SEARCH · PubMed Health

Results for “APPENDIX”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources

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↗

PubMed2005

CT appearance of the normal appendix in adults.

The aims of this study were to identify (1) the normal range of the appendix on computed tomography (CT), (2) the correlation of patient age and sex with the visibility and appearance of the appendix on CT, and (3) the normal variations in wall thickness, intraluminal content, and location of the appendix. Three hundred seventy-two outpatients underwent abdominopelvic CT. The scans were reviewed on the picture archiving and communication system and appendiceal outer-to-outer wall diameter, wall thickness, location, content and its correlation with appendix diameter were analyzed. The appendix was visualized in 305/372 patients. Its location relative to the cecum was highly variable. The diameter range was 3-10 mm; in 42% of cases the diameter was greater than 6 mm. When the intraluminal content (185/305) was visualized, the diameter was slightly superior to the mean (p=0.0156). In 329 CT scans in which oral contrast material was given, the appendix was filled by contrast material in 74/329 patients. The appendix wall thickness was measurable in 22/305 patients (average 0.15 cm). There is significant overlap between the normal and abnormal CT appearance of the appendix. Consequently the diagnosis of acute appendicitis should be based not only on the appearance of the appendix but also on the presence of secondary signs.

Administration, Oral↗

PubMed1992

The frequency of histopathological abnormalities in incidental appendectomy in urological patients: the implications for incorporation of the appendix in urinary tract reconstruction.

In 1980 Mitrofanoff described the use of the isolated appendix as an intermittent catheterization route to empty a continent urinary reservoir. The procedure was popularized and numerous variations on the same principle were reported. Presence of histopathological abnormalities in the appendix may limit its suitability for reconstructive purposes. We studied the frequency of incidental histopathological abnormalities in appendixes removed electively in 122 urological patients during a radical pelvic operation. The implications for incorporation of the appendix in urinary tract reconstruction are evaluated. A total of 38 patients (31.1%) had notable histological abnormalities of the appendix: 35 had fibrous obliteration of the lumen, 2 had carcinoid tumor and 1 had a mucocele of the appendix. The rate of abnormal appendixes was significantly higher in elderly patients (more than 70 years old). Incidental pathology of the appendix is a frequent finding that may affect the immediate results and the late outcome of urinary tract reconstruction using the appendix. When such strategy of urinary tract reconstruction is considered, potential histopathological abnormalities should be anticipated. The patients should be informed and aware of possible unexpected changes in the preplanned procedure, while the surgeon must be familiar with these alternative reconstructive methods.

Adult↗

PubMed2000

Phenotypic pattern of B cells in the appendix: reduced intensity of CD19 expression.

UNLABELLED: The lymphoid tissue of the appendix is considered as part of the gut-associated lymphoid tissue (GALT). In order to understand better the immunological significance of the appendix we analyzed the cellular composition of normal and inflamed human appendix tissue by flow cytometer with special attention to expression of the CD19 and CD5 markers on B cells. Cellular analysis was also performed on peripheral and appendical vein blood samples as well as on omentum and peritoneal fluid samples. The study population included seventeen patients aged 2-15 yr. (mean age - 11.5 yr.) undergoing appendectomy. Ten children were diagnosed with acute appendicitis while 7 had a normal appendix. RESULTS: Compared to the peripheral blood, the appendix contained a significantly higher percentage of CD19 cells (47.6% of total lymphocytes versus 15%, p<0.0001), and B1 cells (4.98% of total lymphocytes versus 2.42%, p=0.001). In addition, the intensity of CD19-staining was markedly decreased in the appendix (mean - 395.7), and also in the omentum (mean - 398.2) as compared to peripheral lymphocytes (mean - 497.7, p<0.0001 for both comparison). Comparison between the inflamed and the non-inflamed appendices revealed that the inflamed appendix contained a significantly higher proportion of B1 cells (5.64% of total lymphocytes versus 3.53%, p=0.032), and also a higher B1/b cell ratio (0.13 vs. 0.07, p=0.01). CONCLUSIONS: These results indicate that the appendix tissue contains higher number of B1 (and B) cells compared to the peripheral blood and that these cells play a role in the primary immune response to acute infection/inflammation in the appendix. Appendiceal B cell population is unique in term of CD19 intensity expression on their surface.

