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Pellegrino R, Gravina AG. When the vermiform appendix resembles a polyp: Be cautious of an intussuscepted appendix polypectomy. World J Clin Cases 2024; 12:6124-6128. [PMID: 39328857 PMCID: PMC11326104 DOI: 10.12998/wjcc.v12.i27.6124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 07/05/2024] [Accepted: 07/10/2024] [Indexed: 07/29/2024] Open
Abstract
This article discusses a recently published case report on a rare instance of type IV appendiceal intussusception with a concurrent mucinous adenocarcinoma of the cecum in a young individual. The report highlights challenges in diagnosing appendiceal intussusception, emphasizing the importance of endoscopic expertise in preventing impulsive decisions such as inappropriate polypectomies. The rarity of the concurrent intussuscepted appendix and mucinous cecal cancer is underscored, prompting consideration of malignancy in appendiceal intussusception cases. Additionally, the report addresses the increasing incidence of early-onset colorectal cancer and the need for a revaluation of diagnostic paradigms in the context of evolving epidemiological trends. The awareness of potential misinterpretations and the imperative for further investigation into this rare condition are emphasized.
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Affiliation(s)
- Raffaele Pellegrino
- Division of Hepatogastroenterology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Antonietta Gerarda Gravina
- Division of Hepatogastroenterology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples 80138, Italy
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2
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Pellegrino R, Gravina AG. When the vermiform appendix resembles a polyp: Be cautious of an intussuscepted appendix polypectomy. World J Clin Cases 2024; 12:6132-6136. [DOI: 10.12998/wjcc.v12.i27.6132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 07/05/2024] [Accepted: 07/10/2024] [Indexed: 07/29/2024] Open
Abstract
This article discusses a recently published case report on a rare instance of type IV appendiceal intussusception with a concurrent mucinous adenocarcinoma of the cecum in a young individual. The report highlights challenges in diagnosing appendiceal intussusception, emphasizing the importance of endoscopic expertise in preventing impulsive decisions such as inappropriate polypectomies. The rarity of the concurrent intussuscepted appendix and mucinous cecal cancer is underscored, prompting consideration of malignancy in appendiceal intussusception cases. Additionally, the report addresses the increasing incidence of early-onset colorectal cancer and the need for a revaluation of diagnostic paradigms in the context of evolving epidemiological trends. The awareness of potential misinterpretations and the imperative for further investigation into this rare condition are emphasized.
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Affiliation(s)
- Raffaele Pellegrino
- Division of Hepatogastroenterology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Antonietta Gerarda Gravina
- Division of Hepatogastroenterology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples 80138, Italy
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Coutureau J, Mandoul C, Verheyden C, Millet I, Taourel P. Acute abdominal pain in women of reproductive age: keys to suggest a complication of endometriosis. Insights Imaging 2023; 14:94. [PMID: 37222834 DOI: 10.1186/s13244-023-01433-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/08/2023] [Indexed: 05/25/2023] Open
Abstract
Although endometriosis is a common gynecological condition in women of reproductive age, a complication of endometriosis is rarely considered as the differential diagnosis of acute abdominal pain in that context. However, acute events in women with endometriosis can represent life-threatening conditions, which require emergent treatment and often surgical management. Mass effect of endometriotic implants can give rise to obstructive complications, specifically occurring in the bowel or in the urinary tract, while inflammatory mediators released by ectopic endometrial tissue can lead to inflammation of the surrounding tissues or to superinfection of the endometriotic implants. Magnetic resonance imaging is the best imaging modality to reach the diagnosis of endometriosis, but an accurate diagnosis is possible on computed tomography, especially in the presence of stellar, mildly enhanced, infiltrative lesions in suggestive areas. The aim of this pictorial review is to provide an image-based overview of key findings for the diagnosis of acute abdominal complications of endometriosis.
