We reviewed 2159 consecutive cases of surgically resected appendices. The appendectomy specimen consisted of 91 cases of acute focal appendicitis (5.4%), 926 cases of acute suppurative appendicitis (55.1%), 228 cases of acute gangrenous appendicitis (13.6%), 63 cases of periappendicitis (3.8%), 13 cases of pure fibrous obliteration of the lumen (FOL; 0.8%), 18 cases of other diseases (7 mucoceles, 2 mucinous cystic neoplasms, 4 carcinoids, 2 metastatic carcinomas, 2 tuberculous appendicitides, and 1 eosinophilic appendicitis; 1%), and 342 cases with no diagnostic abnormality (20.3%). Patients having acute appendicitis ranged from 3 to 84 years of age, and patients in their 10's and 20's occupied over half of 2159 cases. Diagnostic accuracy of the acute appendicitis was 79.7%. Incidence of the acute appendicitis was suspected to be 7.2/100,000/year. Twenty eight cases of acute appendicitis were associated with diverticula. In the former acute primary diverticulitis led to acute appendicitis in 14 of 28 cases. Among 478 incidental appendectomy cases, there were 3 acute focal appendicitides, 1 acute suppurative appendicitis, 1 eosinophilic appendicitis, 32 periappendicitides, 1 mucocele, 40 pure FOLs, 1 deciduosis, 1 endometriosis, and 1 diverticulosis without inflammation. There were 69 cases of FOL (32 complete forms and 37 incomplete forms), among which 13 cases were associated with acute appendicitis. FOL was more frequent in female patients as well as patients over 40 years of age. Incomplete FOL was considered to progress to complete form with age. The incidence of appendiceal diverticula was higher, whereas the incidences of carcinoid tumor and FOL were lower compared with that in the western report. In 14 of 28 cases the appendiceal diverticulum was the site in which acute appendicitis began.
Appendectomy ; Appendicitis ; Appendix* ; Carcinoid Tumor ; Diverticulitis ; Diverticulum ; Endometriosis ; Eosinophils ; Female ; Humans ; Incidence ; Inflammation ; Mucins ; Mucocele ; Pathology

PURPOSE: The preoperative diagnosis of acute appendicitis is often challenging. Sometimes, pathologic results of the appendix embarrass or confuse surgeons. Therefore, more and more imaging studies are being performed to increase the accuracy of appendicitis diagnoses preoperatively. However, data on the effect of this increase in preoperative imaging studies on diagnostic accuracy are limited. We performed this study to explore unexpected appendiceal pathologies and to delineate the role of preoperative imaging studies in the diagnosis of acute appendicitis. METHODS: The medical records of 4,673 patients who underwent an appendectomy for assumed appendicitis between 1997 and 2012 were reviewed retrospectively. Pathological results and preoperative imaging studies were surveyed, and the frequencies of pathological results and preoperative imaging studies were investigated. RESULTS: The overall rate of pathology compatible with acute appendicitis was 84.4%. Unexpected pathological findings, such as normal histology, specific inflammations other than acute appendicitis, neoplastic lesions, and other pathologies, comprised 9.6%, 3.3%, 1.2%, and 1.5%, respectively. The rate of unexpected pathological results was significantly reduced because of the increase in preoperative imaging studies. The decrease in normal appendices contributed the most to the reduction while other unexpected pathologies did not change significantly despite the increased use of imaging studies. This decrease in normal appendices was significant in both male and female patients under the age of 60 years, but the differences in females were more prominent. CONCLUSION: Unexpected appendiceal pathologies comprised 15.6% of the cases. Preoperative imaging studies reduced them by decreasing the negative appendectomy rate of patients with normal appendices.
Appendectomy ; Appendicitis ; Appendix ; Diagnosis ; Female ; Humans ; Inflammation ; Male ; Medical Records ; Pathology* ; Retrospective Studies ; Surgeons

Appendicitis ; Appendix ; pathology ; surgery ; Hernia, Inguinal ; diagnosis ; surgery ; Humans ; Male ; Middle Aged

Adenocarcinoma, Mucinous ; pathology ; Aged ; Appendectomy ; methods ; Appendiceal Neoplasms ; pathology ; surgery ; Appendicitis ; pathology ; Appendix ; pathology ; Carcinoid Tumor ; pathology ; surgery ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Male