Adolescent↗

PubMed2005

Appendix is a priming site in the development of ulcerative colitis.

AIM: The role of the appendix has been highlighted in the pathogenesis of ulcerative colitis (UC). The aims of this study were to elucidate the immuno-imbalances in the appendix of UC patients, and to clarify the role of the appendix in the development of UC. METHODS: Colonoscopic biopsy specimens of the appendix, transverse colon, and rectum were obtained from 86 patients with UC: active pancolitis (A-Pan; n = 15), active left-sided colitis (A-Lt; n = 25), A-Lt with appendiceal involvement (A-Lt/Ap; n = 10), inactive pancolitis (I-Pan; n = 14), and inactive left-sided colitis (I-Lt; n = 22), and from controls. In the isolated mucosal T cells, the CD4/CD8 ratio and proportion of activated CD4+ T cells were investigated, and compared with controls. RESULTS: In the appendix, the CD4/CD8 ratio significantly increased in A-Lt and A-Lt/Ap. The ratio in the appendix also tended to increase in A-Pan. In the rectum, the ratio significantly increased in all UC groups. In the appendix, the proportion of CD4+CD69+ (early activation antigen) T cells significantly increased in all UC groups. In the rectum, the proportion of CD4+CD69+ T cells significantly increased only in A-Pan. The proportion of CD4+HLA-DR+ (mature activation antigen) T cells significantly increased only in the rectum of A-Pan, but not in the other areas of any groups. CONCLUSION: The increased CD4/CD8 ratio and predominant infiltration of CD4+CD69+ T cells in the appendix suggest that the appendix is a priming site in the development of UC.

Adult↗

PubMed2000

Diverticulosis of the appendix with diverticulitis: case report.

Diverticulum of the appendix is rarely encountered. A case of appendiceal diverticulosis is described. A 46-year-old male patient was sent to our hospital with presentation of acute appendicitis-like symptoms. The appendix was removed by laparoscopic appendectomy, and it showed erythematous change with local peritoneal reaction and omental shift at the tip. Pathological examination revealed three diverticula in the appendix. One of them was inflamed but the appendix itself was not. All three diverticula were pseudodiverticula, lacking muscularis propria. The appendix in this case showed only focal inflammatory change, which differs from what occurs in acute appendicitis, where diffuse inflammation of the appendix is usually noted. In cases of an appendix with only focal erythematous change, minor lesions such as diverticulitis may be revealed by pathological examination, and an appendectomy is still warranted. Diverticulitis of the appendix cannot be differentiated from acute appendicitis preoperatively. Image studies including abdominal computed tomography scan, ultrasonography, and plain film cannot improve the diagnosis. To our knowledge, diverticulosis of the appendix has never been reported in Taiwan.

Appendicitis↗

PubMed2005

Significance of increased proliferation of immature plasma cells in the appendix of patients with ulcerative colitis.

The etiology of ulcerative colitis (UC) is not known. Recent studies support a primary role of the appendix in the pathogenesis of UC, however phenotypical studies of proliferating cells in the appendix have not been reported. We report phenotypical studies of lymphocytes and of proliferating subpopulations in the appendix of patients with inflammatory bowel disease and of controls. Surgical samples of the appendix were obtained from 5 patients with colon cancer, 5 with acute appendicitis, 12 with UC and 7 with Crohn's disease (CD). Frozen sections were cut from fixed samples, and immunostained with lymphocyte markers and anti-Ki-67 antibodies. The number of Ki-67(+) proliferating cells, CD19, and CD138 cells was significantly higher in the appendix of patients with UC than in controls, patients with acute appendicitis, and patients with CD. Immunohistological double staining revealed significant proliferation of CD3, CD19, and CD138 cells in the appendix of patients with UC. The proportions of Ki-67(+) cells in CD3, CD19, and CD138 cells were significantly higher in both total UC patients and patients in remission-stage UC, than in controls, patients with acute appendicitis, and patients with CD. Lamina propria cells in the appendix of patients with UC showed augmented proliferation with increased numbers of CD19 and CD138 cells. The number of CD3 cells was not significantly increased, but the proportion of proliferating CD3 cells was increased. An increased proportion of Ki-67(+) cells in CD19 and CD138 cells represents proliferation of immature plasma cells in the appendix of patients with UC, and proliferation of such immature plasma cells was seen in both active- and remission-stage UC. Proliferation of immature plasma cells in the appendix of patients with UC suggests a primary role of humoral immune responses in the pathogenesis of UC.

