Appendiceal neoplasms: Suspected findings and reports of 14 cases

Background

Neoplastic lesions of the vermiform appendix are still considered to be rare, some studies suggest that appendix cancer may be on the rise, with an estimated incidence of 0.08-0.1% of all appendiceal specimens. The lifetime incidence of malignant appendiceal tumors ranges from 0.2 to 0.5%.

Patients and Methods

Our study is applied at the Department of General Surgery at tertiary training and research hospital; 14 patients who had appendectomy or right hemicolectomy between December 2015 and April 2020 were evaluated.

Results

The mean age of the patients was 52.3 ± 15.1 (range, 26-79) years. Gender of the patients were: five (35.7%) men and nine (64.3%) women. The clinical diagnosis was appendicitis without suspected findings in 11 (78.6%), appendicitis with suspected findings (appendiceal mass, etc.) in three (21.4%) of the patients, and there is no patient with asymptomatic or other rare findings. Surgeries applied for the patients were: nine (64.3%) underwent open appendectomy, four (28.6%) underwent laparoscopic appendectomy, and one (7.1%) underwent open right hemicolectomy. Histopathologic results were as follows: five (35.7%) neuroendocrine neoplasm, eight (57.1%), noninvasive mucinous neoplasm, and one (7.1%) adenocarcinoma.

Conclusion

While diagnosis and management of appendiceal pathology, surgeons should be familiar with suspected findings of appendiceal tumors and discuss them with patients to the possibility of histopathologic results.

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study

BACKGROUND

Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours.

METHODS

In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186.

FINDINGS

Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039).

INTERPRETATION

Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation.

FUNDING

None.

Does Previous Perianal Surgery for Benign Diseases Have an Impact on Timing of Hospital Admission in Patients with Colorectal Cancer?

Objective. Colorectal cancer (CRC) is one of the most common and fatal malignancies worldwide. Although the clinical presentation varies according to the location of the tumor, hematochezia, tenesmus, changes in the defecation habit, chronic constipation, abdominal pain, and distension are the most common findings of CRCs. We aimed to investigate whether patients with CRC who had a surgical history for benign anal disease have more negative tumoral features or not. Material and Methods. Two-hundred fifty two patients who underwent surgery for CRC between 2010 and 2016 at general surgery clinic in Ankara Numune Training and Research Hospital included in this study. Patients were classified into two groups; patients who had undergone surgery for benign perianal disease such as hemorrhoid, anal fissure, perianal abscess and fistulae (Group 1) and patients without past history for perianal surgery (Group 2). Results. A total of 252 CRC patients with a mean age of 64.2 years were included in the study. There were 95 (37.7%) females and 157 (62.3%) males. There were 25 (9.9%) patients who had surgical history for benign perianal disease. There were no statistically differences in tumor size, lymph node positivity, presence of distant metastasis, and tumor stage between the groups (p > 0.05). Conclusion. Although not statistically significant, CRC patients with a history of surgery for benign perianal disease had less lymphatic metastases and tumor size than those without prior perianal surgery. We think that this finding is important in that it indicates the importance of detailed and appropriate evaluation of patients with CRC.

Cecal Diverticulitis: A Diagnosis to Keep in Mind When Evaluating Acute Appendicitis

Cecal diverticulitis is a rare cause of right lower-quadrant abdominal pain. As its symptoms mimic those of acute appendicitis, the final diagnosis in the patients is generally confirmed after surgery. Herein, we report a 45-year man who was admitted to the department of emergency with lower right abdominal pain. Cecal diverticulitis was diagnosed on computed tomography (CT) images, and a conservative treatment approach was recommended. He was hospitalised, and intravenous antibiotics and hydration were administered immediately. Oral feeding was interrupted. After five days of intensive medical care, the patient was discharged without any further complications. Based on my experience, I advise that CT can be used to differentiate cecal diverticulitis from the acute appendicitis. In uncomplicated cases, conservative approaches are advised. Key Words: Cecal diverticulitis, Computed tomography, Acute appendicitis, Conservative treatment.

