¿Plastrón o tumor apendicular? / Plastron appendicitis or appendiceal tumor?

Un plastrón apendicular es una masa apendicular palpable que contiene el apéndice inflamado, vísceras adyacentes y el omento mayor, asociado a o no a la presencia de pus. El manejo del plastrón apendicular abscedado es controvertido. Cuando hay signos de sepsis asociados, la indicación es una intervención quirúrgica de urgencia, de lo contrario puede optarse por un tratamiento conservador. La utilización de drenaje percutáneo tiene una alta tasa de efectividad, aunque la tasa de neoplasias no detectadas presenta un porcentaje no despreciable, especialmente en los pacientes mayores de 40 años. El objetivo de esta presentación es comunicar una paciente de 65 años con diagnóstico presuntivo de plastrón apendicular abscedado quien luego del fracaso de los drenajes percutáneos fue sometida a una laparotomía exploratoria y hemicolectomía derecha. El diagnóstico histopatológico fue de adenocarcinoma mucinoso del apéndice. (AU)

A palpable inflammatory appendiceal mass may contain the inflamed appendix, adjacent viscera, and the greater omentum, associated or not with the presence of pus. The management of an inflammatory appendiceal mass is controversial. When there are associated signs of sepsis, the indication is emergency surgery, otherwise, you can opt for a conservative treatment. The use of percutaneous drainage has a high rate of effectiveness, although the rate of undetected neoplasia is not negligible, especially in patients older than 40 years. We present the case of a 65-year-old female patient with a presumptive diagnosis of an appendiceal mass with abscess, who underwent exploratory laparotomy and right hemicolectomy after percutaneous drainage failure. The histopathological diagnosis was mucinous adenocarcinoma of the appendix. (AU)

Invaginación del apéndice: un hallazgo poco frecuente en colonoscopia. Informe de caso / Appendiceal intussusception: a rare finding during colonoscopy. Case report

Resumen Se presenta el caso de una mujer joven con hallazgo endoscópico incidental en una colonoscopia de seguimiento, que consistía en una lesión en el ciego con histología benigna. Se describe el proceso diagnóstico y el tratamiento quirúrgico. Se revisa la literatura existente y se discuten la incidencia, el cuadro clínico y las indicaciones de tratamiento quirúrgico de una patología rara de baja aparición.

Abstract This is the case of a young patient with an incidental endoscopic finding of a lesion in the cecum during follow-up colonoscopy with benign histology. The diagnostic process and surgical treatment are described. The existing literature was reviewed and the incidence, symptoms and indications of surgical treatment of this rare condition are discussed.

Management of pseudomyxoma peritonei originating from the appendix: a single-center experience / 中国肿瘤临床

Objective: To analyze the clinical outcomes of pseudomyxoma peritonei(PMP) originating from the appendix following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Methods: A retrospective study was carried out by analyzing clinical data of patients who diagnosed with PMP originating from appendix and had undergone CRS and HIPEC between January 2012 and December 2018. Results: A total of 604 patients had undergone 621 CRS and HIPEC procedures. The average age of the patients was 56.7 years. Of the patients, 364 (60.3%) were female and 240 (39.7%) were male. The median peritoneal carcinomatosis index (PCI) was 25.7. Of the patients, 28.5% (172/604) had undergone complete cytoreduction (CCR 0/1). In this study, the incidence of grade 3-4 adverse events was 21.7% (131/604), and the perioperative mortality rate was 0.7% (4/604). For the entire cohort, the 5-year survival rate was 53.6%. High-grade pathological subtype CCR 2/3, PCI >20, and grade 3-4 adverse events were independent predictors of a poor overall survival. Conclusions: Appendix-derived PMP is rare, and its treatment should be considered carefully. For patients who are suspected or are confirmed as PMP, early standardized CRS and HIPEC are related to a better prognosis.

Spectrum of computed tomography manifestations of appendiceal neoplasms: acute appendicitis and beyond

Appendiceal neoplasms are rare and often only discovered incidentally during surgery performed for acute appendicitis. Computed tomography (CT) has been demonstrated to be a reliable technique for accurately establishing the preoperative diagnosis of appendiceal neoplasms that manifest as acute appendicitis through the presence of certain imaging findings. Other manifestations of appendiceal neoplasms include appendiceal mass, mucocoele, localised abscess formation, ileus, increasing abdominal girth from pseudomyxoma peritonei, and intussusception. This pictorial essay illustrates varied CT findings of neoplasms of the appendix, with emphasis on the more commonly encountered manifestations of these tumours.

Laparoscopic resection of a appendiceal mucocele / 대한외과학회지

Laparoscopic resection of appendiceal mucoceles has recently been described, but the safety and efficacy are controversial. We present two cases of laparoscopic mucocelectomies involving 14 and 15 cm cystic masses originating from the appendix. The laparoscopic mucocelectomies were performed using four ports. From the beginning of the procedure, a laparoscopic bag was used to safely contain the mucocele, prevent rupture of the mucocele, and retract the mucocele. An endoscopic stapling device was used to transect the base of the cecum. Minimal handling was achieved by gravity and with the use of laparoscopic instruments. Laparoscopic appendectomies are widely performed for acute appendicitis, but laparoscopic resection is not routinely performed for an appendiceal mucocele because of the risk of perforation and subsequent pseudomyxoma peritonei. We report two cases of laparoscopic appendiceal mucocelectomies, which were performed safely with laparoscopic instruments and minimal manipulation.