BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)is an emerging technique.However,its efficacy remains uncertain,and postoperative complications often exacerbate inflammation,thereby increasing the difficulty of surgery.The use of ERAT in appendicitis remains contentious,prompting the presentation of this case report.CASE SUMMARY We report the case of a 43-year-old female patient presenting with intermittent right lower abdominal pain for one day.The patient had undergone ERAT six months previously.Examination revealed stent impaction in the appendix,leading to exacerbated inflammation.Subsequently,a solo single-incision laparo-scopic appendectomy(SSLA)was performed.The ERAT-related complications increased surgical difficulty and prolonged the operation time.Post-SSLA,the patient was hospitalized for one day and showed favorable recovery upon follow-up.CONCLUSION This case highlights the risks of ERAT.Thorough preoperative assessment,proper stent placement during surgery and regular postoperative follow-up are crucial in preventing complications,as their occurrence can increase surgical difficulty.Compared to ERAT,SSLA remains more widely used in clinical practice.Both techniques require further clinical data and research to optimize their application.展开更多
Acute appendicitis(AAp)remains one of the most common abdominal emergencies,requiring rapid and accurate diagnosis to prevent complications and unnecessary surgeries.Conventional diagnostic methods,including medical h...Acute appendicitis(AAp)remains one of the most common abdominal emergencies,requiring rapid and accurate diagnosis to prevent complications and unnecessary surgeries.Conventional diagnostic methods,including medical history,clinical assessment,biochemical markers,and imaging techniques,often present limitations in sensitivity and specificity,especially in atypical cases.In recent years,artificial intelligence(AI)has demonstrated remarkable potential in enhancing diagnostic accuracy through machine learning(ML)and deep learning(DL)models.This review evaluates the current applications of AI in both adult and pediatric AAp,focusing on clinical data-based models,radiological imaging analysis,and AI-assisted clinical decision support systems.ML models such as random forest,support vector machines,logistic regression,and extreme gradient boosting have exhibited superior diagnostic performance compared to traditional scoring systems,achieving sensitivity and specificity rates exceeding 90%in multiple studies.Additionally,DL techniques,particularly convolutional neural networks,have been shown to outperform radiologists in interpreting ultrasound and computed tomography images,enhancing diagnostic confidence.This review synthesized findings from 65 studies,demonstrating that AI models integrating multimodal data including clinical,laboratory,and imaging parameters further improved diagnostic precision.Moreover,explainable AI approaches,such as SHapley Additive exPlanations and local interpretable model-agnostic explanations,have facilitated model transparency,fostering clinician trust in AI-driven decision-making.This review highlights the advancements in AI for AAp diagnosis,emphasizing that AI is used not only to establish the diagnosis of AAp but also to differentiate complicated from uncomplicated cases.While preliminary results are promising,further prospective,multicenter studies are required for large-scale clinical implementation,given that a great proportion of current evidence derives from retrospective designs,and existing prospective cohorts exhibit limited sample sizes or protocol variability.Future research should also focus on integrating AI-driven decision support tools into routine emergency care workflows.展开更多
BACKGROUND Pediatric perforated appendicitis(PPA)is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy.Antibiotic selection differs significantly among pediatric centers,and ...BACKGROUND Pediatric perforated appendicitis(PPA)is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy.Antibiotic selection differs significantly among pediatric centers,and an ideal postoperative antiinfective approach for PPA management has yet to be established.AIM To examine the spectrum of pathogenic bacteria in pediatric PPA and to summarize the postoperative experience with carbapenem(CBP)and cephalosporin(CPS)antibiotics.METHODS We retrospectively analyzed medical records of 65 children(43 boys,22 girls;mean age 6.92±3.41 years)with PPA who underwent surgery at our hospital between December 2019 and August 2022.Data were collected in September 2023.Based on postoperative antibiotic selection,patients were divided into CBP(32 cases)and CPS(33 cases)groups.Chi-square and T-tests compared recovery outcomes,while univariate and multivariate regression models identified independent factors affecting postoperative recovery.RESULTS There were no significant differences between the two groups in gender,age,weight,height,body mass index,baseline ear temperature,or heart rate(P>0.05).Escherichia coli(40.00%)and Pseudomonas aeruginosa(24.62%)were the most common pathogens in PPA.Postoperative analysis showed significantly shorter C-reactive protein(CRP)recovery times in the CPS group than in the CBP group[(6.18±1.84)vs(8.12±3.48)days,P=0.009].Univariate logistic regression indicated CPS selection(OR=0.32,95%CI:0.10-0.97,P=0.044)was significantly associated with a higher CRP recovery rate within 7 days.Multivariate analysis confirmed CPS selection(OR=3.49,95%CI:1.19-10.24,P=0.023)as an independent factor affecting CRP recovery within 7 days postoperatively.CONCLUSION The choice of CBP or CPS independently affects CRP recovery within 7 days.CBP offers no advantage over CPS in treating PPA,with CPS also demonstrating favorable clinical outcomes.展开更多
BACKGROUND Ovarian vein thrombosis(OVT)is a rare condition that most commonly affects postpartum women.It is particularly prevalent in the first 10 days postpartum,a period when women are more prone to developing this...BACKGROUND Ovarian vein thrombosis(OVT)is a rare condition that most commonly affects postpartum women.It is particularly prevalent in the first 10 days postpartum,a period when women are more prone to developing this condition.The right ovarian vein is often affected due to its tortuous nature and less competent valves.OVT presents similarly to acute abdominal conditions,such as acute appendicitis,especially when the right ovarian vein is involved.Given the overlap in clinical presentation,diagnosis requires high-quality imaging techniques and a high degree of suspicion.CASE SUMMARY Herein,we report a rare case of OVT in a young postpartum female who presented to the emergency department with signs and symptoms of acute abdomen.The patient had a history of pulmonary tuberculosis treatment.A provisional diagnosis of a perforated appendix was made,and a lower midline exploratory laparotomy was planned.During surgery,the appendix and inte-stines appeared normal,but a distended and thrombosed right ovarian vein was found.The affected ovarian vein was excised,and the patient was placed on anti-coagulants postoperatively.The recovery was unremarkable,and anticoagulants were continued for six months.CONCLUSION OVT is most commonly seen in the early postpartum period,especially within the first 10 days.Due to its anatomical characteristics,the right ovarian vein is more commonly involved.The clinical presentation of OVT can closely mimic acute abdomen or acute appendicitis,making diagnosis challenging.Accurate diagnosis requires a high index of suspicion and advanced imaging techniques to differentiate OVT from other conditions with similar presentations.展开更多
