The acute scrotum (AS) in the pediatric population is a medical emergency. AS is usually caused by testicular torsion (TT) and torsion of the appendix testis (TAT). The current study explored which demographic and clinical characteristics can help distinguish between TT and TAT. We analyzed all children ≤16 years who underwent surgical exploration for AS. The patients were divided into Group 1/TT and Group 2/TAT. Ninety patients were included in the study (24 with TT and 66 with TAT). The peak incidence of TT was significantly higher than in the TAT group (p<0.001). Scrotal pain was more prevalent in the TAT group (p=0.02), whereas systemic signs (nausea/vomiting and abdominal pain) affected more frequently the TT patients (p=0.003 and p<0.001, respectively). The duration of symptoms was significantly longer in the TAT group (p<0.001). The duration of symptoms in the TT cohort significantly impacted the testicular salvage (p=0.008). Color Doppler ultrasound (CDUS) findings of absent/decreased testicular blood flow in the affected testis strongly favored the diagnosis of TT (p<0.001). The older age, shorter duration of symptoms, systemic signs, and CDUS findings can help distinguish between the two most common acute scrotum causes.

• MeSH
• Appendix * MeSH
• Demography MeSH
• Child MeSH
• Humans MeSH
• Retrospective Studies MeSH
• Testis diagnostic imaging   MeSH
• Spermatic Cord Torsion * diagnosis   surgery   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH

• MeSH
• Appendectomy MeSH
• Appendix * anatomy & histology   immunology   growth & development   MeSH
• Ecological and Environmental Phenomena MeSH
• Humans MeSH
• Primates MeSH
• Mammals MeSH
• Gastrointestinal Microbiome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Appendiceal mucocele is a rare disease with an incidence of 0.07-0.63% of all appendectomies and was first described in 1842 by Carl von Rokitansky. It is defined as an abnormal intraluminal accumulation of mucin. The clinical picture of AM can vary from asymptomatic mass in the right lower quadrant to symptoms of acute appendicitis. In some cases, AM can be found accidentally on CT performed due to other reasons or during surgery. Diagnosis consists mainly of imaging methods such as ultrasound, CT, and MRI with the finding of encapsulated cystic mass with calcifications. The main goal of surgical treatment is to remove an intact mucocele and prevent spillage of mucin into the peritoneal cavity. We present a case of large mucocele treated with laparoscopic right hemicolectomy.

• MeSH
• Appendix * diagnostic imaging   surgery   MeSH
• Colectomy MeSH
• Laparoscopy * MeSH
• Humans MeSH
• Mucins MeSH
• Mucocele * diagnostic imaging   surgery   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

Mukokéla apendixu je obstrukční dilatace apendixu, která vzniká v důsledku vyplnění jeho lumen hlenem. Jedná se o vzácný stav, který je u poloviny pacientů asymptomatický. Jeho závažnost závisí na příčině vzniku dilatace apendixu. V malém procentu případů dochází k ruptuře dilatovaného apendixu s rozvojem závažné komplikace, která se označuje jako pseudomyxom peritonea. Protože část mukokél vzniká na maligním podkladě, je tento stav většinou řešen chirurgickou resekcí.

Appendiceal mucocele is an obstructive dilatation of the appendix, which results from the filling of its lumen with mucus. This is a rare condition that is asymptomatic in half of the patients. Its severity depends on the cause of appendiceal dilatation. In a small percentage of cases, the dilated appendix ruptures, leading to the development of serious complication; this is termed as pseudomyxoma peritonei. Due to the possibility of malignant etiology of the mucocele, surgical resection remains an essential part of the treatment.

