摘要 :
Objectives: This narrative review aims to collate the data in the existing literature on appendicoliths, by reviewing the available information on appendicoliths that have been previously reported in 24 publications, and providing...
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Objectives: This narrative review aims to collate the data in the existing literature on appendicoliths, by reviewing the available information on appendicoliths that have been previously reported in 24 publications, and providing the information in one article. Key findings: Appendicoliths are frequent culprits in causing luminal obstruction of the appendix, leading to appendicitis. They are calcified masses formed as a result of the aggregation of faecal par-ticulates and inorganic salts within the lumen of the appendix. The presence of appendicoliths in an inflamed appendix influences the patient's treatment, as surgery is usually done to avoid appendix perforation and abscess formation, and also to prevent a future recurrence of the disease. Appendicoliths are mostly imaged using CT, Ultrasound, and plain X-rays; however, CT is the most frequently used modality, particularly in the imaging of complications caused by 'retained' appendicoliths. 'Retained' appendicoliths and their consequential abscesses have been reported in the sub-hepatic and intrahepatic regions, pelvic and tubo-ovarian regions, gluteal region, subcutaneous layer, subphrenic region, and through the diaphragm into the chest cavity. Conclusion: This review provides useful information on the imaging appearances and complications caused by the presence of appendicoliths in an inflamed appendix, and it also provides information on the clinical implications of 'dropped' appendicoliths during appendectomy. Implications for practice: Based on the findings of this review, it is recommended that the appropriate imaging modality (ultrasound and/or CT) should be considered when imaging appendicoliths and its complications. It is also suggested that retained appendicolith be considered a differential diagnosis when imaging patients with a history of appendectomy due to complicated appendicitis/perforation.
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Because barium sulfate (BaSO 4 ) is not harmful to the mucosa, it is widely used for gastrointestinal imaging. Barium appendicitis is a very rare complication of barium meals and barium enema. We report a case of acute appendiciti...
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Because barium sulfate (BaSO 4 ) is not harmful to the mucosa, it is widely used for gastrointestinal imaging. Barium appendicitis is a very rare complication of barium meals and barium enema. We report a case of acute appendicitis associated with retained appendiceal barium. A 47-year-old man presented with right lower abdominal pain after upper gastrointestinal imaging was performed using barium 1?month earlier. The abdominal plain roentgenogram showed an area of retained barium in the right lower quadrant. Multiplanar reconstruction of computed tomography scans showed barium retention in the appendix. Emergency appendectomy was performed. A cross section of the specimen revealed the barium mass. Barium-associated appendicitis is a very rare clinical entity but we should be cautious of this uncommon disease when we encounter barium deposits in the appendix after barium examination. This report is significant because barium was identified both macroscopically and microscopically.
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Because barium sulfate (BaSO4) is not harmful to the mucosa, it is widely used for gastrointestinal imaging. Barium appendicitis is a very rare complication of barium meals and barium enema. We report a case of acute appendicitis ...
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Because barium sulfate (BaSO4) is not harmful to the mucosa, it is widely used for gastrointestinal imaging. Barium appendicitis is a very rare complication of barium meals and barium enema. We report a case of acute appendicitis associated with retained appendiceal barium. A 47-year-old man presented with right lower abdominal pain after upper gastrointestinal imaging was performed using barium 1 month earlier. The abdominal plain roentgenogram showed an area of retained barium in the right lower quadrant. Multiplanar reconstruction of computed tomography scans showed barium retention in the appendix. Emergency appendectomy was performed. A cross section of the specimen revealed the barium mass. Barium-associated appendicitis is a very rare clinical entity but we should be cautious of this uncommon disease when we encounter barium deposits in the appendix after barium examination. This report is significant because barium was identified both macroscopically and microscopically.
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The presence of an appendiceal fecalith should not be considered as a categorical sign of acute appendicitis. The fecalith may, however, be responsible for abdominal pain - right lower quadrant tenderness without associated append...
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The presence of an appendiceal fecalith should not be considered as a categorical sign of acute appendicitis. The fecalith may, however, be responsible for abdominal pain - right lower quadrant tenderness without associated appendicitis, i.e. appendiceal colic. When a patient presents with right lower quadrant abdominal tenderness, abdomino-pelvic computerized tomography (CT) may establish this diagnosis by demonstrating the presence of the appendicolith but without evidence of appendiceal inflammation or infection. Spontaneous migration of the appendicolith may result in cure. In this previously unpublished clinical case, the CT demonstrates the spontaneous passage of the appendicolith, which coincided in time with the resolution of the abdominal pain syndrome. When a patient presents with typical symptoms of appendiceal colic and CT findings of an appendicolith without appendicitis, appendectomy will certainly relieve the pain. But if the stone passes spontaneously, the need for appendectomy is debatable, particularly in a high-risk patient. (C) 2014 Elsevier Masson SAS. All rights reserved.
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Purpose Acute appendicitis may present as uncomplicated and complicated and these disease forms differ both epidemiologically and clinically. Complicated acute appendicitis has traditionally been defined as an appendicitis complic...
