¿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)

The optimal surgical time of laparoscopic appendicectomy after conservative treatment of appendiceal abscess in children / 中华实用儿科临床杂志

Objective:To explore the optimal surgical time of laparoscopic appendectomy after conservative treatment of appendiceal abscess in children.Methods:Clinical data of 86 children with appendiceal abscess diagnosed in the Department of General Surgery, Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2016 to June 2020 were retrospectively analyzed.According to the delayed laparoscopic appendectomy interval after the appendiceal abscess was cured, 86 children were divided into group A, B and C. Briefly, patients in the 3 groups were treated with laparoscopic appendectomy 4 weeks, 8 weeks and over 12 weeks after the appendiceal abscess was cured, respectively.Children with recurrent appendicitis during delayed operation were not included.The incidence of appendicitis recurrence during delayed operation, the incidences of intraoperative complications, conversion to laparotomy, and postoperative complications, operation time, the time of postoperative intestinal function recovery, and postoperative hospital stay were compared among 3 groups.Results:There were 10, 31 and 45 cases in group A, B and C, respectively.Among them 10, 30 and 39 patients received laparoscopic appendectomy, and 0, 1 and 6 cases had appendicitis recurrence in group A, B and C, respectively.There were no significant differences in the age, gender, diameter of appendiceal abscess, inflammatory indexes at diagnosis of diagnosing appendiceal abscess, cure time of conservative treatment of abscess, and inflammatory indexes at laparoscopic appendectomy among the 3 groups (all P>0.05). The incidence of appendicitis recurrence in group C(13.33%) was significantly higher than that in group A (0) and group B (3.22%)( P<0.05). There was no significant difference in the incidence of appendicitis recurrence between group A and group B( P>0.05). The incidences of intraoperative(group A, B, C was 40.00%, 10.00%, 10.26%, respectively) and postoperative complications (group A, B, C was 40.00%, 6.70%, 5.10%, respectively), and conversion to laparotomy(group A, B, C was 20.00%, 0, 0), operation time [group A, B, C was (106.70±7.42) d, 41.40±10.44) d, (39.60±11.27) d, respectively], postoperative intestinal function recovery time [group A, B, C was(5.80±2.15) d, (0.93±0.17) d, (0.83±0.11) d], and postoperative hospital stay[group A, B, C was(12.40±4.15) d, (1.67±0.31) d, (1.58±0.44) d] in group A were significantly higher than those in group B and group C(all P<0.05), but no significant differences were found between group B and group C(all P>0.05). Conclusions:Eight weeks are the best time for laparoscopic appendectomy after conservative treatment of appendiceal abscess in children.

Investigation of early appendectomy in appendicular abscess / 局解手术学杂志

Objective To evaluate the feasibility and safety of early appendectomy in appendicular abscess. Methods Fifty patients with appendicular abscess who received early appendectomy in our hospital from January 2009 to June 2012 were considered as the abscess group,50 cases patients received acute appendicitis surgery were regarded as the control group. The postoperative hospital stay,cost of hospi-talization,operative time,the amount of bleeding in operation and complications were retrospectively analyzed. Results The operative time of abscess group was (68±23) min,and the control group was (49±14) min (P0. 05). All patients were cured. Conclusion Early treatment of appendiceal abscess is safe and alternate to conventional conservative treatment followed by interval appendectomy. It is not only to avoid the secondary hospitalization and treatment fail-ure,but also save the cost of hospitalization and minimize the medical expenses.

A Case of Successful Colonoscopic Drainage of Peri-appendiceal Abscess Complicating Acute Appendicitis / 대한소화기내시경학회지

Traditionally, early appendectomy has been the cornerstone of therapy for acute appendicitis. However, once appendiceal perforation and abscess formation occurs, the optimal means of treatment and the timing of operation is controversial. Recently, it was reported that radiologically guided percutaneous abscess drainage and antibiotic therapy, as an initial nonoperative management, was effective and safe. Recent experience with endoscopic transmural drainage of pancreatic pseudocysts or even pancreatic abscesses prompted us to use the similar technique for the primary treatment of peri-appendiceal abscess. We report a case of peri-appendiceal abscess complicating acute appendicitis which was successfully treated by colonoscopic transmural internal drainage.

Epigastric appendiceal abscess with spontaneous drainage into the stomach

The appendiceal abscess is a common complication of acute appendicitis and usually is located in the right lower quadrant of the abdomen. An epigastric appendiceal abscess has never been reported at an unusual location. We experienced an unusual case of a 49-year-old man with an epigastric appendiceal abscess. Initially, this abscess was suspected to be a pancreatic abscess. Abdominal CT scan and barium enema demonstrated a hyperrotated cecum with an appendiceal abscess in the left upper quadrant of the abdomen. An gastroscopy revealed a small fistula-like lesion with purulent coating at the bulging posterior gastric wall. The abscess resolved spontaneously. We believe that the abscess drained into the stomach through a small fistula between the stomach and abscess cavity. There was no recurrence for over 6 months.