Clinical significance of appendiceal diverticulum: a significant marker for appendiceal neoplasia in Australian patients.

Autor: Chan DL; Department of Surgery, Campbelltown Hospital, Sydney, Australia.; Faculty of Medicine, Department of Surgery, University of New South Wales, Sydney, Australia., Lim C; Department of Surgery, Campbelltown Hospital, Sydney, Australia., Bakhtiar A; Department of Surgery, Campbelltown Hospital, Sydney, Australia., Khoury M; Department of Surgery, Campbelltown Hospital, Sydney, Australia., Smigelski M; Western Sydney University, Sydney, Australia.; The MARCS Institute for Brain, Behaviour and Development, Penrith, Australia., Yeh D; Department of Surgery, Campbelltown Hospital, Sydney, Australia.; Western Sydney University, Sydney, Australia., Ravindran P; Department of Surgery, Campbelltown Hospital, Sydney, Australia. dr.praveenravindran@gmail.com.; Western Sydney University, Sydney, Australia. dr.praveenravindran@gmail.com.; The MARCS Institute for Brain, Behaviour and Development, Penrith, Australia. dr.praveenravindran@gmail.com.; Department of Surgery, Liverpool Hospital, Liverpool, NSW, Australia. dr.praveenravindran@gmail.com.
Jazyk: angličtina
Zdroj: International journal of colorectal disease [Int J Colorectal Dis] 2018 Nov; Vol. 33 (11), pp. 1569-1574. Date of Electronic Publication: 2018 May 21.
DOI: 10.1007/s00384-018-3086-7
Abstrakt: 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.
Databáze: MEDLINE
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