Roentgen aspects of primary appendiceal intussusception

Laparoscopic appendectomy for appendiceal intussusception assisted by colonoscopy: A case report

Introduction

Appendiceal intussusception sometimes results from appendiceal cancer. Ileocecal resection instead of appendectomy is often chosen as a treatment as it is technically difficult to resect the appendix alone without causing dissemination of appendiceal cells to the abdominal cavity. Herein, we present the first report of a case in which appendiceal intussusception was treated by resection of the appendix alone via simultaneous colonoscopy and laparoscopy.

Presentation of case

A 40-year-old man underwent laparoscopic appendectomy for appendiceal intussusception. Since a neoplastic cause could not be completely ruled out, we planned to carry out oncologically safe appendectomy that would not expose the tumor to the abdominal cavity. The resection was performed in the lumen of the cecum rather than in the abdominal cavity to prevent dissemination of appendiceal cells to the peritoneal cavity during surgery. Histopathologic examination revealed chronic inflammation of the appendix but no malignancy. The postoperative course was uneventful.

Discussion

Here, we present a case in which laparoscopic resection of the mesoappendix and colonoscopy-assisted resection of the appendix were performed in combination in a patient with appendiceal intussusception. When the possibility of malignancy is low, this maneuver may prevent patients from undergoing ileocecal resection with lymph node dissection as it prevents exposure of the abdominal cavity to the tumor.

Conclusion

Simultaneous performance of laparoscopy and intraoperative colonoscopy is feasible and, from an oncological viewpoint, may be preferable when the cause of appendiceal intussusception is unknown or malignancy is not suspected.

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Appendiceal intussusception with unknown cause usually requires ileocecal resection.

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We successfully treated this disorder via combination of colonoscopy and laparoscopy.

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Our procedure is advantageous in cases with incidental malignancy.

Invagination of the appendix due to endometriosis presenting as acute appendicitis

Appendicitis and endometriosis are commonly encountered surgical problems. Endometrial involvement of the appendix is rare and very few cases have been reported in the literature. True diagnosis of appendix invagination is highly difficult due to variable symptoms. Noting the findings which are in favour of invagination in patients diagnosed with acute appendicitis is of great significance in order to be prepared for changing surgical attempts. This case describes a 34 year old female patient diagnosed with infertility who was operated on for acute appendicitis. In the pathological assessment, endometrial involvement of the appendix was seen. The classification, symptoms, radiological appearance and treatment of appendix invagination described in the literature are discussed.

Intussusception of the appendix: comprehensive review of the literature

BACKGROUND

Intussusception of the appendix is a rare disease that constitutes a diagnostic challenge to the surgeon. The literature on this condition is limited to case reports. The demographics, presentation, and treatment remain debatable in the absence of a comprehensive review of the literature.

DATA SOURCES

This article reports a case of a 40-year-old woman who presented with intussusception of the appendix caused by endometriosis. A comprehensive review of the English literature in PubMed was performed. The trends in incidence, sex predilection, presentation, and treatment of appendiceal intussusception were derived based on the reports of 191 patients.

COMMENTS

The incidence was more common in adults (76%) than in children (24%). Female patients (72%) were 2 times more affected in adults than in children, whereas male patients (58%) seem to be more affected in the pediatric population. Intussusception of the appendix has most commonly a chronic presentation (63%). Endometriosis (33%) and inflammation (76%) were the most common pathologic findings in adults and children, respectively. Only 49% of patients were treated by simple appendectomy; 49% patients underwent partial colectomy; and 2% of patients had their appendixes endoscopically removed.

Intussusception of the appendix secondary to endometriosis: a case report

INTRODUCTION

Intussusception of the appendix is an extremely rare condition that ranges from partial invagination of the appendix to involvement of the entire colon. Endometriosis is an exceptionally rare cause of appendiceal intussusception and only very few cases have been reported in the literature to date.

CASE PRESENTATION

A 40 year-old woman presented to clinic with a long history of lower abdominal pain, loose motions and painful, heavy periods. Subsequent colonoscopy revealed submucosal endometriotic nodules in the sigmoid as well as a polyp thought to be arising from the appendix, which had inverted itself. She was referred to a colorectal surgeon because the polyp could not be removed endoscopically despite several attempts. At laparotomy, the appendix had intussuscepted but it was possible to reduce it and therefore a simple appendicectomy was carried out. On histology, there were widespread endometrial deposits within the wall of the appendix and this was thought to be the basis for the intussusception.

CONCLUSION

Histological evidence of the lead point is of crucial importance in cases of appendiceal intussusception, in order to exclude an underlying neoplastic process. Consequently, surgical resection is necessary either through an open or a laparoscopic approach. Gastrointestinal endometriosis should be considered as a cause of appendiceal intussusception in post-menarchal women with episodic symptoms and proven disease.