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Affiliation(s)
- Juliette Coutureau
- Department of Medical Imaging, CHU Lapeyronie, Universitary Hospital of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France.
| | - Caroline Mandoul
- Department of Medical Imaging, CHU Lapeyronie, Universitary Hospital of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Cecile Verheyden
- Department of Medical Imaging, CHU Lapeyronie, Universitary Hospital of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Ingrid Millet
- Department of Medical Imaging, CHU Lapeyronie, Universitary Hospital of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Patrice Taourel
- Department of Medical Imaging, CHU Lapeyronie, Universitary Hospital of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
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Borruel Nacenta S, Ibáñez Sanz L, Sanz Lucas R, Depetris M, Martínez Chamorro E. Update on acute appendicitis: Typical and untypical findings. RADIOLOGÍA (ENGLISH EDITION) 2023; 65 Suppl 1:S81-S91. [PMID: 37024234 DOI: 10.1016/j.rxeng.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/08/2022] [Indexed: 04/08/2023]
Abstract
Acute appendicitis is the most common indication for emergency abdominal surgery throughout the world and a common reason for consultation in emergency departments. In recent decades, diagnostic imaging has played a fundamental role in identifying acute appendicitis, helping to reduce the rate of blind laparotomies and hospital costs. Given the results of clinical trials supporting the use of antibiotic therapy over surgical treatment, radiologists need to know the diagnostic criteria for complicated acute appendicitis to be able to recommend the best treatment option. This review aims not only to define the diagnostic criteria for appendicitis in different imaging modalities (ultrasonography, computed tomography, and magnetic resonance imaging), but also to explain the diagnostic protocols, atypical presentations, and other conditions that can mimic appendicitis.
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Actualización de la apendicitis aguda: hallazgos típicos y atípicos. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fuller MY, Leino DG, Reyes-Múgica M, Kovach AE, Velázquez Vega JE, Caltharp S, Bhatti T, Gonzalez RS. Ingested Foreign Bodies Can Cause Appendicitis and Perforation: A Multi-Institutional Case Series. Pediatr Dev Pathol 2022; 25:499-503. [PMID: 35400217 DOI: 10.1177/10935266221083188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Appendicular foreign bodies are a rare, under-described cause of appendicitis. We performed this study to determine the varied causes and consequences of foreign-body appendicitis. METHODS On retrospective review of the pathology archives of seven institutions, we identified 56 appendix specimens containing a foreign body (defined as ingested, non-digestible material). We recorded the type of foreign body, patient age and sex, and other findings, as available. RESULTS Mean patient age was 7.7 years (range: 1 day-18 years). The foreign bodies included hair, plant material, magnets, other metallic material, BB pellets, foreign material not otherwise specified, and other miscellaneous objects. Of 48 cases with available clinical information, 31 patients presented with abdominal pain, and 22 were preoperatively diagnosed as having appendicitis/appendicular inflammation. Seven patients had appendiceal perforation (13%). The foreign body was grossly identified in 34/47 cases with available gross descriptions. Twenty-seven cases had an identifiable foreign body microscopically; 10 were associated with giant cell reaction. DISCUSSION Hair and plant materials were the most common foreign objects found in the appendix; they often cause mucosal damage and giant cell reaction. Metallic objects were less common. Although appendicular foreign bodies in children are rare and sometimes asymptomatic, they may lead to perforation.
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Affiliation(s)
- Maren Y Fuller
- Texas Children's Hospital/Baylor College of Medicine, 3989Houston, TX, USA
| | | | | | - Alexandra E Kovach
- Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, 21629Nashville, TN, USA.,Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | - Tricia Bhatti
- Children's Hospital of Philadelphia, 6567Philadelphia, PA, USA
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[Incidental and "leave me alone" findings in the GI tract-part 1 : Intestinal lumen and intestinal wall]. Radiologe 2022; 62:57-70. [PMID: 35024886 DOI: 10.1007/s00117-021-00957-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
CLINICAL PROBLEM Due to the widespread use of computed tomography (CT) and magnetic resonance imaging (MRI) asymptomatic incidental findings of the gastrointestinal tract (GI) are increasingly being recognized. Incidental findings are frequently not part of the primary inquiry from referring physicians but it is obligatory to make a diagnosis and to stipulate the need for further clarification. RADIOLOGICAL STANDARD PROCEDURES A multitude of incidental findings in the intestinal lumen, in the intestinal wall and in the adjacent mesenterium or subperitoneal space are shown in CT and MRI. METHODOLOGICAL INNOVATIONS AND ASSESSMENT The first part of the two-part overview addresses the intestinal incidental findings in the lumen, such as coproliths, invaginations, mucoceles and chronic dilatations. In the intestinal wall, thickenings of neoplastic and nonneoplastic origins are discussed. Many of the findings can be classified as benign and as "leave me alone lesions" do not necessitate any further clarification but in contrast others need a definitive clarification. The most important incidental findings in the GI tract are systematically classified, illustrated and evaluated with respect to the clinical relevance, depending on the localization (e.g. stomach, small and large intestines).
