Laparoscopy
J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan in An Atlas of Gynecologic Oncology, 2018
The appendix is an elongated vestigial diverticulum of the cecum, which is richly endowed with lymphoid tissue. It is normally 7 to 10 cm in length but lengths up to 30 cm have been recorded. It receives blood supply from the appendicular artery, which is a branch of the lower division of the ileocecal artery. An accessory appendicular artery may be present in almost 50% of patients. The major vessels enter the mesoappendix a short distance from the base of the appendix. The location of the appendix is variable; up to 70% will be retrocecal and the remainder present primarily in front of the large bowel. Although it is usually found in the right iliac fossa, in maldescent of the cecum or advanced pregnancy the appendix may be seated in the right hypochondrium. In rare conditions, such as situs inversus, the appendix is in the left iliac fossa.
The appearance of the body after death
Jason Payne-James, Richard Jones in Simpson's Forensic Medicine, 2019
Decomposition results in liquefaction of the soft tissues over a period of time, the appearance of which, and the rate of progress of which, is a function of the ambient temperature: the warmer the temperature, the earlier the process starts and the faster it progresses. In temperate climates the process is usually first visible to the naked eye at about 3–4 days as an area of green discoloration of the right iliac fossa of the anterior abdominal wall. This ‘greening’ is the result of the extension of the commensal gut bacteria through the bowel wall and into the skin, where they decompose haemoglobin, resulting in the green colour. The right iliac fossa is the usual origin as the caecum lies close to the abdominal wall at this site, but then can extend throughout the body (Figure 5.6a). This green colour is but an external marker of the profound changes that are occurring in the body as the gut bacteria find their way out of the bowel lumen into the abdominal cavity and the blood vessels.
Appendectomy
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
Acute appendicitis is usually diagnosed on the basis of the classical clinical symptoms of migratory right iliac fossa pain, nausea, right lower quadrant tenderness, and fever. Children aged over 5 years more often experience a longer delay in diagnosis and higher incidence of perforation. Every effort should be made to confirm the diagnosis of appendicitis before surgery. Formerly reported rates of negative explorations (20–40%) are no longer acceptable. Repeated clinical examinations and appropriate imaging should reduce the negative rates below 10%. Abdominal US is an excellent and accurate screening tool for acute appendicitis. Computed tomography (CT) has slightly higher sensitivity and specificity than US, but the radiation dose remains a significant concern. Therefore, CT with minimized radiation dose is preserved for special situations and complicated patients with an unclear diagnosis and increased operation risk. Significant medical conditions causing appendicitis-like symptoms should be ruled out by clinical examination, laboratory tests, and imaging. These include right basal pneumonia, cholecystitis, meningitis, urinary tract infections, Henoch–Schönlein purpura, and acutely presenting ketoacidosis of type 1 diabetes.
Mucinous cystadenoma with fibroma: a rare combination of collision tumour
Published in Journal of Obstetrics and Gynaecology, 2022
Tanisha Singla, Chintamani Pathak, Anam Singh, Gaurav Singla, Swati Singla, Naveen Kumar R.
A 50-year-old postmenopausal female presented with complaints of progressive abdominopelvic discomfort over a year, associated with the development of a lower abdominal lump for the past 10 months. She had a past history of total abdominal hysterectomy done 12 years back for uterine leiomyomas. Her general physical examination was within normal limits. There was no history of any hormonal symptoms. Systemic examination of the abdomen revealed a large lower abdominal mass in the left iliac fossa measuring approximately 15−20 cm in size. An MRI revealed a large 200 × 180 × 60 mm well circumscribed left ovarian mass having heterologous low signal intensity with associated mild ascites on T2W imaging. T1W delayed post contrast axial MRI imaging showed heterologous enhancement of the left ovarian mass (Figure 1(A)). No pleural effusion was seen. Clinically fibroma of left ovary was suspected. Tumour markers, like CEA and AFP, were within normal limits but CA 125 levels were mildly raised. The patient underwent a left salpingoopherectomy.
Acute pelvic inflammatory disease as a rare cause of acute small bowel obstruction
Published in Acta Chirurgica Belgica, 2019
Alexandre Haumann, Sarah Ongaro, Olivier Detry, Paul Meunier, Michel Meurisse
A 27-year-old female patient was admitted to the emergency department for abdominal pain that started 48 hours prior to presentation, associated with pseudo-grippal syndrome. Symptoms predominated in the right iliac fossa and progressively spread to the entire abdomen. The patient also suffered from nausea and vomiting. Her vital signs were normal and she was afebrile. Abdominal examination was significant for tenderness of the whole abdomen and McBurney’s sign. She had no medical or surgical history. Intrauterine contraceptive device (ICD) was set up with no complication 1 month earlier. Laboratory tests revealed normal leucocytosis of 9870/mm3 with hyperneutrocytophilia of 75.6% and mild C-reactive protein increase at 42 mg/L (normal values: 0.0–5.0 mg/l). Liver and renal functions were normal as well as serum chemistry and human chorionic gonadotropin.
Beyond the commonest: right lower quadrant abdominal pain is not always appendicitis
Published in Alexandria Journal of Medicine, 2020
Mahmoud Agha, Maha Sallam, Mohamed Eid
Another one 67 y male patient (0.1%) was presented with severe acute appendicitis like symptoms and signs. CT scan revealed showed a linear dense foreign body in the mesentery, in close relation to the tip of a pre-ileal inflamed appendix. There was an ileocecal mucosal hyperenhancement and submucosal edema and regional stranding of the right iliac fossa fat planes. This mesenteric foreign body was surrounded with a considerable ring-enhancing collection, which was reported as sealed appendicular perforation with periappendicular abscess Figure 11(a-b). The patient was first managed conservatively with intense broad-spectrum short antibiotic course, with repeated CT scan after 1 week. The second study revealed a significant resolution of the collection and clearly demonstrated the residual inflamed appendix. Figure 11 (C-D) Operative feedback history documented a sealed appendicular perforation with extra-appendicular fish bone foreign body.
Related Knowledge Centers
- Cephalothorax
- Lumbosacral Joint
- Pelvic Brim
- Torso
- Abdominal Cavity
- Thorax
- Intervertebral Disc
- Pelvis
- Tagma
- Thoracic Diaphragm