Colonoscopic diagnosis of appendiceal intussusception: a case report

Intussusception of the appendix is an uncommon condition and the diagnosis is rarely made preoperatively. Intussusception of the appendix may mimic a neoplastic lesion. Colonoscopy is a valuable tool for diagnosis of the appendiceal intussusception. A 17-yr-old female admitted with repeated abdominal pain, nausea, vomiting and febrile sensation. We diagnosed as appendiceal intussusception by colonoscopy, which showed a polypoid tumor (about 1.5 cm) in the cecum. This sessile polypoid mass looks like foreskin or glans. We present colonoscopic finding of appendiceal intussusception and review the literature.

Intussusception of the appendix that reduced spontaneously during follow-up in a patient on hemodialysis therapy

A 63-year-old man on long-term hemodialysis therapy was hospitalized due to right lower abdominal pain. CT scan demonstrated a multiple concentric structure in the ileocecal region. Colonoscopy showed a polyp-like tumor arising from the expected location of the appendix, with a dimple at the top. Barium enema study revealed a submucosal tumor-like filling defect in the cecum with non-filling of the appendix. A diagnosis of intussusception of the appendix (IA) was made. During the follow-up, IA reduced spontaneously. The present case report is the first description of IA in a patient on hemodialysis therapy. Furthermore, spontaneous reduction of IA is indeed rare.

Sonographic diagnosis of intussusception of the appendix vermiformis

We present 2 cases of intussusception of the appendix vermiformis (IAV) in children. Sonographic examination demonstrated a lead point within a characteristic multiconcentric ring sign, and longitudinal sonograms showed the inverted appendix protruding into the cecal lumen. A contrast-enema study, using a water-soluble contrast medium, was performed in each case, and a "coiled-spring" sign or "spiral shell" appearance confirmed the diagnosis. A surgical reduction of the appendix and an appendectomy were performed in each case.

Appendiceal intussusception induced by tubulovillous adenoma with carcinoma in situ: report of a case

Appendiceal intussusception is an uncommon pathologic condition; however, villous adenoma of the appendix is a distinctly rare entity. We report herein a case of appendiceal intussusception induced by tubulovillous adenoma with carcinoma in situ. A 67-year-old man was admitted to our hospital with a 1-year history of lower abdominal pain for investigation. Barium enema showed a filling defect with an irregular surface in the cecum, and colonoscopy revealed a cecal tumor with a granular surface. Pathological examination of biopsy samples revealed tubulovillous adenoma with well-differentiated adenocarcinoma, and a diagnosis of cecal cancer in tubulovillous adenoma was made. Surgery was performed and the resected specimen was found to contain a tumor arising from the appendix. The tumor was 5.5 x 4.5 cm in size in the cecal cavity, and the appendix had invaginated into the cecum at its base. The cut surface of the appendix showed the villous tumor filling the appendiceal lumen and projecting into the cecal cavity. Microscopic examination revealed well-differentiated adenocarcinoma in tubulovillous adenoma. To the best of our knowledge, this is the first report of appendiceal intussusception caused by tubulovillous adenoma with carcinoma of the appendix.

Intussusception of a mucocele of the appendix secondary to an obstruction by endometriosis: report of a case

We treated a patient with a complete invagination of the cecum which contained a mucocele of the appendix secondary to an obstruction by endometriosis. Preoperatively, a barium enema showed a crab's claw-like area without filling in the oral side of the transverse colon. An emergency laparotomy was performed and revealed a mucocele of the appendix to have induced appendicecal invagination; however, no colonic invagination was observed. An appendicecal resection was thus done. Pathologically, the resected specimen was a mucosal hyperplasia with mucin-secreting lesions of the appendix. The theories regarding the pathogenesis of appendicecal mucocele are reviewed and discussed.

Colonoscopic appendicography. A new method for the differential diagnosis of pain in the right lower quadrant

Colonoscopic appendicography is a simple diagnostic measure for surveying the position and anatomical qualities of the appendix. It is complementary to ileocolonoscopy and allows a decision to be made as to whether right lower abdominal pain is due to appendicular disease or not.

Intussusception of the appendix with a calcified fecalith

We treated a patient with a complete invagination of the appendix which contained one large laminated calcified fecalithy. Colonofiberscopy showed a dimpling submucosal tumor, which was palpated as a bony hard tumor at laparotomy. This finding suggested that the fecalith caused an intussusception of the appendix and that such an intussusception should be suspected when there is a bony hard dimpling submucosal tumor in the cecum.

Malignant appendiceal carcinoid with intussusception of the base manifesting as a cecal tumor: report of a case

A case of an appendiceal carcinoid tumor with regional lymph-node metastases is presented. The size of the tumor was remarkable, as the appendix was infiltrated throughout its length. The proximal part of the appendix was intussuscepted into the cecum. Preoperatively, the lesion was diagnosed as a polypoid tumor of the cecum. A primary right hemicolectomy was carried out.