Appendicization of the colon after appendectomy

The blind colonic loop following end to side ileo- sigmoid anastomosis resembles a vermiform appendix in anatomy and function. This anatomical alteration is associated with delayed complications and is not advisable.

An unusual case of small bowel obstruction secondary to internal herniation of distal ileum through a rent between adhered inflamed vermiform appendix and appendices epiploicae

Intestinal obstruction secondary to an internal hernia is rare and that occurring through a rent between the adhered inflamed vermiform appendix and appendices epiploicae of the proximal caecum is so rare that this case was the first of its kind ever to be reported. Such a cause for obstruction should be suspected in a patient with a virgin abdomen with no history/clinical features of an obstructing external hernia or abdominal tumor. A 28 year old man presented to the ER with features of intestinal obstruction, in whom CECT abdomen revealed multiple dilated small bowel loops with breaking-of seen in the region of the terminal ileum. Surgical exploration revealed internal herniation of the distal ileum through a rent between the adhered inflamed vermiform appendix and the appendices epiploicae of the proximal caecum; reduction of which was sufficient to relieve the obstruction and demonstrate healthy reperfusion. Adhesiolysis, epiploicae appendectomy and appendectomy was done with no other points of obstruction along the small bowel. Due to its rarity, non-specific presentation pattern and limited usefulness of imaging for diagnosis, a high index of suspicion with prompt early surgical exploration is a must for a successful outcome in such cases intestinal obstruction; especially in a virgin abdomen.

Acquired Diverticulosis of the Vermiform Appendix: A Rare Case Report

Diverticulosis of the appendix, as a rare and incident disorder, mimics acute or chronic appendicitis and is characterized by herniation of the appendiceal mucosa through the muscular wall. Symptom and laboratory data of diverticular disease usually represent chronic inflammation. In this study, a 43-year-old female with a history of right lower quadrant pain and anorexia represented abdominal tenderness and rebound tenderness in the physical examination and normal laboratory tests. Abdominal sonography did not show any evidence of acute appendicitis. The removed appendix was 12 cm in length and had multiple diverticular protrusions along with it. The histologic examination showed diverticulosis without evidence of inflammation. The patient was discharged two days later in optimal clinical condition. Diverticulosis of the appendix often is confused with acute or chronic appendicitis based on similar presenting symptoms and imaging studies. Although surgery is the definitive treatment of both conditions, an appropriate diagnosis of diverticular disease before surgery is very important because of the association of appendiceal diverticular disease with neoplasm and other complications.

CURRENT GUIDELINES ON EVIDENCED-BASED DIAGNOSIS AND MANAGEMENT OF ACUTE APPENDICITIS

Introduction: Appendicitis is the inflammation of the vermiform appendix. Appendicitis can be considered the most commonly interpretive cause of acute and severe abdominal pain. Acute Appendicitis (AA) is mainly caused by luminal obstruction obstructed by numerous etiologies. This causes an increase in the rate of bacterial overgrowth and mucus production thereby causing necrosis, wall tension and potential perforation. Materials and Methods: The study is a Retrospective cohort and was conducted during the periods of 11 months. The study included 97 patients with appendicitis and divided them based on the protocol by which they receive diagnosis and management. Out of 97 patients, 49 patients were assigned to group 1 and the other 48 patients were assigned to group 2. Group 1 includes those patients who were treated symptomatically and diagnosis and management were given to them according to the wish of the consulting physician. For the determination of outcomes of treatments given to Group 1 and Group 2 patients, the study considered complications found in the patients. These complications are recorded for each of the groups. Also, the study recorded the complication in each of the treatment methods of Group 1 patients. This allowed the authors of this study to find out how outcomes vary when treatment is given differently from that of Alvarado Scoring criteria. Results: The complications that were found in the study participants are fever, generalized peritonitis, perforation, abscess, a mild respiratory infection. The study found that the complications among the patients in Group 1 and Group 2 separately. In Group 1, 8 patients had a fever, while 3 patients had a fever in Group 2. Group 1 patients had all the listed complications including perforation (n=7), abscess (n=4), mild respiratory infection (n=3) and peritonitis (n=2). In Group 2, only 4 patients showed complications including fever in 3 patients and perforation in 1 patient. Conclusion: The study has concluded that following Alvarado criteria in diagnosis and management of acute appendicitis results in the least possible complications. The study suggests the clinicians follow Alvarado criteria for proper management of acute appendicitis. Keywords: Acute appendicitis, Alvarado criteria, appenditis complications, appendicitis diagnosis, appendicitis treatment

Amyand's hernia complicated with appendicitis

Introduction: The finding of a vermiform appendix within the peritoneal sac of an indirect inguinal hernia occurs in approximately 1% of cases. However, the presence of appendicitis within an inguinal hernial sac is found only in 0.08% of the general population.Case report: We present the case of a 58-year-old male patient that was admitted with abdominal pain associated with a small non-reducible right groin mass.Discussion: To establish the correct diagnosis preoperatively, an abdominal and pelvic CT scan is mandatory.Conclusion: Acute appendicitis in an Amyand's hernia is a very rare entity that can be easily misdiagnosed preoperatively. CT is extremely useful in reaching the correct preoperative diagnosis.