Adolescent↗

PubMed2005

Operator-dependent techniques for graded compression sonography to detect the appendix and diagnose acute appendicitis.

OBJECTIVE: The objective of our prospective study was to evaluate the value of various operator-dependent techniques that allow graded compression sonography to detect normal or abnormal vermiform appendix. SUBJECTS AND METHODS: A total of 877 subjects were included in this study. This sample population consisted of two groups: 202 control subjects and 675 patients who were suspected of having acute appendicitis. If detection of the appendix failed after a sufficient number of trials using graded compression scanning, appropriate operator-dependent techniques were used to help graded compression scanning to increase the detectability of the appendix further. The detection rate for the appendix in both groups and the diagnostic accuracy for acute appendicitis were obtained. RESULTS: The initial graded compression sonography examination depicted the appendix in 170 (84%) of 202 subjects in the control group and 601 (89%) of the 675 patients in the patient group. We then added operator-dependent techniques to graded compression sonography for the remaining patients in whom the appendix could not be detected. The additional use of the posterior manual compression technique, low-frequency convex transducer, upward graded compression technique, or left oblique lateral decubitus change of body position allowed graded compression sonography to depict the appendix in an additional 10, eight, six, and four patients in the control group, respectively, and in an additional 27, 23, 11, and seven patients in the patient group. The number of identified appendixes was increased to 198 (98%) of the 202 patients in the control group and to 669 (99%) of the 675 patients in the patient group. Graded compression sonography with operator-dependent techniques in the patient group yielded a sensitivity of 99% (319/321 patients), specificity of 99% (350/354), and an accuracy of 99% (669/675) for acute appendicitis. CONCLUSION: The addition of various operator-dependent techniques to graded compression sonography is useful for allowing improved visualization of both normal and abnormal appendixes.

Acute Disease↗

PubMed1983

[Torsion of appendix of testis and epididymis: a report of 4 cases].

We report our clinical and pathological observations on four patients with torsion of appendix testis or epididymis, and reviewed 72 cases of torsion of the appendages of intrascrotal organs collected from the Japanese literature; 35 cases of torsion of appendix testis, 36 cases of torsion of appendix epididymis and 1 case of torsion of paradidymis . Case 1 was a 10-year-old boy visiting us because of pain and swelling in his right scrotum continuing for the past ten days. His right scrotum was found to contain a hen-egg sized tender mass. The testis and epididymis could not be differentiated by palpation. The blood count disclosed 10,000 white blood cells. At operation, two appendix epididymis were found in his right scrotum. One of them was twisted 360 degrees clockwise and 10 x 8 x 5 mm in size. Case 2 was a 11-year-old boy with complaint of pain in his left lower abdomen and left scrotum for the past three days. Palpation of his left scrotal contents revealed a slightly hard testis and tender epididymis. At operation, we found his left spermatic cord to be twisted 90 degrees counterclockwise and appendix epididymis 180 degrees counterclockwise. The twisted appendix epididymis was 10 x 8 x 7 mm in size. Case 3 was a 13-year-old boy whose complaint was left scrotal pain. The upper pole of his left testis was found to be swollen and tender by palpation. The exposure of his left scrotum at operation revealed that his left epididymis was abnormally attached to his left testis and had two appendices. One of these appendix epididymis was twisted 180 degrees clockwise and measured 10 x 10 x 8 mm. Case 4 was a 19-year-old male who suffered from right testicular pain for the past seven days. He had a history of three intermittent episodes of similar right testicular pain during the past two years. His right testis was enlarged and palpated slightly hard and tender. We explored his right scrotum surgically and found the appendix testis twisted and enlarged to little-finger's head size. However, it was impossible to determine whether the rotation was clockwise or counterclockwise because the twisted appendix was too severely damaged. The preoperative diagnosis was correct in one case and three were erroneously diagnosed as having torsion of spermatic cord. All four cases were treated by surgery which relieved all patients of discomfort.