Objective:To analyze the effects of combined spinal-epidural anesthesia and epidural anesthesia in patients undergoing appendicitis surgery.Methods:Seventy-eight patients who underwent surgical treatment for appendici...Objective:To analyze the effects of combined spinal-epidural anesthesia and epidural anesthesia in patients undergoing appendicitis surgery.Methods:Seventy-eight patients who underwent surgical treatment for appendicitis from February 2022 to February 2025 were selected as samples and randomly divided into two groups.The study group received combined spinal-epidural anesthesia,while the control group received epidural anesthesia.Anesthesia indicators,vital signs,and complication indicators were compared between the two groups.Results:The onset time of anesthesia in the study group was shorter than that in the control group,the visual analog scale(VAS)score was lower than that in the control group,and the highest plane of anesthesia block was lower than that in the control group(P<0.05).At 15 minutes after anesthesia induction and at the end of surgery,the heart rate(HR),mean arterial pressure(MAP),and blood oxygen saturation(SPO2)in the study group were significantly different from those in the control group(P<0.05).The complication rate in the study group was lower than that in the control group(P<0.05).Conclusion:Combined spinal-epidural anesthesia for appendicitis surgery can reduce the impact of anesthesia on vital signs,shorten the onset time of anesthesia,and is highly effective and feasible.展开更多
BACKGROUND Acute appendicitis,a common condition with a higher prevalence among men,has shown an increasing incidence in recent years owing to lifestyle changes.It is characterized by right lower quadrant abdominal pa...BACKGROUND Acute appendicitis,a common condition with a higher prevalence among men,has shown an increasing incidence in recent years owing to lifestyle changes.It is characterized by right lower quadrant abdominal pain,rebound tenderness,and rapid onset.Its pathogenesis is complex and potentially linked to infection,environment,and genetics.Timely intervention is crucial to prevent complications.While surgery is the primary treatment,it carries risks,including postoperative infections that may necessitate re-operation.Gram-negative bacteria release endotoxin(ETX),which induces inflammation and is recognized by toll-like receptor 4(TLR4).This study evaluated ETX and TLR4 levels in patients with acute appendicitis to assess the risk of postoperative incision infections,aiding in prevention and treatment.AIM To explore ETX and TLR4 expression in the blood of patients with acute appendicitis and its association with in postoperative incision infection.METHODS A total of 153 patients with acute appendicitis treated at our hospital between April 2022 and March 2024(n=153)were included in the study.Patients were categorized into infected(n=36)and uninfected(n=117)groups according to the development of postoperative incision infections.General characteristics and blood levels of ETX and TLR4 were compared,and the factors influencing postoperative infection were identified using multivariate logistic regression.ETX and TLR4 predictive values were analyzed using receiver operating characteristic curves.RESULTS No statistically significant differences were observed between the two groups in terms of sex,age,or other general characteristics(P>0.05).Compared to the uninfected group,the infected group had a higher proportion of patients with suppurative or gangrenous appendicitis,longer surgical times,longer incision lengths,and elevated ETX and TLR4 levels(P<0.05).Multivariate logistic regression analysis identified pathological type,surgical method,surgical time,and incision length as factors influencing postoperative incision infection in acute appendicitis.Receiver operating characteristic curve analysis revealed that both ETX and TLR4 levels were predictive factors for postoperative incision infection,with higher prediction efficiency when combined.CONCLUSION Pathological type,surgical method,surgical time,and incision length significantly influence postoperative incision infection risk in patients with acute appendicitis.Elevated ETX and TLR4 levels serve as valuable predictors of post-appendectomy infections.展开更多
BACKGROUND Single-port laparoscopic appendectomy is an advanced minimally invasive surgery that involves the use of upgraded instruments and equipment.We previously modified single-port laparoscopic appendectomy with ...BACKGROUND Single-port laparoscopic appendectomy is an advanced minimally invasive surgery that involves the use of upgraded instruments and equipment.We previously modified single-port laparoscopic appendectomy with needle-type grasping forceps(mSLAN)for patients with simple appendicitis,but the feasibility and safety of our modified procedure need further evaluation in a highquality clinical study.AIM To compare the short-term clinical outcomes of mSLAN with those of conventional three-port laparoscopic appendectomy(CLA)for patients with acute uncomplicated appendicitis.METHODS This single-center,single-blind,prospective,randomized controlled trial included patients who underwent emergency laparoscopic appendectomy for acute uncomplicated appendicitis at our center between April 2024 and August 2024.Patients were randomly divided into the mSLAN group or the CLA group via computergenerated randomization.The primary endpoint was the 24-hour postoperative visual analog scale(VAS)score,and the secondary endpoints included the operative time,24-hour postoperative inflammatory response biomarkers(including white blood cells,the neutrophil ratio,interleukin-6,and C-reactive protein),time to first postoperative exhaust,time to first out-of-bed activity,postoperative length of hospital stay,cost of hospitalization,and incidence of postoperative complications.RESULTS A total of 72 patients were enrolled and randomly divided into 2 groups:The mSLAN group(n=36)and the CLA group(n=36).The 24-hour VAS scores,24-hour postoperative inflammatory response marker levels,first postoperative exhaust times,first out-of-bed activity times,postoperative lengths of hospital stay,operative times,or hospitalization costs did not significantly differ between the two groups.No postoperative complications,including incision infection or hernia,abdominal abscess or intestinal obstruction,were observed during the 1-month postoperative follow-up in either group.CONCLUSION Compared with the CLA protocol,the mSLAN protocol for acute uncomplicated appendicitis yielded comparable short-term clinical outcomes,with a similar operative time and better cosmetic outcomes,indicating its potential for clinical application and superiority for patients with high cosmetic requirements.Further research is needed to evaluate the long-term outcomes.展开更多
