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Jabi R, Elmir S, Bouziane M. First case report of horseshoe appendix in Morocco according according to SCARE guidelines. Ann Med Surg (Lond) 2021; 70:102870. [PMID: 34603719 PMCID: PMC8463815 DOI: 10.1016/j.amsu.2021.102870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction The appendix duplication is a sporadic malformation in which the horseshoe form is the uncommon described variant. To our knowledge, we report the first Moroccan case of a horseshoe appendix in a girl admitted to managing of pain at the right iliac fossa. Case presentation Through this article, we present a very rare case of appendicular duplication. It has not been objectified in radiological exploration and discovered by chance during the operation. Resection then closure of the appendicular bases allowed our patient to heal. The objectives of this work is threefold: i) to report this sporadic case of horeshoe appendix, ii) to emphasize the importance of suspicion of appendicular duplication in appendicular syndrome and iii) to recommend the exploration of the ileoceacal region to avoid surgical complications and medicolegal problems. Conclusion Our case report shows that we have to take into consideration this sporadic presentation of appendicular syndrome and this even in the absence of radiological signs. Our work brings enriched the literature by a new case of horseshoe appendicitis highlighting the importance of surgical treatment. We report a case report of an appendix duplication witch is a very rare congenital malformation. To date, only fifteen cases were published. After careful examination of the literature, we found that this is the first case of this rare entity in Morocco. Appendicular duplication is a rare malformation that often escapes preoperative radiological imaging. We believe that this manuscript can add new perspectives to the surgery practice of this very rare presentation.
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Affiliation(s)
- Rachid Jabi
- Department of General Surgery, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
- Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM), Mohammed Ist University, Oujda, Morocco
- Corresponding author. Department of General Surgery, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco.
| | - Siham Elmir
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Mohammed Bouziane
- Department of General Surgery, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
- Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM), Mohammed Ist University, Oujda, Morocco
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Zhu MY, Fei FM, Chen J, Zhou ZC, Wu B, Shen YY. Endometriosis of the duplex appendix: A case report and review of the literature. World J Clin Cases 2019; 7:2094-2102. [PMID: 31423443 PMCID: PMC6695541 DOI: 10.12998/wjcc.v7.i15.2094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Duplication of the appendix is an infrequent congenital malformation with a complex classification. The horseshoe appendix is a subtype of the duplex appendix and is rarely reported in the literature. Endometriosis is a common gynecological disease that rarely occurs in the appendix. Moreover, horseshoe appendix combined with endometriosis has not been previously reported. CASE SUMMARY Here, we describe a 44-year-old woman who was admitted with a 1-d history of migratory lower right quadrant pain. Physical examination was consistent with the signs of acute appendicitis. The patient underwent an emergency exploratory laparotomy. The distal tip of the appendix was in contact with the cecum by another base, or "horseshoe appendix". In addition, a small intestinal mass and an ovarian mass were identified. Subsequently, appendectomy, partial resection of the small intestine, and right oophorectomy were successively performed. The histopathology confirmed the diagnosis of acute inflammation of the duplex appendix with endometriosis, small intestine endometriosis, and ovarian endometriosis. CONCLUSION Surgeons need to be aware of the possibility of the duplex appendix when performing an appendectomy, and this study emphasizes the importance of exploring the entire abdomen.
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Affiliation(s)
- Ming-Yuan Zhu
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Fa-Ming Fei
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Jing Chen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Zhong-Cheng Zhou
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Bin Wu
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Yi-Yu Shen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
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Choi SJ, Chae G, Park SB, Hong SK, Kim YH, Moon SB, Kim SY, Kim H. Horseshoe appendix identified during laparoscopic appendectomy: A case report and literature review. Medicine (Baltimore) 2019; 98:e14104. [PMID: 30702564 PMCID: PMC6380734 DOI: 10.1097/md.0000000000014104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
RATIONALE The horseshoe anomaly of the vermiform appendix is extremely rare. Preoperative confirmation of this anomaly is difficult; therefore, routine procedures, such as appendectomy, may become unexpectedly challenging when such anomalies are encountered during the surgical process. PATIENT CONCERNS A 33-year-old man presented with abdominal pain in the right lower abdomen owing to acute appendicitis confirmed via computed tomography. Immediate laparoscopic appendectomy was decided as the method for treatment. DIAGNOSIS Horseshoe anomaly was diagnosed as a gross finding during surgery. INTERVENTION First, the appendiceal base was resected and appendectomy was performed via the retrograde method because the appendiceal tip was curled behind the cecum. However, it was discovered that the appendiceal tip was connected to the lateral part of the ascending colon and showed a horseshoe-shaped anomaly. The second appendiceal base arising from the ascending colon was also ligated, and the appendectomy was completed without any further complications. OUTCOMES After successful completion of appendectomy, the patient was discharged without any complications 2 days later. LESSONS An appendiceal anomaly is rarely seen during appendectomy or other forms of abdominal surgery; however, the ability of surgeons to both recognize and categorize an appendiceal anomaly is crucial if detected during surgery. After successfully recognizing the horseshoe anomaly of the appendix, it is important to know that 2 appendiceal base ligations will be required to complete the surgery successfully.