Adolescent↗

PubMed1995

Mucinous cystadenoma of appendix concomitant with perityphlic granuloma.

We describe a case of mucinous cystadenoma of the appendix with perityphlic granuloma. The patient developed a hard palpable mass in the right lower quadrant and barium enema induced irregular bowel wall at the cecum. Based on a preoperative diagnosis of carcinoma of the appendix, we performed a laparotomy. On operation, we found a tumor mass in the region of the appendix; the mass adhered strongly to the retroperitoneum and cecum. Right hemicolectomy was carried out on a diagnosis of carcinoma of the appendix. Microscopic examination revealed mucinous cystadenoma of the appendix with perityphlic granuloma. Mucinous cystadenoma in the appendix is a rare tumor. In this patient, the tumor was accompanied by granuloma formation in adjacent tissues because of mucin expelled from the appendix. This case emphasizes that granuloma formation can make of difficult to differentiate mucinous cystadenoma in the appendix from cancer.

Appendiceal Neoplasms↗

PubMed2004

Developing neonatal rabbit appendix, a primary lymphoid organ, is seeded by immature blood-borne B cells: evidence for roles for CD62L/PNAd, CCR7/CCL21, alpha4beta1 and LFA-1.

Young rabbit appendix is a homologue of chicken bursa of Fabricius; both are crucial sites for preimmune B-cell repertoire development. We describe here some of the molecules involved in the multi-step recruitment of blood-borne B cells into neonatal rabbit developing appendix. Sialyl-Lewis-x, CD62L and integrins such as LFA-1 and alpha4beta1 were detected on B cells in peripheral blood. Peripheral lymph node addressin (PNAd), a CD62L counter-receptor was observed on appendix HEV. We also detected chemokine receptor CCR7 on peripheral blood B cells and one of the CCR7 ligands, CCL21, on appendix HEV but not in appendix follicles. Higher levels of CXCR5 expression compared to CCR7 on appendix B cells suggest that CXCR5 may be involved in recruitment of B cells into follicles. The proportions of appendix B cells expressing CD62L, sialyl-Lewis-x and alpha4beta1 declined between day 3 and 4 weeks after birth while percentages of Lewis-x+ appendix B cells increased. These changes correlate with the stage of repertoire diversification by gene conversion in both rabbits and chickens. The cross-reactivity of antibodies to mouse or human adhesion molecules described in this study indicates that some of the structures of these important molecules are conserved across species.

Animals↗

PubMed1996

Is a histologically normal appendix following emergency appendicectomy alway normal?

BACKGROUND: Appendixes removed from patients with suspected appendicitis often appear normal on histological examination. We examined appendix specimens for expression of abnormal amounts of cytokines, an indicator of an inflammatory response. METHODS: Tumour necrosis factor alpha (TNFalpha) and interleukin-2 (IL-2) expression was measured by in-situ hybridisation in ten specimens from patients with acute appendicitis, 12 normal appendix specimens removed from patients undergoing elective abdominal surgery, and 31 appendix specimens from patients with a clinical diagnosis of appendicitis but an appendix histologically classified as normal. Cytokine-specific RNA antisense probes were prepared by in-vitro transcription and digoxigenin (DIG) labelled. In-situ hybridisation was done on 5 micrometer paraffin sections. Tissue sections hybridised by sense probes acted as negative control for each cytokine. Following hybridisation, the probes were detected by alkaline phosphatase labelled anti-DIG monoclonal antibody and visualised by nitroblue tetrazolium staining. FINDINGS: All histologically proven acute appendicitis specimens demonstrated intense cellular TNFalpha mRNA expression in germinal centres and moderate levels of expression throughout the mucosa. IL-2 mRNA was strongly expressed in the lamina propria and only moderately expressed in germinal centres. Normal appendixes all showed almost complete absence of TNFalpha and IL-2 mRNA expression. Seven of the 31 histologically classified normal appendix specimens from patients with a clinical diagnosis of appendicitis demonstrated TNFalpha and IL-2 mRNA expression similar to acute appendicitis specimens in germinal centres, submucosa, and lamina propria layers. INTERPRETATION: TNFalpha and IL-2 mRNA expression is a sensitive marker of inflammation in appendicitis. A substantial proportion of histologically normal appendixes showed clear evidence of an inflammatory response in the form of increased cytokine expression.

