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PubMedDate not supplied

Growing of caecum and vermiform appendix during the fetal period.

OBJECTIVE: The aim of this study is to investigate the growing of the caecum and the vermiform appendix during the fetal period in human fetuses and the relation between growing and shape of the caecum and the localization of the vermiform appendix. METHODS: 40 male and 40 female externally normal-looking fetuses were studied between 10 and 40 weeks of gestation and were subdivided into fetuses of the 1st, 2nd, and 3rd trimesters and full-term fetuses. The parameters of interest included covering of the caecum with peritoneum, shape of the caecum (long tube, symmetric saccule, asymmetric saccule, extremely large right side--atypical), axial length and width of the caecum localization of the vermiform appendix, length of vermiform appendix and length of the meso-appendix. RESULTS: There was a difference in covering of the caecum with peritoneum between males and females; the caecum was predominantly tube shaped during the fetal period, with the asymmetric saccule towards the end of the fetal period; the localization of the vermiform appendix was subcaecal (39%) during the fetal period and postileal (34%) in female fetuses and subcaecal (48%) in male fetuses--the localization of the vermiform appendix changed according to the caecum shape during the fetal period; we found significant differences in the measurements of vermiform appendix, meso-appendix, and caecum among 1st-, 2nd-, and 3rd-trimester fetuses and full-term fetuses. CONCLUSIONS: There was an increase in the measurements for vermiform appendix, meso-appendix, and caecum with increasing gestational age; the localization of the vermiform appendix depended on the shape of the caecum, was different from that of adults and different between sexes, and there was also a significant difference in covering of the caecum with peritoneum between both sexes.

Appendix↗
PubMed2001

Simultaneous Malone antegrade continent enema and Mitrofanoff principle using the divided appendix: report of a new technique for prevention of stoma complications.

PURPOSE: We determine the results and complications of continent urinary diversion and simultaneous Malone antegrade continent enema (MACE) and the Mitrofanoff principle using the divided appendix, and report on the VQQ and VQ technique for prevention of complications at the stoma level. MATERIALS AND METHODS: Between June 1995 and June 1999, 40 patients 4 to 22 years old (mean age 9.5) underwent Mitrofanoff procedures in conjunction with the MACE and augmentation cystoplasty as primary (5) or salvage (35) therapy. Of the patients 35 had neuropathic bladder, and 5 had bladder and bowel dysfunction without detectable neurological abnormalities. All patients had an antireflux Mitrofanoff channel constructed using distal part of the appendix with its divided mesothelium. The proximal half of the appendix was preserved as a modified MACE. Average length of appendix was 10.3 cm. (range 9 to 15) and no correlation was found between the length of appendix and age of child. The stoma construction was performed as 2 different techniques. The 2 appendix stomas were initially anastomosed with 2 separate triangular posterior V shape skin flaps on the right lower abdominal wall. Both appendix mucosae were completely buried with a single or double quadrilateral skin flap (VQQ and VQ technique). RESULTS: All patients are continent day and night without diapers. Mean followup was 22 months (range 8 to 48) and the overall incidence of complications was 7.5%. Mitrofanoff stomal stenosis due to catheter false passage occurred postoperatively in 1 case, gas leakage from the MACE in 1 and partial mucosal prolapse in 1. CONCLUSIONS: The MACE and Mitrofanoff principle have proved invaluable for the treatment of children with urinary and fecal incontinence. The divided appendix with 2 separate mesotheliums is an ideal channel for simultaneous Mitrofanoff and MACE when the appendix length is 9 cm. or more with a suitable branching mesothelium. When the appendix is short we prefer to use it as the Mitrofanoff and create a pediculed tube flap from the cecum for the MACE. All patients with a short appendix or history of appendectomy operated on by different techniques, such as the Monti procedure, Casale technique, cecal flap or ureteral Mitrofanoff, were excluded from our study. Most of the minor complications are preventable by meticulous technique. The VQQ and VQ stomas have the lowest incidence of complications and produce the most satisfactory cosmetic appearance.

Adolescent↗
PubMed2002

Improved sonographic visualization of the appendix with a saline enema in children with suspected appendicitis.