• Keywords
• mukokéla apendixu, apendikální mucinózní neoplazie,
• MeSH
• Appendix * surgery   pathology   MeSH
• Diagnostic Imaging methods   MeSH
• Diagnosis, Differential MeSH
• Humans MeSH
• Mucocele * surgery   diagnosis   pathology   MeSH
• Appendiceal Neoplasms surgery   diagnostic imaging   MeSH
• Tomography, X-Ray Computed methods   MeSH
• Pseudomyxoma Peritonei diagnosis   MeSH
• Ultrasonography methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

BACKGROUND: Closure of the appendix stump presents the most critical part of laparoscopic appendectomy. The aim of the present study was to compare the medical outcomes and cost analysis of laparoscopic appendectomy with respect to the different methods of stump closure. METHODS: This was a prospective randomized clinical trial conducted in a single institution (University Hospital Ostrava) within a 2-year study period. All included patients were randomized into one of three trial arms (endoloop, hem-o-lok clips or endostapler). RESULTS: In total, 180 patients (60 patients in each arm) were enrolled into the study. The mean length of hospital stay (3.6 ± 1.7 days) was comparable in all study arms. The shortest operative time was noted in the hem-o-lok subgroup of patients (37.9 ± 12.5 min). Superficial surgical site infection was detected in 4.4% of study patients; deep surgical site infection was noted in 1.7% of the patients. The frequency of surgical site infections was comparable in all study arms (p = 0.7173). The mean direct costs of laparoscopic appendectomy were significantly the lowest in the hem-o-lok subgroup of patients. Laparoscopic appendectomy is not a profit-making procedure in our institution (mean profit of made from the study patients was-104.3 ± 579.2 Euro). Closure of the appendix stump by means of endostapler presents the most expensive and the highest loss-incurring technique (p = 0.0072). CONCLUSIONS: The present study indicates that all technical modifications of appendix stump closure are comparable with regards to postoperative complications. The stapler technique is significantly the most expensive. We concluded that hem-o-lok clips have the potential for becoming the preferred method of securing the appendix base during laparoscopic appendectomy. Trial registration NCT03750032 ( http://www.clinicaltrials.gov ).

• MeSH
• Appendectomy MeSH
• Appendicitis * surgery   MeSH
• Appendix * MeSH
• Laparoscopy * MeSH
• Humans MeSH
• Prospective Studies MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH

• Keywords
• hypertermická intraperitoneální chemoterapie, HIPEC,
• MeSH
• Appendix pathology   MeSH
• Cytoreduction Surgical Procedures methods   MeSH
• Hyperthermia, Induced methods   MeSH
• Humans MeSH
• Mucocele * therapy   MeSH
• Peritoneum surgery   MeSH
• Pseudomyxoma Peritonei * etiology   therapy   MeSH
• Check Tag
• Humans MeSH

Úvod: Diagnostika akutní apendicitidy je založena na klinické symptomatologii, hodnocení laboratorních biomarkerů zánětu a na výsledcích zobrazovacích vyšetření. Přesná předoperační diagnostika je klíčovým faktorem ke snížení počtu tzv. negativních apendektomií. Předmětem našeho zájmu bylo zhodnocení významu ultrazvuku v diagnostickém algoritmu akutní apendicitidy. Dále jsme hodnotili přesnost operační diagnózy hodnocené chirurgem ve srovnání s histologickým nálezem. Metody: Provedli jsme retrospektivní analýzu pacientů operovaných pro akutní apendicitidu na naší klinice v období 2015–2017. Porovnali jsme výsledky předoperačních zobrazovacích vyšetření (ultrazvuk, CT) a operační diagnózu (z operačního protokolu) s definitivním histologickým nálezem. Výsledky: Pro akutní apendicitidu bylo operováno 386 pacientů. Na základě histologického vyšetření bylo diagnostikováno 33 (9 %) bez známek zánětu, 309 (80 %) se zánětlivými změnami, 37 chronických apendicitid (10 %) a 7 jiných histologických nálezů (2 %). Ultrazvuk byl proveden u 382 pacientů (99 %). Falešně negativní byl ultrazvuk u 18 pacientů (6 %) z 309 pacientů s histologicky potvrzeným zánětem. Falešně pozitivní byl ultra-zvuk u 16 pacientů (48 %) z 33 pacientů s definitivní histologií bez známek zánětu. Nediagnostický byl ultrazvuk u 104 pacientů (27 %). Operační diagnóza apendixu bez zánětu byla chirurgem popsána u 27 pacientů (7 %). Z toho bylo histologicky bez zánětu 12 případů (44 %), s akutním zánětem 7 případů (26 %), s chronickým zánětem 7 případů (26 %) a 1 jiný nález (4 %). Závěr: Ultrazvuk je vhodná zobrazovací metoda na potvrzení diagnózy akutní apendicitidy, ale ne na její vyloučení. Peroperační hodnocení nálezu na apendixu chirurgem není spolehlivé. Peroperačně hodnocený nezanícený apendix by měl být odstraněn.

