Omental torsion is a rare cause of acute surgical abdomen from omental twisting leading to distal vascular compromise. Preoperative diagnosis has been a dilemma as clinical features, laboratory and radiographic findings are nonspecific and variable, closely mimicking acute appendicitis. Surgical excision has been suggested to offer rapid symptom relief and postoperative recovery. Presented here is a case of a 59-year-old male with omental torsion who presented with generalized abdominal tenderness and was preoperatively diagnosed as ruptured appendicitis who underwent laparotomy with uneventful post-operative course.

Appendicitis is one of the most commonly encountered general surgery emergencies worldwide and has been extensively studied. However, anatomical variations in the position of the appendix may result in atypical clinical presentations, leading to diagnostic difficulty and delays in management. Reported here is a case of subhepatic appendicitis in a young adult patient who successfully underwent laparoscopic appendectomy. Subhepatic appendicitis is a rare surgical entity that should be considered in patients presenting with right upper quadrant abdominal pain. Contrast-enhanced computed tomography and laparoscopy are valuable tools in the diagnosis and management of this uncommon condition.

Amyand’s hernia is a hernia where the appendix is within the inguinal hernial sac. It is often diagnosed by chance due its indeterminate clinical presentation. This case reports a 50-year-old Filipino male who presented with direct and rebound tenderness on the lower abdomen in the presence of a right inguinal bulge. CT scan showed an appendix coursing inferiorly into the pelvis, herniating through a 2 cm defect of the anterior abdominal muscle into the right inguinal region along with mesenteric fat. Laparoscopy confirmed acute appendicitis within an inguinal hernia (Amyand’s hernia Type 2). Diagnostic laparoscopy, appendectomy and primary repair of the right inguinal ring were performed. The patient had an unremarkable post-operative course and was discharged after 2 days. He was advised to undergo IPOM to prevent hernia recurrence. Laparoscopic management can be a safe option for cases of Amyand’s hernia.

Epithelial tumors of the appendix refer to neoplastic lesions originating from the epithelial tissue of the appendix mucosa. These neoplasms exhibit highly heterogeneous pathological features and biological behavior, which contribute to their strong propensity for peritoneal metastasis. Currently, evidence-based medicine regarding appendiceal epithelial neoplasms and the management of their peritoneal metastasis is limited, leading to a lack of standardized clinical practices. To address this, the Professional Committee of Integrated Rehabilitation for Peritoneal Tumors of the Chinese Anti-Cancer Association has organized multidisciplinary experts to focus on key aspects such as the pathological classification of epithelial tumors of the appendix, clinical staging of tumors,the indications for extended resection after local resection, the surgical treatment strategies for concurrent peritoneal metastasis, perioperative rehabilitation, and individualized treatment, while integrating the technical capabilities of relevant specialties. At the same time, it has standardized the perioperative management of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), as well as the clinical application of the pre-rehabilitation system, to enhance the practical operability. Ultimately, the Expert Consensus on the Comprehensive Management of Peritoneal Metastasis from Appendiceal Epithelial Neoplasms (2025 Edition) was developed. This consensus is aimed at further standardizing the systematic diagnosis and treatment process of epithelial tumors of the appendix, thereby reducing the risk of recurrence, improving patient prognosis, and promoting the standardization and homogenization of the diagnosis and treatment of peritoneal metastasis from such tumors.
Humans ; Appendiceal Neoplasms/therapy* ; Peritoneal Neoplasms/therapy* ; Cytoreduction Surgical Procedures ; Consensus ; Hyperthermic Intraperitoneal Chemotherapy

The gut-brain axis is a bidirectional communication pathway connecting the central nervous system and gastrointestinal tract,playing a key role in the occurrence and development of diseases related to this axis.The vermiform appendix,as a part of the gut that is connected to the cecum,has a unique anatomical location,a rich microbiome,and abundant immune cells.Appendicitis and appendectomy have been found to be associated with the development of diseases related to the gut-brain axis.This review first introduces the anatomy and functions of the vermiform appendix and then expounds the associations of appendicitis and appendectomy with diseases related to the gut-brain axis.Furthermore,this review summarizes and prospects the mechanisms of the vermiform appendix in affecting the occurrence and development of diseases related to the gut-brain axis.
Humans ; Appendix/anatomy & histology* ; Brain ; Appendicitis ; Appendectomy/adverse effects* ; Gastrointestinal Microbiome ; Brain-Gut Axis

Both carcinoembryonic antigen and CA19-9 are considered as predictive markers of intestinal cancer recurrence and metastasis.In addition,CA19-9 elevation is considered as a predictive marker of connective tissue disease-related interstitial lung disease.The incidence of oxaliplatin and capecitabine-associated interstitial lung disease is low,and there is no report about CA19-9 as a predictive marker of oxaliplatin and capecitabine-associated interstitial lung disease.This paper reports a case of interstitial lung disease with CA19-9 elevation caused by oxaliplatin and capecitabine adjuvant therapy for ileocecal carcinoma.The change trend of serum carcinoembryonic antigen in this patient was consistent with tumor recurrence and metastasis,and that of serum CA19-9 was consistent with the severity of interstitial lung disease.Therefore,CA19-9 elevation after intestinal cancer surgery does not necessarily indicate the tumor recurrence and metastasis,and attention should be paid to the possibility of oxaliplatin and capecitabine-associated interstitial lung disease.
Humans ; CA-19-9 Antigen/blood* ; Capecitabine ; Cecal Neoplasms/drug therapy* ; Chemotherapy, Adjuvant ; Deoxycytidine/administration & dosage* ; Fluorouracil/administration & dosage* ; Lung Diseases, Interstitial/blood* ; Organoplatinum Compounds/administration & dosage* ; Oxaliplatin

