World Journal of Laparoscopic Surgery

Register      Login

VOLUME 14 , ISSUE 1 ( January-April, 2021 ) > List of Articles

Original Article

Do We Still Encounter Non-appendicitis Pathologies during Laparoscopic Appendectomy?

Yasser A Orban, Mohammed Algazar, Ahmed Farag, Tamer R Elalfy

Citation Information : Orban YA, Algazar M, Farag A, Elalfy TR. Do We Still Encounter Non-appendicitis Pathologies during Laparoscopic Appendectomy?. World J Lap Surg 2021; 14 (1):10-14.

DOI: 10.5005/jp-journals-10033-1432

License: CC BY-NC 4.0

Published Online: 01-04-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Aims and objectives: Acute appendicitis is the most common surgical disease with a lifetime risk of 7–8%. Numerous studies have shown many benefits of laparoscopic appendectomy over open appendectomies, such as better visualization and identification of other abdominal pathologies that can mimic acute appendicitis. Herein, we illustrated the current incidence of non-appendicitis pathologies during laparoscopic appendectomies in our hospital. Materials and methods: A retrospective study was carried out involving patients operated for acute appendicitis laparoscopically at the Surgical Emergency Unit, Zagazig University Hospitals, Egypt, during the period from March 2017 to December 2019. The diagnosis of acute appendicitis was based on clinical examination, laboratory findings, and ultrasonography. We drew out the patients’ demographic data, duration of surgery, and surgical procedure reports. Results: One hundred forty-five patients presented clinically, and confirmed by laboratory and ultrasonography with the diagnosis of acute appendicitis. Eighty-nine were males, 56 were females. The median operative time was 56.5 minutes. Eight cases (5.5%) showed a pathology other than acute appendicitis, including gynecological pathologies, Mickel's diverticulitis, inflamed sigmoid appendices epiploica, low-grade appendiceal mucinous neoplasm, and inflamed cecal diverticulum. Conclusion: Diagnosis of acute appendicitis is challenging up to date. We faced many conditions mimicking acute appendicitis during surgical intervention.