Introduction: The diagnostic process of acute appendicitis is based on clinical symptoms, evaluation of laboratory biomarkers of inflammation and imaging examinations results. Accurate preoperative diagnosis is a key factor in reducing the number of so-called negative appendectomies. The aim of our study was to evaluate the importance of ultrasound in the diagnostic algorithm of acute appendicitis. We also compared the accuracy of the intraoperative diagnosis evaluated by the surgeon with the histopathological findings. Methods: We performed a retrospective analysis of patients operated for acute appendicitis at our surgical department in time period from 2015 to 2017. We compared the results of preoperative imaging examinations (ultrasound, CT) and intraoperative diagnosis (from the surgical record) with final histopathological findings. Results: 386 patients were operated on for acute appendicitis. Histopathological examination revealed 33 patients (9%) with no signs of inflammation, 309 patients (80%) with inflammatory changes, 37 cases (10%) with chronic appendicitis and 7 other histological findings (2%). Ultrasound was performed in 382 patients (99%). False negative ultrasound was obtained in 18 (6%) of 309 patients with histologically confirmed inflammation. Ultrasound gave a false positive finding in 16 (48%) of 33 patients whose histology revealed no signs of inflammation. Equivocal ultrasound was obtained in 104 patients (27%). Intraoperative diagnosis of appendix without inflammation was described by the surgeon in 27 patients (7%). Of these, 12 cases (44%) were histologically non-inflammatory, 7 cases (26%) with acute inflammation, 7 cases (26%) with chronic inflammation and 1 other finding (4%). Conclusion: Ultrasound is a suitable imaging method to confirm the diagnosis of acute appendicitis but not to rule it out. Intraoperative assessment of the appendix by the surgeon is not reliable. Any appendix intraoperatively evaluated as showing no signs of inflammation should be removed.

• MeSH
• Acute Disease MeSH
• Appendectomy MeSH
• Appendicitis * diagnostic imaging   therapy   MeSH
• Appendix anatomy & histology   MeSH
• False Negative Reactions MeSH
• False Positive Reactions MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Ultrasonography MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Úvod: Crohnova choroba je chronické zánětlivé autoimunitní onemocnění, jehož příčina není ani v dnešní době přesně známa. Onemocnění může postihovat jakoukoliv část gastrointestinálního traktu, nicméně nejčastěji postiženou částí je terminální ileum. Crohnova choroba jako taková častěji postihuje ženy a mladší věkové skupiny. Typickými příznaky nemoci jsou průjem, bolesti břicha, ztráta hmotnosti a horečky. Část postižených může mít i extraintestinální příznaky, jako např. exantém, bolesti kloubů, záněty spojivek či méně často jaterní lézi. Kazuistika: V našem sdělení představujeme případ Crohnovy choroby s izolovaným postižením apendixu, kdy defi nitivní diagnóza byla stanovena až z resekátu. Atypická byla u naší pacientky zejména plíživá symptomatologie a endoskopický obraz, neboť většina pacientů s M. Crohn apendixu se prezentuje jako akutní apendicitida. Závěr: M. Crohn apendixu je relativně vzácná varianta této choroby a je méně agresivní oproti jiným místům postižení, chirurgická resekce (apendektomie) je považována za kurativní a riziko relapsů je velice nízké.