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Al-Balas H, Al-Saffar RS, Al-Balas M, Al-Wiswasy MK, Abu Salhiyeh A, Al-Sharqi Y, Yousuf MS, Bani-Hani K. Unusual histopathological findings in appendectomy specimens with clinical diagnosis of acute appendicitis: A retrospective cohort analysis. Ann Med Surg (Lond) 2021; 69:102720. [PMID: 34484720 PMCID: PMC8405965 DOI: 10.1016/j.amsu.2021.102720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION While appendicitis is considered one of most common acute surgical conditions, several studies have reported abnormal histopathological findings in appendectomy specimens; however, sending all appendices to histopathology is not yet routinely done.Here we report many unusual findings. Those unusual findings played a role not only in confirming acute appendicitis as a cause of the presentation in some cases but also discovering etiologies that mimic it with great impact on its management. METHODS Between January 2011 and December 2017, a total of 1510 patients were operated with appendectomy for a primary diagnosis of acute appendicitis. Among them, a total of 72 patients had incidental histopathologic findings in association with acute appendicitis or other pathologies instead of acute appendicitis. A retrospective analysis for those 72 patients was performed with all data being retrieved from the electronic health record system. RESULTS Patients ages ranged between 4 and 71 years with a mean age equal to 23.1 years (SD = 14.2). Majority of patients were women (n = 52; 72.2%). Sixty of the seventy-two cases were seen in patients with negative appendectomies (n = 333) with an overall rate of 18% among this group of patients. The remaining 12 patients had additional findings in histopathology specimens beside acute appendicitis (n = 1131) with an overall rate of 1%. The most commonly reported pathologies were serositis, ovarian cysts, and Enterobius vermicularis in descending frequency. CONCLUSION Identification of unusual histopathological findings during microscopic examination of resected appendices is more common in female patients and in patients with negative appendectomy. histopathologic assessment of specimens will allow detection of congenital, infectious or malignant pathologies that mimic acute appendicitis clinically even in the absence appendicitis microscopically.
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Affiliation(s)
- Hamzeh Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, 13133, Jordan
| | - Raith S. Al-Saffar
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, 13133, Jordan
| | - Mahmoud Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, 13133, Jordan
| | - Mohammad K.M. Al-Wiswasy
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, 13133, Jordan
| | | | - Yasmeen Al-Sharqi
- Department of Histopathology, Prince Hamza Teaching Hospital, Amman, Jordan
| | - Mustafa Saad Yousuf
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, 13133, Jordan
| | - Kamal Bani-Hani
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, 13133, Jordan
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9
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Hines JJ, Mikhitarian MA, Patel R, Choy A. Spectrum and Relevance of Incidental Bowel Findings on Computed Tomography. Radiol Clin North Am 2021; 59:647-660. [PMID: 34053611 DOI: 10.1016/j.rcl.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A wide spectrum of incidental bowel findings can be seen on CT, including but not limited to, pneumatosis intestinalis, diverticular disease, non-obstructive bowel dilatation, transient small bowel intussusception, and submucosal fat. Radiologists should be aware that such findings are almost always benign and of little clinical significance in the absence of associated symptoms. Conversely, vigilance must be maintained when evaluating the bowel, because malignant neoplasms occasionally come to clinical attention as incidental imaging findings. When suspicious incidental bowel wall thickening is detected, the radiologist can alert the clinical team to the finding prior to the patient becoming symptomatic, potentially leading to definitive management at an early, more curable stage.
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Affiliation(s)
- John J Hines
- Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Department of Radiology, Huntington Hospital, Northwell Health, 270 Park Avenue, Huntington, NY 11743, USA.
| | - Mark A Mikhitarian
- Department of Radiology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
| | - Ritesh Patel
- Department of Radiology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
| | - Andy Choy
- Department of Radiology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
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10
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Fields J, Quinn K, Hollinger L, Jones R. Case report: Amyand hernia reincarnate and the utility of computed tomography. ANNALS OF PEDIATRIC SURGERY 2020. [DOI: 10.1186/s43159-020-00042-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Abstract
Background
An Amyand hernia is a rare condition in which the vermiform appendix follows the bowel as it bulges through the inguinal canal. Originally described by Claudius Amyand in 1735 in an 11-year-old boy who had a pin in the appendix (Philos Trans R Soc Lond. 1735;39:329–36), we describe here the first case with CT depicting all components of Dr. Amyand’s original case.