OBJECTIVE: To determine whether abdominal sonography after a saline enema can identify the appendix that is not visualized at graded compression sonography in children with suspected appendicitis. METHODS: High-frequency compression sonography was prospectively performed in 120 consecutive children with suspected appendicitis; the appendix was not identified in 27 of these patients. Among the 27 patients with a nonvisualized appendix, abdominal sonography after a saline enema was performed in 12 to identify the appendix. RESULTS: Abdominal sonography after the saline enema revealed the appendix in all 12 children in whom the appendix was not visualized at graded compression sonography. A normal appendix was found in 11 children, and acute appendicitis confined to the appendiceal tip was found in 1. The appendix was located in the pelvis (n = 5), posterior to the cecum (n = 4), posterior to the ileum (n = 2), and anterior to the ileum (n = 1). The appendix could be identified by using a window of the saline-filled sigmoid colon (n = 5), saline-filled cecum (n = 4), and saline-filled terminal ileum (n = 2). CONCLUSIONS: Abdominal sonography after a saline enema is a helpful technique for depiction of the appendix that is not visible at graded compression sonography in children with suspected appendicitis. Key words: appendix, sonography; appendicitis; children, gastrointestinal tract.

Acute Disease↗
PubMed2004

Miscellaneous conditions of the appendix.

A variety of miscellaneous conditions affect the appendix, both as incidental findings and as causes of clinical signs and symptoms that often mimic appendicitis. Congenital abnormalities of the appendix are rare; the two most commonly reported are congenital absence and appendiceal duplication. Diverticular disease may be an incidental finding, but when inflamed, can be clinically confused with appendicitis. Endometriosis of the appendix, which usually occurs in the setting of generalized gastrointestinal endometriosis, often presents as acute appendicitis, but may present as intussusception, lower intestinal bleeding, and, particularly during pregnancy, perforation. Peritoneal endosalpingiosis often involves the appendiceal serosa and occasionally the wall but has no clinical manifestations in contrast to endometriosis. Vasculitis may be either isolated to the appendix or part of a systemic vasculitis, most often polyarteritis nodosa. Neural proliferations of the appendix include lesions associated with von Recklinghausen's disease, as well as mucosal and axial neuromas that are theorized to progress to fibrous obliteration of the appendix. Mesenchymal tumors of the appendix are most often of smooth muscle type, usually leiomyoma but rarely leiomyosarcoma; nonmyogenic neoplasms such as gastrointestinal stromal tumor, granular cell tumor, Kaposi's sarcoma, and miscellaneous other curiosities occur rarely. Lymphoma affects the appendix exceptionally; in children, Burkitt lymphoma is most common whereas in adults, large cell lymphomas and low grade B-cell lymphomas predominate. Secondary involvement of the appendix by leukemia has been reported. Secondary involvement of the appendix by carcinomas of the female genital tract, particularly ovary, and diverse other sites are in aggregate common but only rarely a clinical or pathological difficulty. Occasionally, however, appendiceal neoplasia that is secondary from another site may dominate the clinical picture and lead to potential pathologic misdiagnosis as primary appendiceal disease.

Appendiceal Neoplasms↗
PubMed1994

[Heterochronic occurrence of bilateral torsion of appendix testis a case report].

An 8-year-old boy who had undergone excision of the left appendix testis for torsion of the left appendix testis about one and a half years previously was brought to our department on February 18, 1991 because of right scrotal pain of 4 days' duration. Palpation revealed induration with tenderness of the superior portion of the right testicle. A scrotal ultrasonographic tomogram revealed a shadow probably representing an enlarged appendix testis. The patient was diagnosed as having torsion of the right appendix testis. There was refractory pain, and there was possibility of reactive epididymitis. So the patient underwent excision of the right appendix testis, two right appendices testis, which had enlarged to 5 mm in diameter were found, histopathological examination revealed slight bleeding and marked edema of the stroma, which may have been caused by torsion of the appendix testis. Scrotal pain subsided postoperatively. Bilateral torsion of the appendix testis is very uncommon, and our case is the 14th case reported. Torsion of the appendix testis occasionally develops. Torsion of the appendix testis occasionally develops bilaterally. When a small, tender mass at the superior pole of testis, torsion of the appendix testis should be considered.

Child↗