Appendectomy↗

PubMed2005

US features of the normal appendix and surrounding area in children.

PURPOSE: To evaluate prospectively the frequency of depiction with ultrasonography (US) of the appendix in children without clinical suspicion of acute appendicitis and to evaluate the US appearance of the normal appendix. MATERIALS AND METHODS: Between March 2003 and July 2003, 146 consecutive patients (62 boys and 84 girls; mean age, 7 years; age range, 2-15 years) without clinical suspicion of acute appendicitis were examined with US. Patients with cystic fibrosis and those with acute abdominal pain were excluded from the study. Outer diameters, mural thickness, and color Doppler flow were measured. Appendiceal lumen and surroundings of the appendix were determined. The overall diameter and mural thickness of the appendix were examined for relationship to age, weight, or height of the patient. For statistical analysis, the Mann-Whitney test, Student t test, and linear regression analysis were applied. RESULTS: In 120 (82%) children, the appendix was depicted with US; in 26 (18%) children, this was not possible. In 114 (95%) of the depicted appendices, the position was classical; we observed six (5%) retrocecal appendices. All appendices were compressible. Mean diameter of the appendix was 0.39 cm (range, 0.21-0.64 cm), and the mean mural thickness was 0.18 cm (range, 0.11-0.27 cm). The appendiceal lumen was empty in 74 (62%) children. The others were filled with fecal material, gas, or both. In 75 (51%) of the 146 children, lymph nodes were present in the right lower quadrant of the abdomen. We found no relation between the age, weight, or height of the examined child and the overall diameter or wall of the appendix. CONCLUSION: The results of this study show that a normal appendix can be depicted with US in 82% of asymptomatic children.

Adolescent↗

PubMed1999

Anomalies of the vermiform appendix and prevalence of acute appendicitis in Khartoum.

OBJECTIVE: To investigate certain anatomical features of the vermiform appendix and the prevalence of acute appendicitis among Sudanese citizens in Khartoum province. DESIGN: A prospective descriptive study of consecutive patients operated by a particular doctor. SETTING: Omdurman and Khartoum Teaching Hospitals from November 1995 to February 1996. INTERVENTION: Appendicectomy and recording particular characteristics of the appendix. MAIN OUTCOME MEASURES: (i) appendix position, (ii) variations of mesopharynx and (iii) length of appendix. RESULTS: Acute appendicitis was found to be more common in males than in females and among adults than children. The average length was 8.9 cm in males and 9.4 cms in females. The appendix was commonly found to be retrocaecal (58.3%) on pelvic (21.7%) or paracaecal (11.7%). Anomalies of the appendix were more common in children than adults and occurred in 47% of cases. CONCLUSION: Average length of the vermiform appendix was longer in females than in males. Ectopic positions such as left-sided appendix were not detected in this study.

Acute Disease↗

PubMedDate not supplied

[Ultrasonography of normal vermiform appendix].

The aim of this study was the detection and visualisation of the normal vermiform appendix and its characteristics by ultrasonography in adults with no clinical suggestion of acute or chronic abdominal disease. A prospective study was performed in 200 subjects. The graded-compression ultrasonography technique was used to explore the lower right quadrant of the abdomen and the pelvis. The examination was performed using a 4 MHz sector array and 7.5 MHz linear array transducer. In a few cases, a 10 MHz linear array transducer was used. The appendix was visualized in 54% of patients. In all cases where the appendix was visualized it was found to be either on the ileo-psoas muscle or directly beneath the abdominal wall. The ileo-caecal valve was visualized in 78% of cases. The transverse diameter was found to be no greater than 6.5 mm except in three cases that had a diameters ranging from 7 to 9 mm. Diameter variability along the length of the same appendix was demonstrated in 5% of subjects. Wall thickness was no greater than 2.5 mm. Our experience suggests that graded-compression ultrasonography is a valuable procedure for detecting the vermiform appendix more frequently than has been previously reported. The patients physical constitution and the anatomical location of the vermiform appendix were found to be important factors affecting the ability to visualize the vermiform appendix. The ability to visualise the normal vermiform appendix ultrasonographically supports the clinical diagnosis and excludes acute appendicitis.