Case presentation
A 10-year-old boy presented with right lower quadrant and groin pain. CT imaging revealed a retained metallic foreign body perforating the appendix, acute appendicitis, and an Amyand hernia. A laparoscopic attempt at reduction failed due to tethering by the needle and inflammation of the hernia sac, requiring an open inguinal exploration and excision of the hernia sac. The patient was discharged on postoperative day 2 with plans for delayed hernia repair.
Conclusions
CT is a crucial diagnostic test for surgical decision-making in Amyand hernias. In this case, it accurately classified the hernia and led to anticipation of unsuccessful laparoscopic hernia reduction. Management in the setting of foreign body and perforation includes appendectomy and tissue herniorrhaphy with delayed formal inguinal hernia repair after inflammation has subsided.
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11
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McClain K, Mourany J, DeLa'O CM. Acute Appendicitis Complicated by a Cecal Mass. Am Surg 2020; 86:1026-1028. [PMID: 32762472 DOI: 10.1177/0003134820942151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Katherine McClain
- Department of Surgery, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - John Mourany
- Department of Surgery, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Connie M DeLa'O
- Department of Surgery, School of Medicine, West Virginia University, Morgantown, WV, USA
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12
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Manatakis DK, Aheimastos V, Antonopoulou MI, Agalianos C, Tsiaoussis J, Xynos E. Unfinished Business: A Systematic Review of Stump Appendicitis. World J Surg 2020; 43:2756-2761. [PMID: 31375871 DOI: 10.1007/s00268-019-05101-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Stump appendicitis is defined as interval inflammation of any residual appendicular tissue, after an appendicectomy. We present a systematic review of case series and case reports on stump appendicitis, emphasising on risk factors, diagnosis and surgical management. METHODS The English literature (1945-2018) was reviewed, using PubMed, Embase and GoogleScholar, combining the terms "appendix", "appendicitis", "stump", "residual", "recurrent" and "retained". In total, 127 studies were included, describing 164 patients (males 59%, mean age 36 ± 17 years). RESULTS Index surgery was open in 59% and laparoscopic in 38%. It was described as "difficult" or "complicated" in 31%. 20% of patients reported episodes of recurrent abdominal pain during the time interval between index and stump appendicitis (range 2 weeks to 60 years, median 2 years). Right lower quadrant pain was the most frequent complain (88%), leukocytosis was found in 56%, whereas 92% of patients underwent imaging testing, which was diagnostic or highly suspicious in 67.5%. Mean delay between beginning of symptoms and surgery was 2.4 ± 2.3 days. The operative approach was open in 61% and laparoscopic in 35% of cases. The operation was characterised as "difficult" or "complicated" in 45%. In the majority (88%), a completion stump appendicectomy was performed, with 11% requiring more extensive procedures. Mean length of resected stump was 3.1 ± 1.6 cm (range 0.5-10 cm). CONCLUSIONS Stump appendicitis may occur following both open and laparoscopic approach, when the residual stump is > 0.5 cm. Its clinical significance lies in the delayed diagnosis, leading to higher incidence of complications and the need for more extensive surgery.
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Affiliation(s)
- Dimitrios K Manatakis
- Department of Surgery, Athens Naval and Veterans Hospital, 11521, Athens, Greece.
- Medical School, University of Crete, Heraklion, Crete, Greece.
| | - Vasileios Aheimastos
- Department of Surgery, Athens Naval and Veterans Hospital, 11521, Athens, Greece
| | | | - Christos Agalianos
- Department of Surgery, Athens Naval and Veterans Hospital, 11521, Athens, Greece
| | - John Tsiaoussis
- Medical School, University of Crete, Heraklion, Crete, Greece
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Abstract
Deep invasive gastrointestinal endometriosis (DIGIE) is a frequent and severe presentation of endometriosis. Although most cases invade the rectosigmoid colon, DIGIE can involve any portion of the gastrointestinal tract from the stomach to the rectum, and is commonly multifocal and multicentric. Although histopathologic confirmation with surgery remains the gold standard for diagnosis, ultrasound (US) and magnetic resonance imaging (MRI) are the key non-invasive imaging modalities for initial assessment. US may be preferred as a screening study because of its easy availability and low-cost. Pelvic MRI and magnetic resonance enterography (MRE) provide substantial advantages for disease mapping in the pre-operative period, particularly in extensive bowel endometriosis. Although medical management of DIGIE with hormonal therapy can help control symptoms, disease course can be relentless and require surgical intervention. Surgical options depend on, the location; length; depth; circumference; multicentric or multifocal disease. With procedures including simple excision, fulguration of superficial lesions, shaving, disc excision, and segmental resection. A successful treatment outcome is largely dependent on good communication between the treating surgeon and the radiologist, who can provide vital information for effective surgical planning by reporting the key elements that we elaborate upon in this paper.
