Risk of appendiceal neoplasm after interval appendectomy for complicated appendicitis: A systematic review and meta-analysis

BackgroundNon-operative management is often the treatment of choice in cases of complicated appendicitis and routine interval appendectomy is not usually recommended. Actually, recent studies show an alarming number of appendiceal neoplasms following interval appendectomy. The aim of this study is to evaluate the prevalence of appendiceal neoplasms and their histological types after interval appendectomy for complicated appendicitis in adults.MethodsA comprehensive literature search of the PubMed, Scopus and Web of Science databases was conducted according to the PRISMA statement. Studies reporting appendiceal neoplasm rates after interval appendectomy and histopathological characteristics were included. The most recent World Health Organization (WHO) classification of malignant tumours was considered. A pooled prevalence analysis for both prevalence and pathology was performed.ResultsA total of eight studies was included: seven retrospective series and one randomized controlled trial. The pooled prevalence of neoplasms after interval appendectomy was 11% (95% CI 7–15; I² = 37.5%, p = 0.13). Appendiceal mucinous neoplasms occurred in 43% (95% CI 19–68), adenocarcinoma in 29% (95% CI 6–51), appendiceal neuroendocrine neoplasm in 21% (95% CI 6–36), globet cell carcinoma in 13% (95% CI -2-28), adenoma or serrated lesions in 20% (95% CI -0-41) of cases.ConclusionThe risk of appendiceal neoplasm in patients treated with interval appendectomy for complicated appendicitis is 11%; mucinous neoplasm is the most common histopathological type. Further studies should investigate this association in order to clarify the biological pathway and clinical implications.     

Retained fecalith after laparoscopic appendectomy

An intraabdominal abscess developed from a retained fecalith following laparoscopic appendectomy. We discuss the prevention and management of retained fecaliths in light of the numerous reports of retained gallstones. Received: 24 January 1997/Accepted: 17 November 1997     

阑尾类癌的临床诊断及治疗

目的探讨阑尾类癌的临床特点及其诊疗方法。方法回顾性分析我院1995年~2007年收治的6例阑尾类癌病人的临床资料。结果术后恢复顺利5例,并发切口感染1例,均痊愈出院。随访3~12年5例,随访6月1例,均无复发和转移。结论阑尾类癌缺乏特异性的临床表现,术前难以作出明确诊断。手术彻底切除癌灶,预后良好。     

阑尾类癌并发低级别阑尾黏液性肿瘤1例

患者女,24岁,因“间断性右下腹疼痛1年”入院,查体:右下腹麦氏点压痛,无反跳痛、肌紧张.腹部超声:右下腹阑尾区见21 mm×11 mm局限性低回声区,阑尾显示不清,阑尾周围积液.血常规:白细胞计数12.80×109/L,中性粒细胞百分比77％.CT平扫:阑尾增粗、壁厚,周围脂肪间隙浑浊,可见条片状高密度影;盆腔内见液体密度影(图1A～1C).CT提示阑尾炎,伴周围渗出;盆腔积液.患者行腹腔镜阑尾切除术,术中见阑尾大小4 cm×3 cm,阑尾壁充血水肿,周围组织中度粘连,有脓汁及粪石嵌顿.病理:肿瘤位于阑尾黏膜层、黏膜下层及固有层内,血管及神经未见肿瘤浸润,核分裂象0～1个/10个高倍视野,阑尾断端未见肿瘤残留(图1D).免疫组化:CgA(+),Syn(+),CD56(+),CK-pan(+),Ki-67(1％+).病理诊断:阑尾低级别神经内分泌瘤G1(类癌),并发低级别阑尾黏液性肿瘤(low-grade appendiceal mucinous neoplasm,LAMN),合并化脓性炎症.     