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Purpose Acute appendicitis may present as uncomplicated and complicated and these disease forms differ both epidemiologically and clinically. Complicated acute appendicitis has traditionally been defined as an appendicitis complicated by perforation or a periappendicular abscess, and an appendicolith represents a predisposing factor of complicated disease. There are histopathological differences between uncomplicated acute appendicitis and the previously established traditional forms of complicated acute appendicitis, but to our knowledge, the histopathological differences between uncomplicated acute appendicitis and complicated acute appendicitis presenting with an appendicolith have not yet been reported. The study purpose was to assess these differences with two prospective patient cohorts: (1) computed tomography (CT) confirmed uncomplicated acute appendicitis patients enrolled in the surgical treatment arm of the randomized APPAC trial comparing appendectomy with antibiotics for the treatment of uncomplicated acute appendicitis and (2) patients with CT-verified acute appendicitis presenting with an appendicolith excluded from the APPAC trial.
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OBJECTIVE. With heightened interest in nonoperative antibiotic management of uncomplicated appendicitis, appendicoliths become a more relevant issue, and because of higher failure rates their presence may be considered a contraind...
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OBJECTIVE. With heightened interest in nonoperative antibiotic management of uncomplicated appendicitis, appendicoliths become a more relevant issue, and because of higher failure rates their presence may be considered a contraindication. The purpose of this study was to investigate the prevalence of appendicoliths at CT in adults with suspected appendicitis.
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Appendicitis is the most common reason for which pediatric patients require emergent surgery. Although surgical removal of the appendix is the standard of care for appendicitis, neutropenic patients require special consideration a...
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Appendicitis is the most common reason for which pediatric patients require emergent surgery. Although surgical removal of the appendix is the standard of care for appendicitis, neutropenic patients require special consideration as optimal management for these patients remains controversial. We present a case series of 3 neutropenic patients with appendicitis, all of whom were managed differently according to the circumstances unique to each case. By reviewing key articles in the literature, we explore the safety and efficacy of both medical and surgical management of neutropenic appendicitis and propose an algorithm to help guide decision making.
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Appendicitis is a common pathology most often caused by an appendicolith. Laparoscopic appendectomy has become the standard operative approach, but it has a higher risk of retained appendicoliths than open laparotomies. This repor...
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Appendicitis is a common pathology most often caused by an appendicolith. Laparoscopic appendectomy has become the standard operative approach, but it has a higher risk of retained appendicoliths than open laparotomies. This report describes a case of a perihepatic abscess due to a retained appendicolith following laparoscopic intervention. The abscess was successfully drained and the appendicolith retrieved percutaneously under fluoroscopic guidance. A literature review and discussion about retained appendicoliths are provided as points for diagnostic consideration.
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Appendicoliths are formed by calcium salts and faecal debris layered and lodged within the appendix. They are detected on unenhanced x-rays in less than 10% of patients with appendicitis. When an appendicolith is found extralumina...
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Appendicoliths are formed by calcium salts and faecal debris layered and lodged within the appendix. They are detected on unenhanced x-rays in less than 10% of patients with appendicitis. When an appendicolith is found extraluminally, it is pathognomonic for perforation of the appendix. Moreover, retained appendicoliths act as a nidus for infection and are likely to be the source of a postoperative intraperitoneal abscess. However, this is very rare with only 30 reported cases of intra-abdominal abscess secondary to an appendicolith in the literature over the past 40 years. Retained, or dropped, appendicoliths most commonly present as an area of high attenuation less than 1cm in diameter with an associated abscess close to the caecum or Morrison's pouch on computed tomography (CT). A study published in 2006 showed that although there is initial success with CT-guided drainage of abscesses secondary to faecaliths, all will recur and formal surgical drainage with removal of the appendicolith is required. This case report highlights not only an unusual complication of a retained appendicolith but also the importance of taking a thorough history and interpreting investigations in the context of the patient's past medical history so as to produce a differential diagnosis and prevent treatment of incorrect conditions.
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Abstract Background An appendicolith-related appendiceal obstruction leading to appendicitis is a commonly encountered surgical emergency that has clear evidence-based management plans. However, there is no consensus on management...
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Abstract Background An appendicolith-related appendiceal obstruction leading to appendicitis is a commonly encountered surgical emergency that has clear evidence-based management plans. However, there is no consensus on management of asymptomatic patients when appendicoliths are found incidentally. The objective of this study was to determine the risk of appendicitis in patients with an incidental finding of the appendicolith. Methods A retrospective matched cohort study of patients with appendicolith discovered incidentally on computed tomographic scan from January 2008 to December 2014 at our institution was completed. The size and position of the appendicolith were ascertained. The study group was matched by age and gender to a control group. Both groups were contacted and interviewed regarding development of appendicitis. Results In total, 111 patients with appendicolith were successfully contacted and included in the study. Mean age was found to be 38?±?15?y with 36 (32%) of the study population being females. Mean length of appendix was 66?±?16?mm, and mean width was 5.8?±?0.9?mm. Mean size of the appendicolith was 3.6?±?1.1?mm (1.4-7.8?mm). Fifty-eight percent of appendicoliths was located at the proximal end or whole of appendix, 31% at mid area, and 11% at the distal end of appendix. All patients of the study and control groups were contacted, and at a mean follow-up of 4.0?±?1.7?y, there was no occurrence of acute appendicitis in either group. Conclusions Patients with incidentally discovered appendicolith on radiological imaging did not develop appendicitis. Hence, the risk of developing acute appendicitis for these patients does not seem higher than the general population.
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