Insidious Onset of Localised Small Intestinal Perforation by Ingested Plastic Fork

Ingestion of a foreign body is generally observed in the psychiatric patients and children. Healthy adult individuals may also swallow a foreign body unintentionally. Here, we report a case of a patient who swallowed a plastic fork and treated with laparoscopic repair. A 46-year man was admitted to the emergency room with the abdominal pain. His physical evaluation and diagnostic imaging revealed free air in the abdomen. Further imaging with CT scan showed a foreign body in the proximal ileum. On taking details of his swallowing history, he remembered swallowing a broken part of a plastic fork unwittingly during dinner. Following the removal of the foreign body, the perforation area was primarily repaired in double layers. The postoperative course was uneventful. An accurate diagnosis of the small intestinal perforation caused by the ingested foreign bodies, particularly in cases where the patient is unaware of the ingestion, can be difficult. CT scan is a useful tool when available to establish the diagnosis before the surgical intervention. Key Words: Small intestine, Perforation, Foreign body, Laparoscopic surgery.

Minimally Invasive Parathyroidectomy: Are Auxiliary Methods Necessary?

OBJECTIVE

To determine the success rate of minimally invasive parathyroidectomies (MIPs) with preoperative scintigraphy and ultrasonography, and to assess whether these imaging modalities are sufficient.

STUDY DESIGN

 Observational study.

PLACE AND DURATION OF STUDY

  Department of General Surgery, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey between March 2017 and December 2019.

METHODOLOGY

Medical records of 61 patients, who underwent MIP to treat primary hyperparathyroidism, were examined. Age, gender, and pre- and postoperative calcium, parathormone, and phosphorus levels were obtained from patient records. For all patients, the parathyroid (PT) glands were localised, using ultrasonography and Tc-99m methoxyisobutylisonitrile (MIBI) scintigraphy.

RESULTS

 The average patient age was 56.89 ± 13.47 years. Of the patients, 83.6% (n = 51) were females. Localisation of the PT glands with preoperative scintigraphy had an accuracy rate of 100%. However, ultrasonographic localisation was unsuccessful in five patients. Adenomas were noted in 44 patients (72.1%), hyperplasia in 15 patients (24.6%), and neoplasia in two patients (3.3%). Serum parathormone and calcium levels were measured 24 hours after surgery, and were found to be significantly reduced compared to the corresponding preoperative levels (p <0.001). Hypocalcaemia developed in four patients (6.6%), two (3.3%) of which were symptomatic. After three months, persistent hyperparathyroidism developed in five patients (8.2%).

CONCLUSION

Parathyroid scintigraphy has been demonstrated to be the gold standard for the preoperative localisation of PT glands. In the absence of scintigraphy, ultrasound guidance is the next useful technique for PT gland localisation. Key Words: Minimal invasive parathyroidectomy, Parathyroid scintigraphy, Ultrasonography, Parathormone.

Factors effecting cecal intubation time during colonoscopy

AIM

The aim of this study is to evaluate the factors that has an effect on Cecal Intubation time (CIT), and to define the relationship between quality of bowel preparation and body mass index (BMI).

PATIENTS METHODS

The Boston Bowel Preparation Scale (BBPS) was used for the evaluation of bowel cleansing. A total of 346 patients were included. The time from anus to caecum was recorded as the time of the cecal intubation time. Patients were defined under 3 subgroup BMI-1; ≤ 24.9, BMI-2; 25-29.9, BMI-3; ≥30.

RESULTS

The mean BMI of women was 29.30 4.25 and men were 26.19 6.14 (p<0,001). Mean Cecal Intubation time was 9.11 6.00 and 10.21 3.45 minutes for women and men (p=0.012). Women with High BMI (≥30) have shorter Cecal Intubation time compared to women with BMI less than 30 (p=0001). When BBPS evaluated, there was a significant difference in BMI-3 due to high scores compared to both BMI-1 and BMI-2 (p<0.001). In BMI-3 group, also women had significantly higher scores in terms of BBPS(p=0.006). Also a negative correlation between BBPS and BMI with CIT has been found (r = - 0.371, p<0.001 / r = -0.191 p<0.001).

CONCLUSION

In our study, women gender and increased BMI has a positive impact on the quality of intestinal cleansing that is associated with shortened Cecal Intubation time.

KEY WORDS

Body Mass Index, Colonoscopy, Cecal intubation.