BACKGROUND Chronic schistosomiasis causes multiple organ and multiple system diseases,especially the digestive system.Schistosome eggs are mainly deposited in the stomach,liver and colorectal,but a few eggs are deposi...BACKGROUND Chronic schistosomiasis causes multiple organ and multiple system diseases,especially the digestive system.Schistosome eggs are mainly deposited in the stomach,liver and colorectal,but a few eggs are deposited in the appendix and cause disease.At present,there are few studies on schistosomal appendicitis.AIM To explore the differences in epidemiological,clinical and pathological characteristics between schistosomal appendicitis and non-schistosomal appendicitis over the past decade in order to assess the impact of schistosomiasis on appendicitis.METHODS The differences of general data,clinical data and laboratory examination data of patients with appendicitis from October 2013 to October 2023 were retrospectively analyzed.All patients were divided into two groups for analysis.There were 136 patients in schistosomal appendicitis group and 5418 patients in non-schistosomal appendicitis group.RESULTS Schistosomal appendicitis accounted for 2.45%of all patients with appendicitis,and the annual proportion in the past decade was 2.2%,2.9%,1.8%,1.9%,3.4%,3.1%,1.9%,1.6%,3%,2.6%,respectively.The prevalence of schistosomal appendicitis was middle-aged and elderly males,with an average age of 61.73±15.335 years.The main population of non-schistosomal appendicitis was middle-aged men,with an average age of 35.8±24.013 years(P<0.001).The distribution of pathological types of appendicitis was different between the two groups(P<0.001).The incidence of acute suppurative appendicitis in non-schistosomal appendicitis was higher than that in schistosomal appendicitis[odds ratio(OR)=0.504;95%confidence interval(CI):0.349-0.728;P<0.001].The proportion of acute attack of chronic appendicitis in schistosomal appendicitis was higher than that in non-schistosomal appendicitis(OR=2.614;95%CI:1.815-3.763;P<0.001).The proportion of schistosomal appendicitis patients complicated with colorectal cancer was higher than that of nonschistosomal appendicitis patients(OR=5.087;95%CI:1.427-18.132;P=0.012).There was no difference in clinical symptoms between the two groups.In the laboratory examination,there was a significant difference in white blood cells between schistosomal appendicitis and non-schistosomal appendicitis.The level of white blood cells in schistosomal appendicitis group was slightly higher than the upper limit of the normal range.Other statistically significant indicators were in the normal range.CONCLUSION Schistosomal appendicitis is a severe condition that is often associated with intestinal malignancies,potentially leading to a poor prognosis.Schistosomal appendicitis is more likely to be misdiagnosed and missed diagnosed in clinical work because of its nonspecific clinical manifestations and laboratory examination.It is crucial to differentiate schistosomal appendicitis in middle-aged and elderly male patients presenting with appendicitis,and to ensure early detection and treatment.展开更多
AIM:To give an overview of the literature on left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT) and midgut malrotation (MM).METHODS:We present a new case of LSAA with SIT and a literatur...AIM:To give an overview of the literature on left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT) and midgut malrotation (MM).METHODS:We present a new case of LSAA with SIT and a literature review of studies published in the English language on LSAA,accessed via PubMed and Google Scholar databases.RESULTS:Ninety-five published cases of LSAA were evaluated and a 25-year-old female,who presented to our clinic with left lower abdominal pain caused by LSAA,is reported.In the reviewed literature,fiftyseven patients were male and 38 were female with an age range of 8 to 82 years and a median age of 29.1 ± 15.9 years.Sixty-six patients had SIT,23 had MM,three had cecal malrotation,and two had a previously unnoted congenital abnormality.Fifty-nine patients had presentedto the hospital with left lower,14 with right lower and seven with bilateral lower quadrant pain,and seven subjects complained of left upper quadrant pain.The diagnosis was established preoperatively in 49 patients,intraoperatively in 19,and during the postoperative period in five;14 patients were aware of having this anomaly.The data of eight patients were not unavailable.Eleven patients underwent laparoscopic appendectomy,which was combined with cholecystectomy in two cases.Histopathological examination of the appendix specimens revealed adenocarcinoma in only two of 95 patients.CONCLUSION:The diagnosis of left lower quadrant pain is based on well-established clinical symptoms,physical examination and physician's experience.展开更多
Pylephlebitis, a rare complication of acute appendicitis, is defined as thrombophlebitis of the portal venous system. Pylephlebitis usually occurs due to secondary infection in the region drained into the portal syste...Pylephlebitis, a rare complication of acute appendicitis, is defined as thrombophlebitis of the portal venous system. Pylephlebitis usually occurs due to secondary infection in the region drained into the portal system. We report a case of pylephlebitis caused by acute appendicitis. The patient was transferred from a private clinic 1 wk after appendectomy with the chief complaints of high fever and abdominal pain. He was diagnosed with pylephlebitis of the portal vein and superior mesenteric vein by CT-scan. The patient was treated with antibiotics and anticoagulation therapy, and discharged on the 25th day and follow-up CT scan showed a cavernous transformation of portal thrombosis.展开更多
BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp ex...BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp exhibit characteristic signs and symptoms;hence,negative AAp and complicated AAp are the primary concerns in research on AAp.In other terms,further investigations and algorithms are required for at least one third of patients to predict the clinical condition and distinguish them from uncomplicated patients with AAp.AIM To use a Stochastic Gradient Boosting(SGB)-based machine learning(ML)algorithm to tell the difference between AAp patients who are complicated and those who are not,and to find some important biomarkers for both types of AAp by using modeling to get variable importance values.METHODS This study analyzed an open access data set containing 140 people,including 41 healthy controls,65 individuals with uncomplicated AAp,and 34 individuals with complicated AAp.We analyzed some demographic data(age,sex)of the patients and the following biochemical blood parameters:White blood cell(WBC)count,neutrophils,lymphocytes,monocytes,platelet count,neutrophil-tolymphocyte ratio,lymphocyte-to-monocyte ratio,mean platelet volume,neutrophil-to-immature granulocyte ratio,ferritin,total bilirubin,immature granulocyte count,immature granulocyte percent,and neutrophil-to-immature granulocyte ratio.We tested the SGB model using n-fold cross-validation.It was implemented with an 80-20 training-test split.We used variable importance values to identify the variables that were most effective on the target.RESULTS The SGB model demonstrated excellent performance in distinguishing AAp from control patients with an accuracy of 96.3%,a micro aera under the curve(AUC)of 94.7%,a sensitivity of 94.7%,and a specificity of 100%.In distinguishing complicated AAp patients from uncomplicated ones,the model achieved an accuracy of 78.9%,a micro AUC of 79%,a sensitivity of 83.3%,and a specificity of 76.9%.The most useful biomarkers for confirming the AA diagnosis were WBC(100%),neutrophils(95.14%),and the lymphocyte-monocyte ratio(76.05%).On the other hand,the most useful biomarkers for accurate diagnosis of complicated AAp were total bilirubin(100%),WBC(96.90%),and the neutrophil-immature granulocytes ratio(64.05%).CONCLUSION The SGB model achieved high accuracy rates in identifying AAp patients while it showed moderate performance in distinguishing complicated AAp patients from uncomplicated AAp patients.Although the model's accuracy in the classification of complicated AAp is moderate,the high variable importance obtained is clinically significant.We need further prospective validation studies,but the integration of such ML algorithms into clinical practice may improve diagnostic processes.展开更多
AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA)in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo distr...AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA)in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system(more than 1 million inhabitants)from 1997 to 2013.Data about treatment,surgery,length of stay were collected.Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.RESULTS From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA,with a crude incidence rate of 89/100000 inhabitants per year;mean age was 24.51±16.17,54.7%were male and the mean Charlson's comorbidity index was 0.32±0.92.Mortality was<0.0001%.Appendectomy was performed in 94.7%of the patients and the mean length of stay was 5.08±2.88 d;the cumulative hospital stay was 5.19±3.36 d and 1.2%of patients had at least one further hospitalization due intestinal occlusion.Laparoscopic appendectomy was performed in 48%of cases.Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98±3.96 d;the relapse rate was 23.1%and the cumulative hospital stay during the study period was 5.46±6.05 d.CONCLUSION The treatment of acute appendicitis in Northern Italy is slowly changing,with the large diffusion of laparoscopic approach;conservative treatment of non-complicated appendicitis is still a neglected option,but rich of promising results.展开更多
Langerhans cell histiocytosis(LCH) is a rare syndrome characterized by unifocal,multifocal unisystem,or disseminated/multi-system disease that commonly involves the bone,skin,lymph nodes,pituitary,or sometimes lung(al...Langerhans cell histiocytosis(LCH) is a rare syndrome characterized by unifocal,multifocal unisystem,or disseminated/multi-system disease that commonly involves the bone,skin,lymph nodes,pituitary,or sometimes lung(almost exclusively in smokers) causing a variety of symptoms from rashes and bone lesions to diabetes insipidus or pulmonary infiltrates.We present a previously unreported case of gastrointestinal LCH as well as a novel characteristic lesion affecting the colon of a young woman who presented with signs and symptoms mimicking acute on chronic appendicitis.Immunohistochemical analysis of appendectomy specimen and nodular specimens on colonoscopy demonstrated S-100,CD1a,and langerin reactivity.The patient underwent systemic chemotherapy with cytarabine and demonstrated excellent response to therapy.展开更多
Colonoscopic diagnosis of asymptomatic early acute appendicitis is exceedingly rare. Although obstruction of common physiologic mechanism of acute appendicitis, all of the previously documented cases in the literature...Colonoscopic diagnosis of asymptomatic early acute appendicitis is exceedingly rare. Although obstruction of common physiologic mechanism of acute appendicitis, all of the previously documented cases in the literature have only shown a patent appendiceal lumen with pus flowing into the cecum. We present the case of a patient undergoing colonoscopy for colorectal cancer evaluation with no abdominal symptoms. An obstructed, swollen appendix was seen. The process was probably initiated during the colonoscopy, documenting perhaps the earliest stage of acute appendicitis for the first time. Endoscopic, CT and microsCOpic documentation of the case is also presented.展开更多
Acute myelogenous leukemia(AML)can involve the gastrointestinal tract but rarely involves the appendix. We report a male patient who had 1 year partial remission from AML and who presented with apparent acute appendic...Acute myelogenous leukemia(AML)can involve the gastrointestinal tract but rarely involves the appendix. We report a male patient who had 1 year partial remission from AML and who presented with apparent acute appendicitis as the initial manifestation of leu-kemia relapse.Pathological findings of the appendix revealed transmural infiltrates of myeloblasts,which indicated a diagnosis of leukemia.Unfortunately,the patient died from progression of the disease on the 19th d after admission.Although leukemic cell infiltration of the appendix is uncommon,patients with leu-kemia relapse can present with symptoms mimicking acute appendicitis.展开更多
AIM: To compare the profile of postoperative outcome in secondary peritonitis with sepsis due to complicated appendicitis in two cohorts(drainage vs no-drainage) after appendicectomy in adults in the modern era of eff...AIM: To compare the profile of postoperative outcome in secondary peritonitis with sepsis due to complicated appendicitis in two cohorts(drainage vs no-drainage) after appendicectomy in adults in the modern era of effective antibiotics. METHODS: A retrospective review of all adult patients who were operated for secondary peritonitis with sepsis due to complicated appendicitis was carried out. Total of 209 patients were identified from May 2005 to April 2009 with operative findings of gangrenous or perforated appendix. The patients were divided into two cohorts, those where prophylactic drainage was established(n = 88) and those where no drain was used(n = 121). Abdominal drain was removed oncethe drainage ceased or decreased(< 10-20 mL/d in closed system of drainage or when once daily dressing was minimally soaked in open system). Broad spectrum antibiotics to cover the gut flora were started in both cohorts at diagnosis and were stopped once septic features resolved. Peritoneal fluid for aerobic culture and sensitivity were routinely obtained intra operatively; however antibiotic regimens were not changed unless patient failed to respond to the antibiotics based on the institutional protocol. The co-morbidities and their influence on primary end points were noted. Immunocompromised patients, appendicitis complicated by inflammatory bowel disorder and tumors were excluded from the study. RESULTS: Disease stratification and other demographic features were comparable in both cohorts. There was zero mortality in drainage group while as one patient(0.82%) died in the non-drainage group. The median duration(in days) of hospital stay(6.5 vs 4); antibiotic use(5 vs 3.5); regular parental analgesic use(5 vs 3.5) and paralytic ileus(2.5 vs 2) was more common in the drainage group. Incidence of major wound infection in patients 14(15.9%) vs 22(18.18%) and residual intraabdominal sepsis(inter loop collection/abscess)-7(8%) vs 13(10.74%) requiring secondary intervention was not significantly different in drainage and non-drainage cohorts respectively. One patient in the drainage cohort had faecal fistula(1.1%). CONCLUSION: The complicated appendicitis in the modern era of antibiotics does not necessitate the use of prophylactic drain placement which at times may even prove counterproductive.展开更多
Schistosomal appendicitis is very rare in developed countries like the USA,Europe,and Japan.The author reviewed 311 pathologic archival specimens of vermiform appendix over the past 10 years.One case of schistosomal a...Schistosomal appendicitis is very rare in developed countries like the USA,Europe,and Japan.The author reviewed 311 pathologic archival specimens of vermiform appendix over the past 10 years.One case of schistosomal appendicitis was recognized.Therefore,the incidence of this disease was 0.32% in all appendices surgically resected in our hospital.The patient was a 41-year-old woman presenting with lower abdominal pain.She was a sailor traveling to many countries including endemic areas.Physical examination,laboratory data,and imaging modalities suggested an acute appendicitis,and appendectomy was performed under the diagnosis of ordinary appendicitis.Histologically,numerous schistosomal eggs were present in the vasculatures throughout the appendiceal walls.Some of the eggs were calcified.Stromal foreign body reaction was also recognized.The appendicitis was phlegmonous consisting of severe infiltrations of neutrophils and eosinophils.Acute serositis was also noted.Examination of feces revealed numerous eggs of Schistosoma mansoni.Clinicians should be aware of schistosomal appendicitis.展开更多