A 4-year-old female with acute lower abdominal pain was admitted with the diagnosis of periappendiceal abscess made by ultrasonography. At laparotomy, the appendix was normal, but the left ovary was twisted and necrotic. Appendectomy and left salpingo-oophorectomy were performed. The pathology of the appendix was normal, and the left tube and ovary were ischemic and had hemorrhagic necrosis. Pediatric adnexal torsion may be difficult to diagnosis clinically. Sonography is the preferred imaging study. It usually confirms a pelvic mass but may not establish the diagnosis. The correct diagnosis of adnexal torsion is often made at exploration. The most common erroneous diagnosis is acute appendicitis or periappendiceal abscess. Therapy for adnexal torsion remains controversial. While extirpation has been the standard of treatment in the past, there are current proponents of conservative therapy with adnexal sparing. Early diagnosis may lead to more frequent salvage of affected adnexa.
Abdominal Pain ; Abscess* ; Appendectomy ; Appendicitis ; Appendix ; Child* ; Child, Preschool ; Diagnosis ; Early Diagnosis ; Female ; Humans ; Laparotomy ; Necrosis ; Ovary ; Pathology ; Ultrasonography

PURPOSE: Appendicitis is the most common abdominal surgical emergency. The diagnosis of appendicitis can be difficult, occasionally taxing the diagnostic skills of even the most experienced surgeon, and especially for diagnosing reproductive women. This study was designed to evaluate the various pathologies of the appendix and the other intraabdominal organs in patients who were preoperatively diagnosed with acute appendicitis, and we wanted to analyze the difference of the perioperative results between the reproductive women and the other patients. METHODS: The study was a retrospective analysis of 1,108 appendectomies that were performed from September 2003 to August 2006. The data were analyzed for the following parameters: the age-related and sex-related incidence of acute appendicitis, the rates of negative appendectomy, negative operation and appendicular perforation, and the incidence of other encountered pathologies. In addition, we present the clinical results of the reproductive women. RESULTS: The diagnostic accuracy for acute appendicitis was 87.2%. The negative appendectomy rate was 11.6% and it was significantly higher (20.8%) in the reproductive women than in the male patients of the same age (P=0.001). On the clinical analyses of the reproductive aged appendicitis group showed they a shorter pain duration and a higher WBC count, and more frequent epigastric discomfort, nausea, vomiting and RLQ tenderness (P< 0.05). CONCLUSION: We noted a high rate of negative appendectomy among reproductive female patients, so more care should be taken to diagnose these patients.
Appendectomy ; Appendicitis* ; Appendix ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Female ; Humans ; Incidence ; Male ; Nausea ; Pathology ; Retrospective Studies ; Taxes ; Vomiting

PURPOSE: The purpose of our study was to retrospectively evaluate the CT images of patients suffering with surgically proven appendicitis to determine the causes of missed diagnoses. MATERIALS AND METHODS: We reviewed the pathology reports of the patients with surgically proven appendicitis from two hospitals during a 3-year period. Thirty-seven such cases with a misdiagnosis were identified and they served as our misdiagnosed group (17 females and 20 males, mean age: 58 years, age range 15-68 years). These were cases that were misdiagnosed on preoperative abdominal CT. All 57 patients in the control group (30 females and 27 males, mean age: 44 years, age range: 21-78 years) had undergone laparotomy for acute appendicitis and they had been correctly diagnosed preoperatively on CT. Two abdominal radiologists evaluated the following items from all 94 CT examinations: 1) an abnormal appendix, 2) periappendiceal fat inflammation, 3) pericecal extraluminal fluid, 4) pericecal extraluminal air, 5) appendicolith, 6) cecal wall thickening, 7) small bowel dilatation, and 8) the pericecal fat content. Statistical analysis was performed using a Chi-squared test and Fisher's exact test. RESULTS: Any abnormal appendix was not visualized, even retrospectively, in 27 (73%) of the 37 patients from the misdiagnosed group, whereas it was not visualized in 13 (23%) of the 57 patients in the control group (p=0.001). Of the patients who had been misdiagnosed, inflammation of the pericecal fat was observed in 21 patients (57%) as compared to 50 (88%) patients in the control group (p=0.001). Pericecal fluid and air were noted in 15 (41%) and 9 (24%) patients, respectively, in the misdiagnosed group and in 19 (33%) and 14 (25%) patients, respectively, in the control group, (p=0.477 and p=0.901, respectively). Appendicolith was found in 3 (8%) misdiagnosed subjects and in 10 (18%) of the controls (p=0.001). Focal cecal wall thickening was noted in 14 (38%) misdiagnosed patients and in 28 (49%) control patients (p=0.28). Small bowel dilatation was noted in 5 (14%) and 4 (7%) patients in the misdiagnosed and control groups, respectively (p=0.477). The numbers of patients showing abundant pericecal fat were 3 (8%) in the misdiagnosed group and 25 (44%) in the control group (p=0.001). CONCLUSION: The main causes of missed diagnosis of acute appendicitis on CT are: non-visualization of an abnormal appendix and a lower index of suspicion by the radiologist. Knowledge of the aforementioned factors may help to avoid the misdiagnosis of appendicitis and so improve the diagnostic accuracy.
Appendicitis* ; Appendix ; Diagnosis ; Diagnostic Errors ; Dilatation ; Female ; Humans ; Inflammation ; Laparotomy ; Male ; Pathology ; Retrospective Studies* ; Tomography, X-Ray Computed