Objective To evaluate the diagnostic value of ultrasound in chronic appendicitis. Methods A retrospective analysis was conducted on the ultrasound imaging features of the appendixes in 68 patients with chronic appendicitis (chronic appendicitis group) confirmed by pathological results at the Affiliated Hospital of Inner Mongolia Medical University from January 2023 to December 2024,as well as 85 healthy volunteers (normal appendix group) of different ages with no history of abdominal pain during the same period.Multivariate Logistic regression was employed to investigate the sensitivity and specificity of different variables in diagnosing chronic appendicitis. Results The chronic appendicitis group had higher appendix diameter (Z=-8.47,P<0.001),unilateral wall thickness (Z=-7.16,P<0.001),and submucosal thickness (Z=-9.73,P<0.001) than the normal appendix group.Appendix diameter (OR=3.11,95%CI=1.37-7.02,P=0.006) and submucosal thickness (OR=5 492.73,95%CI=89.53-336 984.13,P<0.001) were identified as independent factors for diagnosing chronic appendicitis,while gender,age,unilateral wall thickness,and intraluminal conditions had no significant impact on the diagnosis of chronic appendicitis (all P>0.05).When appendix diameter combined with submucosal thickness was used as a joint diagnostic indicator,the model demonstrated the best performance,with the sensitivity of 92.65%,the specificity of 97.65%,and the accuracy increasing to 95.42%. Conclusion The combined use of appendix diameter and submucosal thickness can significantly improve the accuracy,specificity,and reliability of ultrasound in diagnosing chronic appendicitis.
Humans ; Appendicitis/diagnostic imaging* ; Ultrasonography ; Retrospective Studies ; Male ; Female ; Adult ; Chronic Disease ; Middle Aged ; Appendix/diagnostic imaging* ; Sensitivity and Specificity ; Young Adult ; Logistic Models ; Adolescent

Background: Tiered services, differentiated by the financial capacity of patients and related payment arrangements with hospitals, are the norm in Philippine facilities. This study considered how these, together with selected demographic and clinical factors, were associated with surgical care utilization, provision, and outcomes for patients with appendicitis in a public university hospital.

Methods: This was a retrospective cohort study, utilizing data obtained from an electronic patient registry. Patients who underwent emergent appendectomies from January 2017 to December 2018 were included. Data were analyzed using multivariate and logistic regression, with the following dependent variables: time from symptom onset to emergency department consultation (ED Lag), time from consult to surgery (OR Lag), selection for laparoscopic appendectomy (LA), the occurrence of complicated appendicitis (CA), and length of stay (LOS). Morbidities and mortalities were tallied.

Results: There were 1,501 patients included in the study. Young adult males comprised the majority and mostly had non-private accommodations. Non-CA was the impression in more than 80% of cases. Extremes of age were associated with longer ED and OR Lags, greater likelihood of CA, and longer LOS. Patients initially assessed as having CA had shorter OR Lags, were less likely to undergo LA, and had longer LOS. Private patients were more likely to have undergone LA, lower CA odds, and slightly longer LOS.

Conclusions: Variations in surgical care utilization, provision, and outcomes for patients with appendicitis were independently associated with socioeconomic and clinical status differences.

Abdominal Pain/etiology* ; Acute Disease ; Appendicitis/diagnosis* ; Diabetes Mellitus ; Diabetic Ketoacidosis/diagnosis* ; Diagnostic Errors/adverse effects* ; Humans ; Insulin

INTRODUCTION: This study aimed to investigate the ultrasonographic features of paediatric acute appendicitis and incorporate them into a scoring algorithm that will quantify the risk of complications and the strength of recommendation for surgical intervention. METHODS: 179 patients with suspected appendicitis who had undergone ultrasonographic examination were included in this study. Based on their medical evaluation and post-surgical histopathological results, patients were categorised into confirmed appendicitis (n = 101) and non-appendicitis (n = 78) groups. RESULTS: In the appendicitis group, the appendix was visualised in 66 (65.3%) patients. In cases where the appendix was not visualised, we looked out for secondary inflammatory signs, which were present in 32 (31.7%) patients. Using stepwise logistic regression, Blumberg's sign, free fluid or collection, hyperaemia, non-compressible appendix and an appendix diameter > 7 mm were found to be significant predictive factors for appendicitis. A new scoring system called POPs was developed, combining inflammatory predictors and ultrasonography findings, with an area under the receiver operating characteristic curve of 0.958 (95% confidence interval 0.929-0.986). CONCLUSION The newly developed POPs-based diagnosis scheme proved a promising alternative to existing scoring systems such as the Alvarado score. Although further calibration would be beneficial, the proposed scoring scheme is simple and easy to understand, memorise and apply in the emergency room.
Acute Disease ; Appendectomy ; Appendicitis/surgery* ; Appendix/surgery* ; Child ; Humans ; Sensitivity and Specificity ; Ultrasonography/methods*