Ectopic liver tissue (choristoma) on the gallbladder: Acomprehensive literature review

BACKGROUND Liver tissue situated outside the liver with a hepatic connection is usually calledan accessory liver, and that without a connection to the mother liver, is calledectopic liver tissue.AIM To identify studies in the literature on ectopic liver tissue located on thegallbladder surface or mesentery.METHODS We present two patients and review published articles on ectopic liver tissuelocated on the gallbladder surface accessed via PubMed, MEDLINE, GoogleScholar, and Google databases. Keywords used included accessory liver lobe,aberrant liver tissue, ectopic liver tissue, ectopic liver nodule, heterotopic livertissue, hepatic choristoma, heterotopic liver tissue on the gallbladder, and ectopicliver tissue on the gallbladder. The search included articles published before June2020 with no language restriction. Letters to the editor, case reports, reviewarticles, original articles, and meeting presentations were included in the search.Articles or abstracts containing adequate information on age, sex, history of liverdisease, preliminary diagnosis, radiologic tools, lesion size, surgical indication,surgical procedure, and histopathological features of ectopic liver tissue wereincluded in the study.RESULTS A total of 72 articles involving 91 cases of ectopic liver tissue located on the gallbladder surface or mesentery were analyzed. Of these 91 patients, 62 werefemale and 25 were male (no gender available for 4 patients), and the age rangewas 5 d to 91 years. Forty-nine patients underwent surgery for chroniccholecystitis or cholelithiasis, and 14 patients underwent surgery for acutecholecystitis. The remaining 28 patients underwent laparotomy for other reasons.Cholecystectomy was laparoscopic in 69 patients and open in 11 patients. Theremaining 19 patients underwent various other surgical procedures such asautopsy, liver transplantation, living donor hepatectomy, Whipple procedure, andliver segment V resection. Histopathologically, hepatocellular carcinoma wasdetected in the ectopic liver tissue of one patient.CONCLUSION Ectopic liver tissue is a rare developmental anomaly which is usually detectedincidentally. Although most studies suggest that ectopic liver located outside thegallbladder has a high risk of hepatocellular carcinoma, this is not reflected instatistical analysis.

Effect of the COVID-19 pandemic on patients with presumed diagnosis of acute appendicitis

BACKGROUND Acute appendicitis(AAp) is the most frequent cause of acute abdominal pain,and appendectomy is the most frequent emergency procedure that is performed worldwide.The coronavirus disease 2019(COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and trauma.AIM To compare the demographic,clinical,and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 periods.METHODS The demographic,clinical,biochemical,and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19(October 2018-March 2020) and COVID-19(March 2020-July 2021) periods.RESULTS Admissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 period.PreCOVID-19(n = 154) and COVID-19(n = 223) periods were compared for various parameters,and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio(OR):1.76;P = 0.018],presence of AAp findings on ultrasonography(OR:15.4;P < 0.001),confirmation of AAp in the histopathologic analysis(OR:2.6;P = 0.003),determination of perforation in the appendectomy specimen(OR:2.2;P = 0.004),the diameter of the appendix(P < 0.001),and hospital stay(P = 0.003).There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19(median:24 h;interquartile range:34) and COVID-19(median:36 h;interquartile range:60) periods(P = 0.348).The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status(P < 0.001).CONCLUSION The present study showed that in the COVID-19 period,the ultrasonographic determination rate of AAp,perforation rate of AAp,and duration of hospital stay increased.On the other hand,negative appendectomy rate decreased.There was no statistically significant delay in hospital admissions that would delay the diagnosis of AAp in the COVID-19 period.

Xanthogranulomatous appendicitis: A comprehensive literature review

BACKGROUND Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes,plasma cells,neutrophils,and often multinucleated giant cells with or without cholesterol clefts.AIM To review the medical literature on xanthogranulomatous appendicitis(XGA).METHODS We present a patient with XGA and review published articles on XGA accessed via the PubMed,MEDLINE,Google Scholar,and Google databases.Keywords used were“appendix vermiformis,”“appendectomy,”“acute appendicitis,”and“XGA.”The search included articles published before May 2020,and the publication language was not restricted.The search included letters to the editor,case reports,review articles,original articles,and meeting presentations.Articles or abstracts containing adequate information about age,sex,clinical presentation,white blood cells,initial diagnosis,surgical approach,histopathological and immunohistochemical features of appendectomy specimens were included in the study.RESULTS A total of 29 articles involving 38 patients with XGA,were retrospectively analyzed.Twenty(52.6%)of the 38 patients,aged 3 to 78 years(median:34;IQR:31)were female,and the remaining 18(47.4%)were male.Twenty-five patients were diagnosed with acute appendicitis,ruptured appendicitis,or subacute appendicitis,and the remaining 13 patients underwent surgery for tumoral lesions of the ileocecal region.Twenty-two of the patients underwent urgent or semi-urgent surgery,and the remaining 16 patients underwent interval appendectomy.CONCLUSION Xanthogranulomatous inflammation rarely affects the appendix vermiformis.It is associated with significant diagnostic and therapeutic dilemmas due to its variable presentation.It is often associated with interval appendectomies,and a significant number of patients require bowel resection due to the common presentation of a tumoral lesion.XGA is usually identified retrospectively on surgical pathology and has no unique features in preoperative diagnostic studies.