1412 De Garengeot's Hernia Complicated by Perforated Appendicitis and Groin Abscess: Report of A Rare Surgical Emergency

Introduction De Garengeot's hernia is a rare subtype of femoral hernia which contains the vermiform appendix. Acute appendicitis in a femoral hernia is even more unusual, accounting for 0.08% - 0.13% of all cases of femoral hernias. Case presentation A 91-year-old woman was referred with a painful, cellulitic right groin mass. A computed tomography scan demonstrated a right-sided femoral hernia containing a loop of bowel and a collection in the right groin containing fluid and gas. The patient had early dementia but no other major medical co-morbidities. At surgery, she was found to have perforated appendicitis in a right femoral hernia. Most of the appendix and sac had fully disintegrated, forming a large abscess cavity beneath the skin in the right groin which extended down to the upper labia majora. The appendix tip was lying deep within the abscess cavity. A modified McEvedy approach was used to access the peritoneal cavity for the appendicectomy and sutured repair of the femoral neck. The groin abscess cavity was drained and managed with a negative pressure (VAC) dressing. Discussion De Garengeot's hernia is often difficult to diagnose pre-operatively and reporting of cross-sectional imaging may not always be reliable. Currently, there is no gold standard method for repairing these hernias. However, the modified McEvedy approach is well-described and is the preferred technique for emergent femoral hernia presentations. It provides sufficient access to manage both appendicitis and the femoral hernia. Adjuncts such as negative pressures dressings may be used to manage concomitant abscess cavities.

Inflamed Right Inguinal Appendix in a Sixty-four-year-old Man: A Case Report and Review of the Literature

The vermiform appendix has varied locations ranging from retrocaecal, pelvic, paracolic to pre-ileal and postileal. Inguinal appendix or Amyand’s hernia is an extremely rare occurrence with potentially fatal complications. Rarer still is the presence of an inflamed appendix in the inguinal canal in the elderly. Due to its rarity, the pathophysiology and risk factors of the condition are still unclear. Some theorize that it is secondary to a patent processus vaginalis or perhaps the presence of a fibrous band between the hernia sac and testes. Reported herein is a 64-year-old man who presented with a painful irreducible right inguinal swelling. An incarcerated inguinal hernia with the hernia sac harbouring an inflamed vermiform appendix was discovered at surgery. Appendectomy and a primary suture repair of the hernia were carried out. The postoperative period was uneventful. Surgical management of inflamed inguinal appendix carries a risk of septic complications. It is pertinent that every surgeon performing a hernia repair must be aware of this condition and the appropriate treatment modalities.

Acute Appendicitis With Appendiceal Intususseption

Intussusception of the appendix is the introduction of the appendix into the lumen of the cecum may be accompanied by the development of acute appendicitis, or proceed without it. The combination of intussusception and acute inflammation of the appendix makes the diagnosis of appendicitis difficult due to the absence of classic clinical symptoms. The article presents the case of successful treatment of a patient with an untypical clinical presentation of acute appendicitis that developed in an invaginated vermiform appendix.

Amyand Hernia in a Pediatric Patient With Acute Perforated Appendicitis Undergoing Laparoscopy: A Brief Report and Literature Review

An 8-year-old male presented for evaluation of symptoms consistent with appendicitis. Upon laparoscopy, the patient was found to have appendicitis with a concomitant Amyand hernia. The latter pathology highlights a rare presentation of inguinal hernias in which the vermiform appendix herniates into the inguinal canal. Inguinal hernias are frequently encountered in pediatric populations; however, Amyand hernias have seemingly negligible incidence in all age demographics. These comprise roughly 1% of all diagnosed abdominal hernias. When seen in concurrence with appendicitis, the incidence is 0.13%. Recent literature has sought to classify types of Amyand hernias and criteria described by Losanoff and Basson is an attempt to guide surgical management. Although our management did not coincide with the proposed management above, the patient made a full recovery. In conclusion, Amyand hernias remain a rare entity that can be indistinguishable from routine inguinal hernias on clinical examination and management of Amyand hernia with appendicitis is not well defined.