Daniel Leonard Chan1,2, Christopher Lim1, Arsalan Bakhtiar1, Matthew Khoury1, Michelle Smigelski3,4, Dean Yeh1,3, Praveen Ravindran5,6,7,8. 1. Department of Surgery, Campbelltown Hospital, Sydney, Australia. 2. Faculty of Medicine, Department of Surgery, University of New South Wales, Sydney, Australia. 3. Western Sydney University, Sydney, Australia. 4. The MARCS Institute for Brain, Behaviour and Development, Penrith, Australia. 5. Department of Surgery, Campbelltown Hospital, Sydney, Australia. dr.praveenravindran@gmail.com. 6. Western Sydney University, Sydney, Australia. dr.praveenravindran@gmail.com. 7. The MARCS Institute for Brain, Behaviour and Development, Penrith, Australia. dr.praveenravindran@gmail.com. 8. Department of Surgery, Liverpool Hospital, Liverpool, NSW, Australia. dr.praveenravindran@gmail.com.
Abstract
INTRODUCTION: Diverticula of the appendix (DA) have a reported incidence of up to 2.1%. They are primarily detected incidentally, through imaging and intraoperative or histologic diagnosis. This study's objective was to examine the prevalence of DA, and its relationship with inflammation and neoplasia, as well as review the literature with respect to clinical outcomes and ability to identify DA preoperatively. METHODOLOGY: A retrospective search of all patients undergoing an appendicectomy for right lower quadrant pain at a single institution between 2004 and 2017 was conducted. Histopathology reports for evidence of DA, location of the DA, presence of inflammation, and any relationship between DA and neoplasms (adenoma, carcinoma, carcinoid, lymphoma, and mucinous neoplasm) within the appendix were reviewed. Clinical notes, operative records, and preoperative imaging were also reviewed. RESULTS: Two thousand seven hundred eleven patient were included in the study, with a mean age of 34 years, with acute appendicitis found in 82.5%. 31.6% of patients with DA had associated inflammation of the DA. DA was present in 57 patients (2.1%), with 55 patients in the total cohort having neoplasia (2.0%). Patients with DAs were ten times more likely to have appendicular neoplasm than patients without a DA (17.5 vs 1.8%; p < 0.0001, OR 11.8 95%, CI 5.6-24.8). CONCLUSION: This is the first Australian study demonstrating DAs are a significant marker of appendiceal neoplasm. Appendicectomy in all incidentally discovered diverticulum should be considered. Due to a paucity of data, research is required into this area to assess for the need for endoscopy following diagnosis.
INTRODUCTION: Diverticula of the appendix (DA) have a reported incidence of up to 2.1%. They are primarily detected incidentally, through imaging and intraoperative or histologic diagnosis. This study's objective was to examine the prevalence of DA, and its relationship with inflammation and neoplasia, as well as review the literature with respect to clinical outcomes and ability to identify DA preoperatively. METHODOLOGY: A retrospective search of all patients undergoing an appendicectomy for right lower quadrant pain at a single institution between 2004 and 2017 was conducted. Histopathology reports for evidence of DA, location of the DA, presence of inflammation, and any relationship between DA and neoplasms (adenoma, carcinoma, carcinoid, lymphoma, and mucinous neoplasm) within the appendix were reviewed. Clinical notes, operative records, and preoperative imaging were also reviewed. RESULTS: Two thousand seven hundred eleven patient were included in the study, with a mean age of 34 years, with acute appendicitis found in 82.5%. 31.6% of patients with DA had associated inflammation of the DA. DA was present in 57 patients (2.1%), with 55 patients in the total cohort having neoplasia (2.0%). Patients with DAs were ten times more likely to have appendicular neoplasm than patients without a DA (17.5 vs 1.8%; p < 0.0001, OR 11.8 95%, CI 5.6-24.8). CONCLUSION: This is the first Australian study demonstrating DAs are a significant marker of appendiceal neoplasm. Appendicectomy in all incidentally discovered diverticulum should be considered. Due to a paucity of data, research is required into this area to assess for the need for endoscopy following diagnosis.
Entities:
Keywords:
Appendectomy; Appendix; Diverticulum; General surgery; Neoplasms
Authors: Joseph Misdraji; Rhonda K Yantiss; Fiona M Graeme-Cook; Ulysses J Balis; Robert H Young Journal: Am J Surg Pathol Date: 2003-08 Impact factor: 6.394
Authors: Sree Harsha Tirumani; Margaret Fraser-Hill; Rebecca Auer; Wael Shabana; Cynthia Walsh; Frank Lee; John G Ryan Journal: Cancer Imaging Date: 2013-02-22 Impact factor: 3.909