Appendicitis is one of the most common condition causing an acute abdomen in young adult population. Two-hundreds and fifty-nine cases of acute appendicitis provened by surgery and pathology during recent 2 years in Han-ll Hospital were studied and analyzed by preoperative plain abdominal X-ray. One case of barium enema was also done. The results were as follows; 1. Male fo female sex ration was 1:1. 2. In age distribution, the most commonage group was from two to four decade. (75.3%) 3. The most common clinical symptom was classical abdominal pain as86.5%. 4. The positive radiographic findings were obtained 75.7% of all cases. 5. Common radiographic findings as follows; 1) Reflex ileus on RLQ (73.7%) 2) Obliteration of Rt. psoas line (41.3%) 3) Scoliosis of lumbar spine(21.2%) 6. The most common site of appendix was retrocecal in position. (84.2%) 7. One case of appendicolith and one case of appendiceal diverticulum were demonstrated.
Abdomen, Acute ; Abdominal Pain ; Age Distribution ; Appendicitis ; Appendix ; Barium ; Diverticulum ; Enema ; Female ; Humans ; Ileus ; Male ; Pathology ; Reflex ; Scoliosis ; Young Adult

PURPOSE: This study was undertaken to describe the clinicopathologic characteristics and evaluate the appropriate management of appendiceal tumors. METHODS: During 5 years between Sep. 2000 and Sep. 2005, 28 appendiceal tumors were identified in a retrospective review of 3,744 cases of appendectomy or right hemicolectomy pathology. RESULTS: Carcinoids were found incidentally as appendicitis. Mucinous cystadenomas were common in women older than 50 aged; half of the cases presented with appendicitis and the other half presented with non-specific abdominal symptoms such as palpable mass, intestinal obstruction and intussusception. Carcinomas were common in the older patients (mean age: 62.8 years) and this presented as periappendiceal abscess. Right hemicolectomy was undertaken when there was evidence of tumor spread beyond the resection margin, and carcinoma and tumors were located in the appendiceal base. Recurrence and metastasis were identified only in the carcinoma cases. CONCLUSION: Most appendiceal tumors presented with appendicitis and periappendiceal abscess. One stage curative resection was possible in more than 76% of the patients, and the prepoperative diagnosis rate was less than 35%. The preoperative diagnosis did not have much impact on the clinical course, and the postoperative pathology was important in determining the additional treatment. Close follow-up is needed for the early detection of recurrence, and all the carcinomas that were advanced as serosal involvement, peritoneal seeding and liver metastasis.
Abscess ; Appendectomy* ; Appendicitis ; Appendix ; Carcinoid Tumor ; Cystadenoma, Mucinous ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Intestinal Obstruction ; Intussusception ; Liver ; Neoplasm Metastasis ; Pathology ; Recurrence ; Retrospective Studies

PURPOSE: Multiple methods are used to diagnose acute appendicitis. However, with the current practice, the negative laparotomy rate for acute appendicitis is from 15% up to 30%. This study was designed to evaluate various pathologies of the appendix and other intraabdominal organs of patients preoperatively diagnosed with acute appendicitis and to analyze clinically the difference between acute appendicitis and other intraabdominal inflammatory diseases. METHODS: We reviewed the pathologic reports of 833 patients who underwent laparotomies for acute appendicitis from January 1997 to December 2001. We grouped these patients by pathology. Group I included patients with a negative appendectomy and no other intraabdominal pathology, group II included those with lesions within the appendix, and group III, those with intraabdominal lesions other than in the appendix. We also analyzed the age, sex distributions, the typical symptoms of appendicitis, the duration of symptoms, fever, and leukocytosis of 100 patients with typical appendicitis by random sampling to find the clinical differences that existed between pelvic inflammatory disease and cecal diverticular disease presented as appendicitis. RESULTS: The diagnostic accuracy for acute appendicitis was 79.7%, and the negative appendectomy and negative laparotomy rates were 17.4% and 15.5%, respectively. The percents of patients in group I, II, and III were 10.4%, 82.6%, and 7.0%, respectively. CONCLUSIONS: It is important to consider the possibility of various pathologies during diagnostic and operative procedures for an acute abdomen, especially one occurring in the right lower quadrant.
Abdomen, Acute ; Appendectomy ; Appendicitis* ; Appendix ; Diagnosis, Differential* ; Female ; Fever ; Humans ; Laparotomy ; Leukocytosis ; Pathology* ; Pelvic Inflammatory Disease ; Sex Distribution ; Surgical Procedures, Operative