Adolescent↗

PubMed1991

[Rare anomalies in the development of the appendix].

Anomalies of the appendix are extremely uncommon. Cases of complete agenesia have been reported only few times. Even "lucky" surgeons usually do not have the opportunity of seeing in more than once in ca career. Abnormal development of the appendix usually takes the form of a double appendix. About 60 such cases have been reported so far describing several types of the abnormality. Type A is described as a single appendix with the body or tip branching, or, alternatively, completely divided like a double-barreled gun. Type Bis described as occurrence of completely separated appendices with bases also being located on different sites of the cecum (the avian type) or with both bases springing from the intestinal tenia (tenia-coli type). Type C is a doubled cecum, each containing its own appendix. Type D is a horseshoe appendix with two openings at the common cecum All these anomalies are of great practical importance, and a surgeon has to bear them in mind during an operation, since in case he overlooks them the operated patient may experience grave consequences. They also may be the forensic issue in cases when repeated explorative laparotomy reveals "previously removed" vermiform appendix. We report a case of a horseshoe appendix with mesenterial incarceration of the terminal ileum and resulting partial intestinal gangrene necessitating intestinal resection and terminolateral ileotransversostomy. The postoperative course was characterised with partial gangrene of the cecom and fistula of the intestines on a completely intact part of the intestinal wall which could be explained by possible presence of anomalous vascularization in the area.

Aged↗

PubMed2000

Laparoscopic antegrade continence enema in situ appendix procedure for refractory constipation and overflow fecal incontinence in children with spina bifida.

PURPOSE: The antegrade continence enema procedure allows patients with neurogenic bowel to administer large volume enemas through a right lower quadrant stoma to flush the colon every other day. This procedure results in freedom from refractory constipation and diapers required by unexpected episodes of overflow fecal incontinence. We present a simplified laparoscopic technique using in situ appendix. MATERIALS AND METHODS: A total of 6 male and 10 female children with a mean age of 12 years (range 4 to 21) and neurogenic bowel secondary to myelomeningocele underwent the antegrade continence enema in situ appendix procedure. The procedure was done with laparoscopic assistance, and associated with other bladder and bladder outlet reconstructive surgery in 5 patients. In 3 patients, a purely laparoscopic antegrade continence enema in situ appendix procedure was performed. The appendix and cecum were mobilized, and the tip of the appendix was anastomosed directly to the skin of the right lower quadrant through 1 of the 5 mm. lower quadrant port sites. The continence mechanism is simply a function of the appendix length and the mucosal coaptation of the appendiceal lumen. A 6Fr silicone Foley catheter is used to stent the mucocutaneous anastomosis. Concomitant procedures included ileocystoplasty, ileovesicostomy, sigmoidovesicostomy or ureterovesicostomy, and/or pubovaginal sling done through a low Pfannenstiel incision after laparoscopic mobilization of the appendix and cecum. RESULTS: The 3 patients treated with the laparoscopic antegrade continence enema procedure ate the day of surgery and were discharged home the next morning. Constipation and fecal incontinence resolved in all cases. All antegrade continence enema stomas were catheterized easily with a 6 or 8Fr feeding tube and were continent. Complications in the 8 laparoscopic and laparoscopic assisted cases included stomal stenosis requiring dilation in the office and obstructive volvulus associated with malrotation requiring segmental resection. Patient mothers in particular were gratified by this procedure at a mean followup of 11/2 years. CONCLUSIONS: The simplified antegrade continence enema in situ appendix procedure works well for refractory constipation and overflow fecal incontinence in children with neurogenic bowel secondary to spina bifida. Coaptation of the appendiceal lumen and use of small catheters allow for persistent continence without a formal surgically constructed valve mechanism. The combined antegrade continence enema and either ileovesicostomy or sigmoidovesicostomy continent urinary diversion procedures allow children to control bowel and bladder evacuation programs. A laparoscopic approach is reasonable particularly in cases requiring no other procedures.

Adolescent↗