Watch video about laparoscopic appendectomy surgery here for FREE! You'll see how doctors do with our appendix!.Appendicitis Updated Review
Review all aspect of appendicitis including symptoms, sign, investigation,treatment and surgery
Watch video about laparoscopic appendectomy surgery here for FREE! You'll see how doctors do with our appendix!.Malignant of Appendix, Carcinoid, CA appendix
Primary malignant tumors were found in 1.4% of appendices in the same large series. Carcinoid and argentaffin tumors comprise the majority of appendiceal cancers, and the appendix is the commonest location of carcinoid tumors of the gastrointestinal tract. Carcinoid tumors of the appendix are usually benign, but the uncommon tumor that is over 2 cm in diameter may exhibit malignant behavior. Most appendiceal carcinoids are found in the tip of the organ, while a few are at the base. About half of these tumors are discovered during an appendectomy for acute appendicitis, and the remainder are identified incidentally. Lesions less than 2 cm in diameter invade the appendiceal wall in 25% of cases, but only 3% metastasize to lymph nodes, and hepatic metastases and the carcinoid syndrome are truly rare. Appendectomy alone is adequate treatment unless the lymph nodes are visibly involved, the tumor is more than 2 cm in diameter, mucinous elements are present in the tumor (adenocarcinoid), or the mesoappendix or base of the cecum is invaded. Right hemicolectomy is recommended for these more aggressive lesions.
Mucocele of Appendix
Mucocele of the appendix is a cystic, dilated appendix filled with mucin. Simple mucocele is not a neoplasm and results from chronic obstruction of the proximal lumen, usually by fibrous tissue. If the appendiceal contents distally are sterile, mucous cells continue to secrete until distention of the lumen thins the wall and interferes with nutrition of the lining cells; histologically, simple mucocele is lined by flattened cuboidal epithelium or no epithelium at all. Simple mucocele is cured by appendectomy.
Less commonly, mucocele is caused by a neoplasm—cystadenoma, or adenocarcinoma grade 1 in the older terminology. This lesion may arise de novo or (perhaps) in a preceding simple mucocele. In cystadenoma, the lumen is filled with mucin but the wall is lined by columnar epithelium with papillary projections. Tumor does not infiltrate the appendiceal wall and does not metastasize, although it may recur locally after appendectomy. Cystadenoma is believed to undergo malignant change in some instances. Appendectomy is adequate treatment.
Tumor of the appendix
Benign tumors, including carcinoids, were found in 4.6% of 71,000 human appendix specimens examined microscopically. Benign neoplasms may arise from any cellular element and are usually incidental findings. Occasionally, a neoplasm obstructs the appendiceal lumen and produces acute appendicitis. No treatment other than appendectomy is indicated.
Appendicitis Imaging Studies
Localized air-fluid levels, localized ileus, or increased soft tissue density in the right lower quadrant is present in 50% of patients with early acute appendicitis. Less common findings are a calculus, an altered right psoas shadow, or an abnormal right flank stripe. The finding on plain films of a calculus in the right lower quadrant coupled with pain in this area strongly supports a diagnosis of appendicitis. Although perforated peptic ulcer is by far the most common cause of free intraperitoneal air, free air is also a rare manifestation of perforated appendicitis. In general, however, the findings on plain films are nonspecific and rarely of help in diagnosis. A suggestion that barium enema may contribute to the diagnosis has not been supported by experience.