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Raposo Rodríguez L, Fernández García N, Tovar Salazar D, Gómez Illán R, Díaz Sánchez T. Imaging findings for mucinous tumors tumortumorof the abdomen and pelvis. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Imaging findings for mucinous tumors of the abdomen and pelvis. RADIOLOGIA 2019; 61:370-387. [PMID: 31078302 DOI: 10.1016/j.rx.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/25/2019] [Accepted: 03/15/2019] [Indexed: 11/23/2022]
Abstract
This article aims to describe the imaging findings for mucinous tumors of the abdomen and pelvis, which have a similar appearance on imaging tests regardless of the organ in which they develop. Due to the high water content of mucus, the appearance of these tumors is generally similar to that of water on ultrasonography, computed tomography, and magnetic resonance imaging. Another common feature of mucin-producing tumors is that calcifications are often present. The rupture of these lesions and accumulation of mucinous material in the peritoneal cavity gives rise to pseudomyxoma peritonei. It is important to identify mucinous tumors because they have a different prognosis and clinical course than non-mucinous tumors and require different management. Depending on their anatomic location and their imaging characteristics, the treatment approach varies from follow-up to radical surgery together with chemotherapy or radiotherapy or both.
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16
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Cevallos JM, Molina GA, Aguayo WG, Cacuango LP, Espin DS, Ramos DR, Lopez SC. A nail in the appendix, accidental discovery on an asymptomatic patient. J Surg Case Rep 2019; 2019:rjy335. [PMID: 30647896 PMCID: PMC6326104 DOI: 10.1093/jscr/rjy335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 07/10/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022] Open
Abstract
Inadvertent ingestion of foreign bodies is a common condition within clinical practice. It rarely produces any symptoms. The diagnosis is difficult since most patients do not recall having swallowed any object. Needles, pins, keys, nails and bones are among the most commonly ingested foreign bodies. Severe complications are uncommon, but if present they can put patients’ lives at risk. Although extremely rare, the ingested foreign body may end lodging in the appendix, posing a challenge for the clinical team. Once the exact location of the object is confirmed, the extraction of the foreign object must be performed to avoid complications. The present report describes a case of a young adult patient, who presented to the emergency room after a routine medical examination. A 30 mm metallic nail was discovered in the tip of the appendix. After a failed endoscopic approach an appendectomy was performed, and the patient underwent a complete recovery.
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Affiliation(s)
- Jaime M Cevallos
- Department of General Surgery, Hospital San Francisco, IESS Quito, Ecuador
| | | | - William G Aguayo
- Department of General Surgery, Hospital San Francisco, IESS Quito, Ecuador
| | - Lorena P Cacuango
- Department of Gastroenterology, Hospital San Francisco, IESS Quito, Ecuador
| | - Darwin S Espin
- Department of General Surgery, Hospital San Francisco, IESS Quito, Ecuador
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17
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Appendiceal neoplasm risk associated with complicated acute appendicitis-a population based study. Int J Colorectal Dis 2019; 34:39-46. [PMID: 30242478 DOI: 10.1007/s00384-018-3156-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Appendiceal tumors are rare, but high neoplasm rates have been reported at interval appendectomy after periappendicular abscess. Non-operative management of uncomplicated acute appendicitis has shown promising results. The data on appendiceal tumor incidence and presentation among acute appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated acute appendicitis. Objective was to assess appendiceal tumor incidence and tumor association to appendicitis in patients with uncomplicated and complicated acute appendicitis. METHODS This nationwide population-based registry study was conducted from 2007 to 2013. The Finnish Cancer Registry and the National Institute for Health Registry were used to combine data on all appendiceal tumors and acute appendicitis diagnosis with medical reports evaluated at eight study hospitals. RESULTS Altogether, 840 appendiceal tumors were identified, and out of these, 504 patient reports were reviewed, including 472 patients in this study. Tumor was diagnosed at appendectomy for suspected acute appendicitis in 276 patients (58%). In the whole study, histologically acute appendicitis and tumor were both present in 53% (n = 250), and out of these, 41% (n = 102) were complicated and 59% (n = 148) uncomplicated acute appendicitis. The associated tumor risk was significantly higher in complicated acute appendicitis compared with uncomplicated cases (3.24% vs. 0.87%, p < 0.001). Overall tumor prevalence among acute appendicitis patients was 1.24%. CONCLUSIONS Appendiceal tumor prevalence in acute appendicitis was low. Tumor risk was significantly higher in complicated acute appendicitis compared with uncomplicated acute appendicitis. The risk of missed appendiceal tumors related to antibiotic therapy of uncomplicated acute appendicitis is very low.