Double cecal appendix is a rare anatomical variation. Approximately 100 cases have been reported worldwide. It is usually diagnosed incidentally during emergency appendectomies due to inflammatory processes in the cec...Double cecal appendix is a rare anatomical variation. Approximately 100 cases have been reported worldwide. It is usually diagnosed incidentally during emergency appendectomies due to inflammatory processes in the cecal appendix. Case presentation: male, white, 36 years old, obese, presenting with pain in the lower abdomen for 24 h followed by nausea, vomiting and mild fever. He was subjected to additional tests, with the leukogram showing leukocytosis and abdominal ultrasonography depicting cecal appendix with thickened wall, locally associated with small quantities of liquid and intestinal loop obstruction. He underwent laparotomy, revealing acute appendicitis. Another intestinal loop obstruction was identified next to the ileum, leading to recognizing another cecal appendix after local dissection. Double appendectomy and segmental iliectomy were performed although not needed. Results of the anatomopathological examination of the surgical samples showed acute inflammation in the two cecal appendices. So, performing a routine retroperitoneal release and a complete cecum evaluation during such surgical procedures is recommended and suggested due to the possibility of not identifying a second cecal appendix.展开更多
Acute abdominal pain with signs and symptoms of peritonitis due to sudden extravasation of chyle into the peritoneal cavity is a rare condition that is often mistaken for other disease processes. The diagnosis is rare...Acute abdominal pain with signs and symptoms of peritonitis due to sudden extravasation of chyle into the peritoneal cavity is a rare condition that is often mistaken for other disease processes. The diagnosis is rarely suspected preoperatively. We report a case of spontaneous chylous peritonitis that presented with typical symptoms of acute appendicitis such as intermittent fever and epigastric pain radiating to the lower right abdominal quadrant before admission.展开更多
基金Supported by National Key R and D Program of China-Key Special Project on Diagnostic and Therapeutic Equipment and Biomedical Materials,No.2023YFC2412005。
文摘BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)is an emerging technique.However,its efficacy remains uncertain,and postoperative complications often exacerbate inflammation,thereby increasing the difficulty of surgery.The use of ERAT in appendicitis remains contentious,prompting the presentation of this case report.CASE SUMMARY We report the case of a 43-year-old female patient presenting with intermittent right lower abdominal pain for one day.The patient had undergone ERAT six months previously.Examination revealed stent impaction in the appendix,leading to exacerbated inflammation.Subsequently,a solo single-incision laparo-scopic appendectomy(SSLA)was performed.The ERAT-related complications increased surgical difficulty and prolonged the operation time.Post-SSLA,the patient was hospitalized for one day and showed favorable recovery upon follow-up.CONCLUSION This case highlights the risks of ERAT.Thorough preoperative assessment,proper stent placement during surgery and regular postoperative follow-up are crucial in preventing complications,as their occurrence can increase surgical difficulty.Compared to ERAT,SSLA remains more widely used in clinical practice.Both techniques require further clinical data and research to optimize their application.
文摘Acute appendicitis(AAp)remains one of the most common abdominal emergencies,requiring rapid and accurate diagnosis to prevent complications and unnecessary surgeries.Conventional diagnostic methods,including medical history,clinical assessment,biochemical markers,and imaging techniques,often present limitations in sensitivity and specificity,especially in atypical cases.In recent years,artificial intelligence(AI)has demonstrated remarkable potential in enhancing diagnostic accuracy through machine learning(ML)and deep learning(DL)models.This review evaluates the current applications of AI in both adult and pediatric AAp,focusing on clinical data-based models,radiological imaging analysis,and AI-assisted clinical decision support systems.ML models such as random forest,support vector machines,logistic regression,and extreme gradient boosting have exhibited superior diagnostic performance compared to traditional scoring systems,achieving sensitivity and specificity rates exceeding 90%in multiple studies.Additionally,DL techniques,particularly convolutional neural networks,have been shown to outperform radiologists in interpreting ultrasound and computed tomography images,enhancing diagnostic confidence.This review synthesized findings from 65 studies,demonstrating that AI models integrating multimodal data including clinical,laboratory,and imaging parameters further improved diagnostic precision.Moreover,explainable AI approaches,such as SHapley Additive exPlanations and local interpretable model-agnostic explanations,have facilitated model transparency,fostering clinician trust in AI-driven decision-making.This review highlights the advancements in AI for AAp diagnosis,emphasizing that AI is used not only to establish the diagnosis of AAp but also to differentiate complicated from uncomplicated cases.While preliminary results are promising,further prospective,multicenter studies are required for large-scale clinical implementation,given that a great proportion of current evidence derives from retrospective designs,and existing prospective cohorts exhibit limited sample sizes or protocol variability.Future research should also focus on integrating AI-driven decision support tools into routine emergency care workflows.
基金Supported by Jiaxing Science and Technology Plan Project,No.2024AD30035.
文摘BACKGROUND Pediatric perforated appendicitis(PPA)is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy.Antibiotic selection differs significantly among pediatric centers,and an ideal postoperative antiinfective approach for PPA management has yet to be established.AIM To examine the spectrum of pathogenic bacteria in pediatric PPA and to summarize the postoperative experience with carbapenem(CBP)and cephalosporin(CPS)antibiotics.METHODS We retrospectively analyzed medical records of 65 children(43 boys,22 girls;mean age 6.92±3.41 years)with PPA who underwent surgery at our hospital between December 2019 and August 2022.Data were collected in September 2023.Based on postoperative antibiotic selection,patients were divided into CBP(32 cases)and CPS(33 cases)groups.Chi-square and T-tests compared recovery outcomes,while univariate and multivariate regression models identified independent factors affecting postoperative recovery.RESULTS There were no significant differences between the two groups in gender,age,weight,height,body mass index,baseline ear temperature,or heart rate(P>0.05).Escherichia coli(40.00%)and Pseudomonas aeruginosa(24.62%)were the most common pathogens in PPA.Postoperative analysis showed significantly shorter C-reactive protein(CRP)recovery times in the CPS group than in the CBP group[(6.18±1.84)vs(8.12±3.48)days,P=0.009].Univariate logistic regression indicated CPS selection(OR=0.32,95%CI:0.10-0.97,P=0.044)was significantly associated with a higher CRP recovery rate within 7 days.Multivariate analysis confirmed CPS selection(OR=3.49,95%CI:1.19-10.24,P=0.023)as an independent factor affecting CRP recovery within 7 days postoperatively.CONCLUSION The choice of CBP or CPS independently affects CRP recovery within 7 days.CBP offers no advantage over CPS in treating PPA,with CPS also demonstrating favorable clinical outcomes.