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Liu J, Dong C, Wang H, Sun D, Liang R, Gao Z, Wang L. One type of duplex appendix: horseshoe appendix. Ther Clin Risk Manag 2018; 14:1987-1992. [PMID: 30349277 PMCID: PMC6190621 DOI: 10.2147/tcrm.s179929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A horseshoe appendix is a subtype of duplex appendix, in which the appendix is shaped like a circle that may lead to an internal hernia and result in intestinal necrosis. This subtype is extremely rare, with only 13 cases reported worldwide to date, and easily triggers a series of medico-legal consequences due to the neglect of another infection base of the appendix. We describe a 22-year-old man who presented with a 3-day history of fever and was diagnosed with pneumonia. After receiving antibiotics for 3 days in the Department of Pneumology, he was found to have a periappendiceal abscess. He underwent appendectomy after 3 days of conservative treatment failure in the Department of General Surgery. During the operation, we found that he had a horseshoe appendix with the two bases forming a circle, each communicating with the cecum. We provide a review of 13 cases presented in the literature, with a discussion of the clinical features, diagnosis, and surgical approach of the horseshoe appendix to make the general surgeon get a clear concept of this type of appendicitis.
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Affiliation(s)
- Jin Liu
- General Surgery, Center for New Material and New Precision Technology of Cancer Therapy, Dalian Medical University, Dalian, Liaoning, China,
| | - Chengyong Dong
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China, ;
| | - Haibo Wang
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China, ;
| | - Deguang Sun
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China, ;
| | - Rui Liang
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China, ;
| | - Zhenming Gao
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China, ;
| | - Liming Wang
- General Surgery, Center for New Material and New Precision Technology of Cancer Therapy, Dalian Medical University, Dalian, Liaoning, China, .,Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China, ;
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Appendiceal Duplication: A Comprehensive Review of Published Cases and Clinical Recommendations. World J Surg 2018; 42:574-581. [PMID: 28799135 DOI: 10.1007/s00268-017-4178-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Duplex appendix is very rare (incidence 0.004%) but has clinical relevance given the frequency of appendicectomies performed. Failure to recognise duplication can result in failure of treatment and medico-legal consequences. A review of published cases was undertaken to identify factors that may help in managing this rare condition. METHODS All English and non-English publications were identified in PubMed, Embase and Cochrane databases. Patient demographics, intraoperative findings, anatomical details and histopathology were analysed. RESULTS A total of 141 cases were identified [male/female ratio 1.4:1, median age 20 years (range foetus to 69 years)]. Duplication of the appendix ranges from branching of the appendix trunk to a fully matured appendix located elsewhere along the colon. Most can be categorised by the Cave-Wallbridge classification. There were 22 Type A, 8 Type B1, 46 Type B2 and 10 Type C cases (Cave-Wallbridge). There were six cases of horseshoe and two cases of triple appendix. Six reports gave anatomical descriptions that could not be classified by Cave-Wallbridge categories and in 11 cases there were no anatomical descriptions. CONCLUSIONS An anteriorly placed appendix, away from the convergence of the taenia, or a normal appendix in the presence of convincing clinical or radiological signs of appendicitis should instigate a careful examination of the caecal pole and possible exploration of the retrocaecal space for appendiceal duplication. If the patient had previous surgery for congenital abnormalities, Type B1 or Type C duplication should be considered.
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Takabatake K, Ikeda J, Furuke H, Kato C, Kishimoto T, Kumano T, Imura K, Shimomura K, Kubota T, Taniguchi F, Shioaki Y. A case of a horseshoe appendix. Surg Case Rep 2016; 2:140. [PMID: 27878571 PMCID: PMC5120162 DOI: 10.1186/s40792-016-0261-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/09/2016] [Indexed: 12/11/2022] Open
Abstract
Anomalies of the appendix are extremely rare, and a horseshoe appendix is even rarer. A literature search has revealed only five reported cases. In this report, we present a case of a horseshoe appendix.A 78-year-old man was referred for further examination following a positive fecal occult blood test. A mass in his ascending colon was detected on colonoscopy, while computed tomography showed that it was connected to the appendix. Tumor invasion derived from the ascending colon or appendix was suspected. We diagnosed ascending colon cancer prior to laparoscopic ileocecal resection. Macroscopic findings showed that the appendix connected to the back side of the mass, while microscopic findings showed that the mucosa and submucosa were continuous from the appendiceal orifice in the cecum to the other orifice in the ascending colon, where a type 1 tumor was observed on the orifice. We eventually diagnosed the patient with tubulovillous adenoma and a horseshoe appendix.A horseshoe appendix communicates with the colon at both ends and is supplied by a single fan-shaped mesentery. Cases are classified by the disposal of the mesentery and the location of the orifice. Anatomical anomalies should be considered despite the rarity of horseshoe appendices.