Introduction: Crohn's disease is a chronic inflammatory autoimmune disease with unknown etiology. Although the disease may involve any part of the gastrointestinal tract, the most frequently affected site is the terminal ileum. Crohn's disease itself is more common in women and in younger patients. Typical symptoms of the condition are diarrhoea, abdominal pain, weight loss and fever. A part of patients may present with extraintestinal symptoms like exanthema, joint pain, conjunctivitis or less often a hepatic lesion. In our publication, we have reported a rare case of Crohn's disease with isolated involvement of the appendix, in which the definitive diagnosis was established after the surgery. Case report: Our patient presented with atypical symptoms and endoscopy findings. The majority of patients with Crohn's disease of the appendix present as if they had acute appendicitis. Conclusion: Appendiceal form of Crohn's disease is a relatively rare variety of Crohn's disease and is less aggressive than in the other locations. Surgical resection (appendectomy) is considered to be curative and the risk of relapse is very low.

• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Appendectomy MeSH
• Appendix * anatomy & histology   pathology   MeSH
• Abdomen diagnostic imaging   MeSH
• Crohn Disease * diagnosis   therapy   MeSH
• Diagnosis, Differential MeSH
• Fever MeSH
• Incidence MeSH
• Colectomy MeSH
• Colonoscopy MeSH
• Middle Aged MeSH
• Humans MeSH
• Rare Diseases MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Appendix * MeSH
• History of Medicine MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Publication type
• Comment MeSH

Apendicitida je nejčastější břišní náhlá příhoda. Diagnóza může být ihned jasná u pacientů s klasickými příznaky a znaky. Atypické příznaky mohou výrazně ztížit stanovení diagnózy a zpozdit léčbu. Klasickým příznakem je bolest. Dále může být nevolnost, zvracení a nechutenství. Vyšetření břicha prokáže lokalizovanou bolestivost a rigiditu břišního svalstva v pravém dolním kvadrantu. Laboratorní vyšetření obvykle prokáže leukocytózu s posunem doleva a zvýšené hodnoty C reaktivního proteinu. Ke stanovení diagnózy výrazně pomohou nativní snímek břicha, ultrasonografické nebo CT vyšetření. V roce 1889 byla apendektomie akceptována jako standardní léčba, protože zachraňovala životy, a od té doby platí dictum: odstranění zánětlivě změněného apendixu je nezbytné!

Appendicitis is the most common abdominal emergency. While the clinical diagnosis may be easy in patients who present with classic signs and symptoms. Atypical presentations may result in diagnostic embarrassment and delay in treatment. Typical sign is abdominal pain. Furthermore, it can be nausea, vomiting and anorexia. Abdominal examination reveals localised tenderness and muscular rigidity in the right lower abdominal quadrant. Laboratory data usually reveal an elevated leukocytosis with a left shift and elevated C-reactive protein. To establish the diagnosis greatly help native abdominal X-ray, ultrasound or CT. In1889, an appendectomy was accepted as the standard treatment, because they save lives and since then dictum: removal of the inflamed appendix changed, it is necessary!

• MeSH
• Abdomen, Acute diagnosis   etiology   physiopathology   MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Appendicitis * history   diagnosis   surgery   complications   physiopathology   MeSH
• Appendix anatomy & histology   physiology   physiopathology   MeSH
• Time Factors MeSH
• Surgical Procedures, Operative MeSH
• History of Medicine MeSH
• History, Modern 1601- MeSH
• History, Medieval MeSH
• Diagnosis, Differential MeSH
• Child MeSH
• Physical Examination MeSH
• Laparoscopy MeSH
• Humans MeSH
• Tomography, X-Ray Computed MeSH
• Aged MeSH
• Pregnancy MeSH
• Check Tag
• History, Medieval MeSH
• Child MeSH
• Humans MeSH
• Aged MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Historical Article MeSH
• Review MeSH