文摘BACKGROUND Ovarian vein thrombosis(OVT)is a rare condition that most commonly affects postpartum women.It is particularly prevalent in the first 10 days postpartum,a period when women are more prone to developing this condition.The right ovarian vein is often affected due to its tortuous nature and less competent valves.OVT presents similarly to acute abdominal conditions,such as acute appendicitis,especially when the right ovarian vein is involved.Given the overlap in clinical presentation,diagnosis requires high-quality imaging techniques and a high degree of suspicion.CASE SUMMARY Herein,we report a rare case of OVT in a young postpartum female who presented to the emergency department with signs and symptoms of acute abdomen.The patient had a history of pulmonary tuberculosis treatment.A provisional diagnosis of a perforated appendix was made,and a lower midline exploratory laparotomy was planned.During surgery,the appendix and inte-stines appeared normal,but a distended and thrombosed right ovarian vein was found.The affected ovarian vein was excised,and the patient was placed on anti-coagulants postoperatively.The recovery was unremarkable,and anticoagulants were continued for six months.CONCLUSION OVT is most commonly seen in the early postpartum period,especially within the first 10 days.Due to its anatomical characteristics,the right ovarian vein is more commonly involved.The clinical presentation of OVT can closely mimic acute abdomen or acute appendicitis,making diagnosis challenging.Accurate diagnosis requires a high index of suspicion and advanced imaging techniques to differentiate OVT from other conditions with similar presentations.
文摘Objective:To analyze the effects of combined spinal-epidural anesthesia and epidural anesthesia in patients undergoing appendicitis surgery.Methods:Seventy-eight patients who underwent surgical treatment for appendicitis from February 2022 to February 2025 were selected as samples and randomly divided into two groups.The study group received combined spinal-epidural anesthesia,while the control group received epidural anesthesia.Anesthesia indicators,vital signs,and complication indicators were compared between the two groups.Results:The onset time of anesthesia in the study group was shorter than that in the control group,the visual analog scale(VAS)score was lower than that in the control group,and the highest plane of anesthesia block was lower than that in the control group(P<0.05).At 15 minutes after anesthesia induction and at the end of surgery,the heart rate(HR),mean arterial pressure(MAP),and blood oxygen saturation(SPO2)in the study group were significantly different from those in the control group(P<0.05).The complication rate in the study group was lower than that in the control group(P<0.05).Conclusion:Combined spinal-epidural anesthesia for appendicitis surgery can reduce the impact of anesthesia on vital signs,shorten the onset time of anesthesia,and is highly effective and feasible.
文摘BACKGROUND Acute appendicitis,a common condition with a higher prevalence among men,has shown an increasing incidence in recent years owing to lifestyle changes.It is characterized by right lower quadrant abdominal pain,rebound tenderness,and rapid onset.Its pathogenesis is complex and potentially linked to infection,environment,and genetics.Timely intervention is crucial to prevent complications.While surgery is the primary treatment,it carries risks,including postoperative infections that may necessitate re-operation.Gram-negative bacteria release endotoxin(ETX),which induces inflammation and is recognized by toll-like receptor 4(TLR4).This study evaluated ETX and TLR4 levels in patients with acute appendicitis to assess the risk of postoperative incision infections,aiding in prevention and treatment.AIM To explore ETX and TLR4 expression in the blood of patients with acute appendicitis and its association with in postoperative incision infection.METHODS A total of 153 patients with acute appendicitis treated at our hospital between April 2022 and March 2024(n=153)were included in the study.Patients were categorized into infected(n=36)and uninfected(n=117)groups according to the development of postoperative incision infections.General characteristics and blood levels of ETX and TLR4 were compared,and the factors influencing postoperative infection were identified using multivariate logistic regression.ETX and TLR4 predictive values were analyzed using receiver operating characteristic curves.RESULTS No statistically significant differences were observed between the two groups in terms of sex,age,or other general characteristics(P>0.05).Compared to the uninfected group,the infected group had a higher proportion of patients with suppurative or gangrenous appendicitis,longer surgical times,longer incision lengths,and elevated ETX and TLR4 levels(P<0.05).Multivariate logistic regression analysis identified pathological type,surgical method,surgical time,and incision length as factors influencing postoperative incision infection in acute appendicitis.Receiver operating characteristic curve analysis revealed that both ETX and TLR4 levels were predictive factors for postoperative incision infection,with higher prediction efficiency when combined.CONCLUSION Pathological type,surgical method,surgical time,and incision length significantly influence postoperative incision infection risk in patients with acute appendicitis.Elevated ETX and TLR4 levels serve as valuable predictors of post-appendectomy infections.
基金Supported by the Natural Science Foundation of Liaoning Province,No.2023-MS-354the Science and Technology Project for Youth of Chaoyang Central Hospital,China Medical University,Liaoning Province,China.
文摘BACKGROUND Single-port laparoscopic appendectomy is an advanced minimally invasive surgery that involves the use of upgraded instruments and equipment.We previously modified single-port laparoscopic appendectomy with needle-type grasping forceps(mSLAN)for patients with simple appendicitis,but the feasibility and safety of our modified procedure need further evaluation in a highquality clinical study.AIM To compare the short-term clinical outcomes of mSLAN with those of conventional three-port laparoscopic appendectomy(CLA)for patients with acute uncomplicated appendicitis.METHODS This single-center,single-blind,prospective,randomized controlled trial included patients who underwent emergency laparoscopic appendectomy for acute uncomplicated appendicitis at our center between April 2024 and August 2024.Patients were randomly divided into the mSLAN group or the CLA group via computergenerated randomization.The primary endpoint was the 24-hour postoperative visual analog scale(VAS)score,and the secondary endpoints included the operative time,24-hour postoperative inflammatory response biomarkers(including white blood cells,the neutrophil ratio,interleukin-6,and C-reactive protein),time to first postoperative exhaust,time to first out-of-bed activity,postoperative length of hospital stay,cost of hospitalization,and incidence of postoperative complications.RESULTS A total of 72 patients were enrolled and randomly divided into 2 groups:The mSLAN group(n=36)and the CLA group(n=36).The 24-hour VAS scores,24-hour postoperative inflammatory response marker levels,first postoperative exhaust times,first out-of-bed activity times,postoperative lengths of hospital stay,operative times,or hospitalization costs did not significantly differ between the two groups.No postoperative complications,including incision infection or hernia,abdominal abscess or intestinal obstruction,were observed during the 1-month postoperative follow-up in either group.CONCLUSION Compared with the CLA protocol,the mSLAN protocol for acute uncomplicated appendicitis yielded comparable short-term clinical outcomes,with a similar operative time and better cosmetic outcomes,indicating its potential for clinical application and superiority for patients with high cosmetic requirements.Further research is needed to evaluate the long-term outcomes.