  1. Sartelli M, Baiocchi GL, Di Saverio S, et al. Prospective observational study on acute appendicitis worldwide (POSAW). World J Emerg Surg 2018;13(1):19. DOI: 10.1186/s13017-018-0179-0.
  2. Vellei S, Borri A. Single-incision versus three-port laparoscopic appendectomy: short- and long-term outcomes. J Laparoendosc Adv Surg Tech 2017;27(8):804–811. DOI: 10.1089/lap.2016.0406.
  3. Cheng H-T, Wang Y-C, Lo H-C, et al. Laparoscopic appendectomy versus open appendectomy in pregnancy: a population-based analysis of maternal outcome. Surg Endosc 2015;29(6):1394–1399. DOI: 10.1007/s00464-014-3810-5.
  4. Yabanoglu H, Caliskan K, Aytac HO, et al. Unusual findings in appendectomy specimens of adults: retrospective analyses of 1466 patients and a review of literature. Iran Red Crescent Med J 2014;16(2):e12931–e12931. DOI: 10.5812/ircmj.12931.
  5. Karam AR, Birjawi GA, Sidani CA, et al. Alternative diagnoses of acute appendicitis on helical CT with intravenous and rectal contrast. Clin Imaging 2007;31(2):77–86. DOI: 10.1016/j.clinimag.2006.12.023.
  6. Howell JM, Eddy OL, Lukens TW, et al. Clinical policy: critical issues in the evaluation and management of emergency department patients with suspected appendicitis. Ann Emerg Med 2010;55(1):71–116. DOI: 10.1016/j.annemergmed.2009.10.004.
  7. Petroianu A. Diagnosis of acute appendicitis. Int J Surg 2012;10(3):115–119. DOI: 10.1016/j.ijsu.2012.02.006.
  8. Mettler FA, Huda W, Yoshizumi TT, et al. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 2008;248(1):254–263. DOI: 10.1148/radiol.2481071451.
  9. Guite KM, Hinshaw JL, Ranallo FN, et al. Ionizing radiation in abdominal CT: unindicated multiphase scans are an important source of medically unnecessary exposure. J Am Coll Radiol 2011;8(11):756–761. DOI: 10.1016/j.jacr.2011.05.011.
  10. Markar SR, Karthikesalingam A, Cunningham J, et al. Increased use of pre-operative imaging and laparoscopy has no impact on clinical outcomes in patients undergoing appendicectomy. Ann R Coll Surg Engl 2011; 93(8):620–623. DOI: 10.1308/003588411X13165261994076.
  11. Boyd CA, Riall TS. Unexpected gynecologic findings during abdominal surgery. Curr Probl Surg 2012;49(4):195–251. DOI: 10.1067/j.cpsurg.2011.12.002.
  12. Seetahal SA, Bolorunduro OB, Sookdeo TC, et al. Negative appendectomy: a 10-year review of a nationally representative sample. Am J Surg 2011;201(4):433–437. DOI: 10.1016/j.amjsurg.2010.10.009.
  13. Grabowski A, Korlacki W, Pasierbek M. Laparoscopy in elective and emergency management of ovarian pathology in children and adolescents. Wideochir Inne Tech Maloinwazyjne 2014;9(2):164–169. DOI: 10.5114/wiitm.2014.41626.
  14. Novoa RA, Shaffer K. Meckel's diverticulitis presenting with abdominal pain and angina. Radiol Case Rep 2015;3(3):166. DOI: 10.2484/rcr.v3i3.166.
  15. Yamaguchi M, Takeuchi S, Awazu S. Meckel's diverticulum. Am J Surg 1978;136(2):247–249. DOI: 10.1016/0002-9610(78)90238-6.
  16. Sand M, Gelos M, Bechara FG, et al. Epiploic appendagitis—clinical characteristics of an uncommon surgical diagnosis. BMC Surg 20077:11. DOI: 10.1186/1471-2482-7-11.
  17. Suresh Kumar VC, Mani KK, Alwakkaa H, et al. Epiploic appendagitis: an often misdiagnosed cause of acute abdomen. Case Rep Gastroenterol 2019;13(3):364–368. DOI: 10.1159/000502683.
  18. van Breda Vriesman AC, Cobben LP, Coerkamp EG, et al. Epiploic appendagitis: MR appearance. Clin Radiol Extra 2002;57(8):3–6. DOI: 10.1053/crae.2002.0002.
  19. Vázquez GM, Manzotti ME, Alessandrini G, Primary epiploic appendagitis: clinical features in 73 cases. Medicina (B Aires) 2014;74(6):448–450. PMID: 25555004.
  20. Patel NB, Wenzke DR. Evaluating the patient with right lower quadrant pain. Radiol Clin North Am 2015;53(6):1159–1170. DOI: 10.1016/j.rcl.2015.06.004.
  21. Yilmaz Ö, Kiziltan R, Bayrak V, et al. Uncommon caecum diverticulitis mimicking acute appendicitis. Case Rep Surg 2016;2016. DOI: 10.1155/2016/5427980.
  22. Oudenhoven LF, Koumans RK, Puylaert JB. Right colonic diverticulitis: US and CT findings-new insights about frequency and natural history. Radiology 1998;208(3):611–618. DOI: 10.1148/radiology.208.3.9722836.
  23. Pantiora EV, Massaras D, Koutalas J, et al. Low-grade appendiceal mucinous neoplasm presenting as adnexal mass: a case report. Cureus 2018;10(11):e3568–e3568. DOI: 10.7759/cureus.3568.
  24. Shaib WL, Assi R, Shamseddine A, et al. Appendiceal mucinous neoplasms: diagnosis and management. Oncologist 2017;22(9):1107–1116. DOI: 10.1634/theoncologist.2017-0081.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.