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18
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Quadri R, Vasan V, Hester C, Porembka M, Fielding J. Comprehensive review of typical and atypical pathology of the appendix on CT: cases with clinical implications. Clin Imaging 2018; 53:65-77. [PMID: 30316106 DOI: 10.1016/j.clinimag.2018.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/13/2018] [Accepted: 08/22/2018] [Indexed: 12/14/2022]
Abstract
Acute appendicitis is the most common abdominal surgical emergency in the United States with approximately 250,000 cases annually. Computed Tomography (CT) has emerged as the most accurate diagnostic test to triage these patients for emergent surgery. Although the radiology search pattern is prioritized to detect an inflamed appendix, not all appearances equate to a typical surgical appendicitis. There are a select set of atypical pathologies involving the appendix that have subtle differences on CT, but can have catastrophic complications if treated with emergent appendectomy. This paper will review the spectrum of CT appearances and clinical management for typical and atypical appendiceal pathologies.
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Affiliation(s)
- Rehan Quadri
- University of Texas Southwestern Department of Radiology, United States of America.
| | - Vasantha Vasan
- University of Texas Southwestern Department of Radiology, United States of America
| | - Caitlin Hester
- University of Texas Southwestern Department of Surgery, United States of America
| | - Matthew Porembka
- University of Texas Southwestern Department of Surgery, United States of America
| | - Julia Fielding
- University of Texas Southwestern Department of Radiology, United States of America
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Foley WD. CT Features for Complicated versus Uncomplicated Appendicitis: What Is the Evidence? Radiology 2018; 287:116-118. [PMID: 29558303 DOI: 10.1148/radiol.2018180022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- W Dennis Foley
- From the Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, Wis 53226
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Demir MK, Savas Y, Furuncuoglu Y, Cevher T, Demiral S, Tabandeh B, Aslan M. Imaging Findings of the Unusual Presentations, Associations and Clinical Mimics of Acute Appendicitis. Eurasian J Med 2017; 49:198-203. [PMID: 29123444 DOI: 10.5152/eurasianjmed.2017.17218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
There are many kinds of unusual presentations or associations and clinical mimics of acute appendicitis, and definitive diagnosis requires knowledge of the imaging findings in some cases. The unusual presentations and associations of acute appendicitis included in this study are perforated appendicitis, acute appendicitis occurring in hernias, acute appendicitis with cystic endosalpingiosis, intussusception of appendix, and acute appendicitis with pregnancy. We also present uncommon gastrointestinal, urinary and gynecologic clinical mimics of acute appendicitis including anomalous congenital band, duplication cysts, giant Meckel's diverticulitis, inflammatory fibroid polyp, renal artery thrombosis, spontaneous urinary extravasation and OHVIRA syndrome. Familiarity with these entities may improve diagnostic accuracy and enable the quickest and most appropriate clinical management.
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Affiliation(s)
- Mustafa Kemal Demir
- Department of Radiology, Bahçeşehir University School of Medicine, Göztepe Medical Park Hospital, İstanbul, Turkey
| | - Yildiray Savas
- Department of Radiology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Yavuz Furuncuoglu
- Department of Internal Medicine, Bahçeşehir University School of Medicine, Göztepe Medical Park Hospital, İstanbul, Turkey
| | - Tarik Cevher
- Department of Surgery, Göztepe Medical Park Hospital, İstanbul, Turkey
| | - Serdar Demiral
- Department of Surgery, Atakent Acıbadem Hospital, İstanbul, Turkey
| | - Babek Tabandeh
- Department of Surgery, Bahçeşehir University School of Medicine, Göztepe Medical Park Hospital, İstanbul, Turkey
| | - Melisa Aslan
- Medical Student, Bahcesehir University School of Medicine, İstanbul, Turkey
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