Torsion of abdominal appendages presenting with acute abdominal pain

Diseases of the abdominal appendages are rare causes of abdominal pain in all age groups. Patients and Nine patients with torsion and infarction of abdominal appendages were retrospectively reviewed. Four patients had torsion and infarction of the appendices epiploicae, four patients had torsion and infarction of part of the greater omentum, and one patient had torsion and infarction of the falciform ligament. The patient with the falciform ligament disease represents the first reported case of primary torsion and infarction of the falciform ligament, and the patient with the transverse colon epiploica represents the first reported case of vibration-induced appendix epiploica torsion and infarction. The patient with the falciform ligament disease presented with a tender upper abdominal mass, and the remaining patients were operated upon with the preoperative diagnosis of acute appendicitis. The presence of normal appendix with free serosanguinous fluid in the peritoneal cavity should raise the possibility of a disease, and calls for further evaluation of the intra-abdominal organs. If the diagnosis is suspected preoperatively, CT scan and ultrasound may lead to a correct diagnosis and possibly conservative management. Laparoscopy is playing an increasing diagnostic and therapeutic role in such situations

Inversion of the normal appendix druging the course of abdominal surgery: a procedure not to be forgotten

A retrospective study, assessing the safety and feasibility of inverting the normal appendix during the course of abdominal surgery. Between early 1989 and early 1999 and during the course of open abdominal surgery 108 patients underwent total inversion of their normal looking appendix [74 cholecystectomies, 19 peptic ulcer operations, 12 splenectomies, 2 external hernias, one hydatid liver disease] and recently 2 laparoscopic inversions of the appendix were performed during the course of laparoscopic cholecystectomy. Inversion was easy and added 5-10 minutes to the operation time during open surgery cases. Early in the series there were three conversions to formal appendectomy because of fibrosis of the appendix in patients over 40 years of age, which led us to restrict inversion to patients under 40 years and with no fibrosis. There were 2 wound infections in cholecystectomy patients [2/74=2.7%] and 1 wound infection in peptic ulcer patients [1/19=5.3%]. During the same period 306 patients underwent open cholecystectomy without appendicular inversion and of these 9 developed wound infection [9/306=2.9%]. In 20 patients who underwent peptic ulcer surgery without appendicular inversion there was one case of wound infection [1/20=5%]. Following the introduction of laparoscopic cholecystectomy in September 1995 2 patients underwent laparoscopic inversion of the appendix during laparoscopic cholecystectomy without any postoperative complications. Total inversion of the appendix during the course of open abdominal surgery is a safe and useful adjuvant, obviates the risk of opening the intestine of formal appendectomy and eliminates the risk of future appendicitis which is significant especially in splenectomised patients. Laparoscopic inversion may have a place, but it needs further evaluation