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Affiliation(s)
- Kazuya Takabatake
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama, Kyoto, Kyoto, Japan.
| | - Jun Ikeda
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama, Kyoto, Kyoto, Japan
| | - Hirotaka Furuke
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama, Kyoto, Kyoto, Japan
| | - Chikage Kato
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama, Kyoto, Kyoto, Japan
| | - Takuya Kishimoto
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama, Kyoto, Kyoto, Japan
| | - Tatsuya Kumano
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama, Kyoto, Kyoto, Japan
| | - Kenichiro Imura
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama, Kyoto, Kyoto, Japan
| | - Katsumi Shimomura
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama, Kyoto, Kyoto, Japan
| | - Takeshi Kubota
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama, Kyoto, Kyoto, Japan
| | - Fumihiro Taniguchi
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama, Kyoto, Kyoto, Japan
| | - Yasuhiro Shioaki
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama, Kyoto, Kyoto, Japan
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Singh CG, Nyuwi KT, Rangaswamy R, Ezung YS, Singh HM. Horseshoe Appendix: An Extremely Rare Appendiceal Anomaly. J Clin Diagn Res 2016; 10:PD25-6. [PMID: 27134939 DOI: 10.7860/jcdr/2016/16569.7494] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/14/2016] [Indexed: 12/17/2022]
Abstract
Appendiceal anomalies are extremely rare malformations that are usually found incidentally. Agenesis and duplication of the appendix has been well documented however, the cases of horseshoe appendix reported is very limited, only four cases reported so far. Here, we report a four and half-year-old who underwent interval appendectomy. Intraoperatively both the ends of the appendix were found to be communicating with the cecum with two separate base or stump located at a sagital disposal- the so called "horseshoe appendix".
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Affiliation(s)
- Ch Gyan Singh
- Assistant Professor, Department of General Surgery, RIMS , Imphal, Manipur, India
| | - Kuotho T Nyuwi
- Junior Resident, Department of General surgery, RIMS , Imphal, Manipur, India
| | - Raju Rangaswamy
- Junior Resident, Department of General Surgery, RIMS , Imphal, Manipur, India
| | - Yibenthung S Ezung
- Junior Resident, Department of General Surgery, RIMS , Imphal, Manipur, India
| | - H Manihar Singh
- Professor, Department of General Surgery, RIMS , Imphal, Manipur, India
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Takeuchi K, Kosaka N, Kinoshita K, Sakai T, Sawai K, Imamura Y, Kimura H. A rare congenital anomaly, bridge-like appendiceal fistula to the terminal ileum, demonstrated by MDCT. Surg Radiol Anat 2012; 35:523-7. [DOI: 10.1007/s00276-012-1055-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 12/06/2012] [Indexed: 01/07/2023]
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Varshney M, Shahid M, Maheshwari V, Mubeen A, Gaur K. Duplication of appendix: an accidental finding. BMJ Case Rep 2011; 2011:2011/mar05_1/bcr0120113679. [PMID: 22707653 DOI: 10.1136/bcr.01.2011.3679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Duplication of appendix is extremely rare anomaly. The reported incidence is 0.004-0.009%. In most of the cases the finding is accidental. Here the authors are presenting a case of type A duplex appendix in a 25-year male patient.
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Affiliation(s)
- Manoranjan Varshney
- Department of Pathology, J.N. Medical College, Aligarh, Uttar Pradesh, India
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Griffiths EA, Jagadeesan J, Fasih T, Mercer-Jones M. Bifid vermiform appendix: a case report. ACTA ACUST UNITED AC 2006; 63:176-8. [PMID: 16757368 DOI: 10.1016/j.cursur.2006.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Appendiceal anomalies are extremely rare: they have a reported incidence of between 0.004% and 0.009% of appendectomy specimens. The authors report a case of a patient who was found to have 2 appendices at emergency laparotomy, review the classification system used, and discuss the potential clinical pitfalls of similar cases. CASE REPORT A 23-year-old man was admitted as an emergency with abdominal pain and vomiting. The operative finding was of a bifid appendix. One appendix was grossly gangrenous and lacked a mesoappendix, whereas the other had a mesoappendix and appeared macroscopically normal. The appendices shared a common base that arose from the cecum in the typical anatomical position. No other intra-abdominal malformations were present at inspection during laparotomy. Histology confirmed features of gangrenous appendicitis. His postoperative recovery was uneventful, and he was discharged after 4 days. CONCLUSION Although rare, it is important for several reasons that surgeons are aware of the potential anatomical anomalies and malpositions of the vermiform appendix: first, a missed second appendix may result in serious clinical and medico-legal consequences; second, a double appendix can be confused with other intra-abdominal conditions; and finally, they can be associated with other congenital abnormalities.
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Affiliation(s)
- Ewen A Griffiths
- Department of General Surgery, Queen Elizabeth Hospital, Gateshead, United Kingdom.
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