Adult Intussusception of Appendicular Mucinous Cystoadenoma

Intussusception is a rare cause of adult intestinal obstruction. Clinical manifestations are not specific, which makes a preoperative diagnosis difficult to establish and often causes delay. We report a case of acute intestinal obstruction due to ileocolic intussusception. An emergency laparoscopy was performed revealing an obstructive mass at the ileocecal region resulting from an appendicular tumor. A right hemicolectomy was conducted. The pathologic examination of the resected sample concluded the mass comprised an appendicular mucinous cystoadenoma. We discuss the clinical features, preoperative diagnosis, and surgical strategies of adult intussusception, as well as the uncommon finding of an appendicular mucinous tumor as its causative lesion, with a review of the available literature.     

Case of idiopathic and complete appendiceal intussusception

Appendiceal intussusception is a rare disease in which the appendix invaginates into the cecum. It is often caused by organic diseases. The present case involved an appendiceal intussusception without an organic disease, and laparoscopic resection of part of the cecum was performed. Appendiceal intussusception has various causes, including malignant diseases. Therefore, diagnosis and selection of operative method are complex and could potentially lead to an excessively invasive option. By performing SILS with a multiuse single‐site port, we were able to provide an appropriate, non‐invasive treatment that had a good esthetic outcome.     

Mucocele of Appendiceal Stump – an Atypical Presentation and a Diagnostic Dilemma

Background: Appendiceal mucocele is a well-recognised entity that can present in a variety of clinical syndromes or can occur as an incidental surgical finding. The term mucocele is inherently imprecise and inclusive of both benign and malignant lesions. Mucocele of the appendiceal stump is a rare entity.

Aim: We present a case of an appendiceal stump mucocele caused by a mucinous cystadenoma clinically presented as a giant retroperitoneal mass. Diagnosis was made postoperatively, after pathological study of the surgical sample.

Case report: The case of a 54-year-old woman, with a previous appendectomy, suffering from a painful mass in the right lower quadrant of the abdomen, is reported. Imaging showed a large cystic structure at the base of the caecum. Surgery revealed a 13 x 5.5 cm retroperitoneal cystic mass, which was excised together with the appendiceal remnant. Pathological diagnosis was that of a mucocele arising from the appendiceal stump due to the development of a benign mucinous cystadenoma. The patient was discharged on the fourth post-operative day after an uneventful recovery.

Conclusion: Mucocele of the appendiceal stump is a rare entity. In spite of extensive pre-operative investigations, preoperative diagnosis may still remain elusive and may only be made at the time of surgery.     

Long term survival and perioperative propensity score matched outcomes of diaphragmatic resections compared to stripping in cytoreductive surgery + intra-peritoneal chemotherapy

ObjectivesTo assess the impact of short and long term outcomes of diaphragm resection and repair in cyto-reductive surgery (CRS) and intra-peritoneal chemotherapy (IPC).Methods1230 consecutive CRS/IPC procedures were performed between 1996 and 2018 in Sydney, Australia. Among these, 652 underwent diaphragmatic intervention. The analysis was preformed according to histological subtype. First diaphragm interventions were compared to non-diaphragmatic CRS. Secondly, diaphragm resection was compared to diaphragm stripping. Overall survival and recurrence free survival was assessed based on histological diagnosis.ResultsThere were no differences between the resection and stripping groups for the colorectal cohort. For mesothelioma, increased incidences of pleural effusions in the resection group were noted (63% vs.28%, p = 0.017). In HAMNs, the resection group was associated with increased reoperations (42% vs. 15%, p = 0.03) and in hospital death (16.7% vs. 0.6%, p = 0.012). Resection in LAMNs were linked with increased transfusion requirements (9 vs. 6, p = 0.01), reoperation (39% vs. 23%, p = 0.05) and prolonged length of stay (34 days vs. 25 days, p = 0.02).There were no differences in overall survival and recurrence free survival in colorectal cancer. Median overall survival was decreased in mesothelioma by 20 months. In LAMNs the median survival was significantly decreased for the resection group. Similarly, the resection group had a 4-month earlier recurrence.ConclusionWe conclude that diaphragm interventions are an essential part of CRS. They are associated with increased perioperative morbidity. This morbidity is not attributable to whether the patient underwent diaphragm stripping or resection. However in mesothelioma and LAMNs, requiring diaphragm resection is likely to be an indicator for tumor aggression.