文摘BACKGROUND Chronic schistosomiasis causes multiple organ and multiple system diseases,especially the digestive system.Schistosome eggs are mainly deposited in the stomach,liver and colorectal,but a few eggs are deposited in the appendix and cause disease.At present,there are few studies on schistosomal appendicitis.AIM To explore the differences in epidemiological,clinical and pathological characteristics between schistosomal appendicitis and non-schistosomal appendicitis over the past decade in order to assess the impact of schistosomiasis on appendicitis.METHODS The differences of general data,clinical data and laboratory examination data of patients with appendicitis from October 2013 to October 2023 were retrospectively analyzed.All patients were divided into two groups for analysis.There were 136 patients in schistosomal appendicitis group and 5418 patients in non-schistosomal appendicitis group.RESULTS Schistosomal appendicitis accounted for 2.45%of all patients with appendicitis,and the annual proportion in the past decade was 2.2%,2.9%,1.8%,1.9%,3.4%,3.1%,1.9%,1.6%,3%,2.6%,respectively.The prevalence of schistosomal appendicitis was middle-aged and elderly males,with an average age of 61.73±15.335 years.The main population of non-schistosomal appendicitis was middle-aged men,with an average age of 35.8±24.013 years(P<0.001).The distribution of pathological types of appendicitis was different between the two groups(P<0.001).The incidence of acute suppurative appendicitis in non-schistosomal appendicitis was higher than that in schistosomal appendicitis[odds ratio(OR)=0.504;95%confidence interval(CI):0.349-0.728;P<0.001].The proportion of acute attack of chronic appendicitis in schistosomal appendicitis was higher than that in non-schistosomal appendicitis(OR=2.614;95%CI:1.815-3.763;P<0.001).The proportion of schistosomal appendicitis patients complicated with colorectal cancer was higher than that of nonschistosomal appendicitis patients(OR=5.087;95%CI:1.427-18.132;P=0.012).There was no difference in clinical symptoms between the two groups.In the laboratory examination,there was a significant difference in white blood cells between schistosomal appendicitis and non-schistosomal appendicitis.The level of white blood cells in schistosomal appendicitis group was slightly higher than the upper limit of the normal range.Other statistically significant indicators were in the normal range.CONCLUSION Schistosomal appendicitis is a severe condition that is often associated with intestinal malignancies,potentially leading to a poor prognosis.Schistosomal appendicitis is more likely to be misdiagnosed and missed diagnosed in clinical work because of its nonspecific clinical manifestations and laboratory examination.It is crucial to differentiate schistosomal appendicitis in middle-aged and elderly male patients presenting with appendicitis,and to ensure early detection and treatment.
文摘AIM:To give an overview of the literature on left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT) and midgut malrotation (MM).METHODS:We present a new case of LSAA with SIT and a literature review of studies published in the English language on LSAA,accessed via PubMed and Google Scholar databases.RESULTS:Ninety-five published cases of LSAA were evaluated and a 25-year-old female,who presented to our clinic with left lower abdominal pain caused by LSAA,is reported.In the reviewed literature,fiftyseven patients were male and 38 were female with an age range of 8 to 82 years and a median age of 29.1 ± 15.9 years.Sixty-six patients had SIT,23 had MM,three had cecal malrotation,and two had a previously unnoted congenital abnormality.Fifty-nine patients had presentedto the hospital with left lower,14 with right lower and seven with bilateral lower quadrant pain,and seven subjects complained of left upper quadrant pain.The diagnosis was established preoperatively in 49 patients,intraoperatively in 19,and during the postoperative period in five;14 patients were aware of having this anomaly.The data of eight patients were not unavailable.Eleven patients underwent laparoscopic appendectomy,which was combined with cholecystectomy in two cases.Histopathological examination of the appendix specimens revealed adenocarcinoma in only two of 95 patients.CONCLUSION:The diagnosis of left lower quadrant pain is based on well-established clinical symptoms,physical examination and physician's experience.
文摘Pylephlebitis, a rare complication of acute appendicitis, is defined as thrombophlebitis of the portal venous system. Pylephlebitis usually occurs due to secondary infection in the region drained into the portal system. We report a case of pylephlebitis caused by acute appendicitis. The patient was transferred from a private clinic 1 wk after appendectomy with the chief complaints of high fever and abdominal pain. He was diagnosed with pylephlebitis of the portal vein and superior mesenteric vein by CT-scan. The patient was treated with antibiotics and anticoagulation therapy, and discharged on the 25th day and follow-up CT scan showed a cavernous transformation of portal thrombosis.
文摘BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp exhibit characteristic signs and symptoms;hence,negative AAp and complicated AAp are the primary concerns in research on AAp.In other terms,further investigations and algorithms are required for at least one third of patients to predict the clinical condition and distinguish them from uncomplicated patients with AAp.AIM To use a Stochastic Gradient Boosting(SGB)-based machine learning(ML)algorithm to tell the difference between AAp patients who are complicated and those who are not,and to find some important biomarkers for both types of AAp by using modeling to get variable importance values.METHODS This study analyzed an open access data set containing 140 people,including 41 healthy controls,65 individuals with uncomplicated AAp,and 34 individuals with complicated AAp.We analyzed some demographic data(age,sex)of the patients and the following biochemical blood parameters:White blood cell(WBC)count,neutrophils,lymphocytes,monocytes,platelet count,neutrophil-tolymphocyte ratio,lymphocyte-to-monocyte ratio,mean platelet volume,neutrophil-to-immature granulocyte ratio,ferritin,total bilirubin,immature granulocyte count,immature granulocyte percent,and neutrophil-to-immature granulocyte ratio.We tested the SGB model using n-fold cross-validation.It was implemented with an 80-20 training-test split.We used variable importance values to identify the variables that were most effective on the target.RESULTS The SGB model demonstrated excellent performance in distinguishing AAp from control patients with an accuracy of 96.3%,a micro aera under the curve(AUC)of 94.7%,a sensitivity of 94.7%,and a specificity of 100%.In distinguishing complicated AAp patients from uncomplicated ones,the model achieved an accuracy of 78.9%,a micro AUC of 79%,a sensitivity of 83.3%,and a specificity of 76.9%.The most useful biomarkers for confirming the AA diagnosis were WBC(100%),neutrophils(95.14%),and the lymphocyte-monocyte ratio(76.05%).On the other hand,the most useful biomarkers for accurate diagnosis of complicated AAp were total bilirubin(100%),WBC(96.90%),and the neutrophil-immature granulocytes ratio(64.05%).CONCLUSION The SGB model achieved high accuracy rates in identifying AAp patients while it showed moderate performance in distinguishing complicated AAp patients from uncomplicated AAp patients.Although the model's accuracy in the classification of complicated AAp is moderate,the high variable importance obtained is clinically significant.We need further prospective validation studies,but the integration of such ML algorithms into clinical practice may improve diagnostic processes.
文摘AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA)in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system(more than 1 million inhabitants)from 1997 to 2013.Data about treatment,surgery,length of stay were collected.Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.RESULTS From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA,with a crude incidence rate of 89/100000 inhabitants per year;mean age was 24.51±16.17,54.7%were male and the mean Charlson's comorbidity index was 0.32±0.92.Mortality was<0.0001%.Appendectomy was performed in 94.7%of the patients and the mean length of stay was 5.08±2.88 d;the cumulative hospital stay was 5.19±3.36 d and 1.2%of patients had at least one further hospitalization due intestinal occlusion.Laparoscopic appendectomy was performed in 48%of cases.Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98±3.96 d;the relapse rate was 23.1%and the cumulative hospital stay during the study period was 5.46±6.05 d.CONCLUSION The treatment of acute appendicitis in Northern Italy is slowly changing,with the large diffusion of laparoscopic approach;conservative treatment of non-complicated appendicitis is still a neglected option,but rich of promising results.
文摘Langerhans cell histiocytosis(LCH) is a rare syndrome characterized by unifocal,multifocal unisystem,or disseminated/multi-system disease that commonly involves the bone,skin,lymph nodes,pituitary,or sometimes lung(almost exclusively in smokers) causing a variety of symptoms from rashes and bone lesions to diabetes insipidus or pulmonary infiltrates.We present a previously unreported case of gastrointestinal LCH as well as a novel characteristic lesion affecting the colon of a young woman who presented with signs and symptoms mimicking acute on chronic appendicitis.Immunohistochemical analysis of appendectomy specimen and nodular specimens on colonoscopy demonstrated S-100,CD1a,and langerin reactivity.The patient underwent systemic chemotherapy with cytarabine and demonstrated excellent response to therapy.
文摘Colonoscopic diagnosis of asymptomatic early acute appendicitis is exceedingly rare. Although obstruction of common physiologic mechanism of acute appendicitis, all of the previously documented cases in the literature have only shown a patent appendiceal lumen with pus flowing into the cecum. We present the case of a patient undergoing colonoscopy for colorectal cancer evaluation with no abdominal symptoms. An obstructed, swollen appendix was seen. The process was probably initiated during the colonoscopy, documenting perhaps the earliest stage of acute appendicitis for the first time. Endoscopic, CT and microsCOpic documentation of the case is also presented.
文摘Acute myelogenous leukemia(AML)can involve the gastrointestinal tract but rarely involves the appendix. We report a male patient who had 1 year partial remission from AML and who presented with apparent acute appendicitis as the initial manifestation of leu-kemia relapse.Pathological findings of the appendix revealed transmural infiltrates of myeloblasts,which indicated a diagnosis of leukemia.Unfortunately,the patient died from progression of the disease on the 19th d after admission.Although leukemic cell infiltration of the appendix is uncommon,patients with leu-kemia relapse can present with symptoms mimicking acute appendicitis.
文摘AIM: To compare the profile of postoperative outcome in secondary peritonitis with sepsis due to complicated appendicitis in two cohorts(drainage vs no-drainage) after appendicectomy in adults in the modern era of effective antibiotics. METHODS: A retrospective review of all adult patients who were operated for secondary peritonitis with sepsis due to complicated appendicitis was carried out. Total of 209 patients were identified from May 2005 to April 2009 with operative findings of gangrenous or perforated appendix. The patients were divided into two cohorts, those where prophylactic drainage was established(n = 88) and those where no drain was used(n = 121). Abdominal drain was removed oncethe drainage ceased or decreased(< 10-20 mL/d in closed system of drainage or when once daily dressing was minimally soaked in open system). Broad spectrum antibiotics to cover the gut flora were started in both cohorts at diagnosis and were stopped once septic features resolved. Peritoneal fluid for aerobic culture and sensitivity were routinely obtained intra operatively; however antibiotic regimens were not changed unless patient failed to respond to the antibiotics based on the institutional protocol. The co-morbidities and their influence on primary end points were noted. Immunocompromised patients, appendicitis complicated by inflammatory bowel disorder and tumors were excluded from the study. RESULTS: Disease stratification and other demographic features were comparable in both cohorts. There was zero mortality in drainage group while as one patient(0.82%) died in the non-drainage group. The median duration(in days) of hospital stay(6.5 vs 4); antibiotic use(5 vs 3.5); regular parental analgesic use(5 vs 3.5) and paralytic ileus(2.5 vs 2) was more common in the drainage group. Incidence of major wound infection in patients 14(15.9%) vs 22(18.18%) and residual intraabdominal sepsis(inter loop collection/abscess)-7(8%) vs 13(10.74%) requiring secondary intervention was not significantly different in drainage and non-drainage cohorts respectively. One patient in the drainage cohort had faecal fistula(1.1%). CONCLUSION: The complicated appendicitis in the modern era of antibiotics does not necessitate the use of prophylactic drain placement which at times may even prove counterproductive.
文摘Schistosomal appendicitis is very rare in developed countries like the USA,Europe,and Japan.The author reviewed 311 pathologic archival specimens of vermiform appendix over the past 10 years.One case of schistosomal appendicitis was recognized.Therefore,the incidence of this disease was 0.32% in all appendices surgically resected in our hospital.The patient was a 41-year-old woman presenting with lower abdominal pain.She was a sailor traveling to many countries including endemic areas.Physical examination,laboratory data,and imaging modalities suggested an acute appendicitis,and appendectomy was performed under the diagnosis of ordinary appendicitis.Histologically,numerous schistosomal eggs were present in the vasculatures throughout the appendiceal walls.Some of the eggs were calcified.Stromal foreign body reaction was also recognized.The appendicitis was phlegmonous consisting of severe infiltrations of neutrophils and eosinophils.Acute serositis was also noted.Examination of feces revealed numerous eggs of Schistosoma mansoni.Clinicians should be aware of schistosomal appendicitis.
文摘Double cecal appendix is a rare anatomical variation. Approximately 100 cases have been reported worldwide. It is usually diagnosed incidentally during emergency appendectomies due to inflammatory processes in the cecal appendix. Case presentation: male, white, 36 years old, obese, presenting with pain in the lower abdomen for 24 h followed by nausea, vomiting and mild fever. He was subjected to additional tests, with the leukogram showing leukocytosis and abdominal ultrasonography depicting cecal appendix with thickened wall, locally associated with small quantities of liquid and intestinal loop obstruction. He underwent laparotomy, revealing acute appendicitis. Another intestinal loop obstruction was identified next to the ileum, leading to recognizing another cecal appendix after local dissection. Double appendectomy and segmental iliectomy were performed although not needed. Results of the anatomopathological examination of the surgical samples showed acute inflammation in the two cecal appendices. So, performing a routine retroperitoneal release and a complete cecum evaluation during such surgical procedures is recommended and suggested due to the possibility of not identifying a second cecal appendix.
基金Supported by the National Natural Science Foundation of China,No.30224801
文摘Acute abdominal pain with signs and symptoms of peritonitis due to sudden extravasation of chyle into the peritoneal cavity is a rare condition that is often mistaken for other disease processes. The diagnosis is rarely suspected preoperatively. We report a case of spontaneous chylous peritonitis that presented with typical symptoms of acute appendicitis such as intermittent fever and epigastric pain radiating to the lower right abdominal quadrant before admission.
