Is appendoscope a new option for the treatment of acute appendicitis?

Acute appendicitis is a common surgical emergency.It is commonly caused by obstruction of the appendiceal lumen due to fecaliths,tumors,or lymphoid hyperplasia.For over a century,appendectomy has been the primary treatment for acute appendicitis.Abraham Groves performed the first open appendectomy in 1883.In 1983,Kurt Semm completed the first laparoscopic appendectomy,heralding a new era in appendectomy.However,appendectomy is associated with certain complications and a rate of negative appendectomies.Studies have suggested controversy over the impact of appendectomy on the development of inflammatory bowel disease and Parkinson’s disease,but an increasing number of studies indicate a possible positive correlation between appendectomy and colorectal cancer,gallstones,and cardiovascular disease.With the recognition that the appendix is not a vestigial organ and the advancement of endoscopic technology,Liu proposed the endoscopic retrograde appendicitis therapy.It is an effective minimally invasive alternative for treating uncomplicated acute appendicitis.Our team has developed an appendoscope with a disposable digital imaging system operated through the biopsy channel of a colonoscope and successfully applied it in the treatment of appendicitis.This article provides an overview of the progress in endoscopic treatment for acute appendicitis and offers a new perspective on the future direction of appendiceal disease treatment.

Influence of sarcopenia and frailty in the management of elderly patients with acute appendicitis

In developed countries,the average life expectancy has been increasing and is now well over 80 years.Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later age groups.Acute appendicitis is one of the most common surgical diseases,with a lifetime risk of 8%.A growing incidence of acute appendicitis has been registered in the elderly population and in the oldest groups(>80 years).Among patients>50-year-old who present to the emergency department for acute abdominal pain,15%have acute appendicitis.In these patients,emergency surgery for acute appendicitis is challenging,and some important aspects must be considered.In the elderly,surgical treatment outcomes are influenced by sarcopenia.Sarcopenia must be considered a precursor of frailty,a risk factor for physical function decline.Sarcopenia has a negative impact on both elective and emergency surgery regarding mortality and morbidity.Aside from morbidity and mortality,the most crucial outcomes for older patients requiring emergency surgery are reduction in function decline and preoperative physical function maintenance.Therefore,prediction of function decline is critical.In emergency surgery,preoperative interventions are difficult to implement because of the narrow time window before surgery.In this editorial,we highlight the unique aspects of acute appendicitis in elderly patients and the influence of sarcopenia and frailty on the results of surgical treatment.

Indication of conservative treatment by antibiotics for uncomplicated and complicated acute appendicitis

BACKGROUND Acute appendicitis is one of the most common emergency abdominal disease,and recent studies have evaluated conservative treatment using antibiotics for uncomplicated appendicitis.Although the efficacy of conservative treatment for uncomplicated appendicitis is known,its efficacy for complicated appendicitis remains unknown,so are risk factors for the conservative treatment of appendi-citis.In our institution,conservative treatment has long been the first choice for most appendicitis cases,except for perforation.Therefore,this novel study inves-tigated the outcomes of conservative treatment for uncomplicated and compli-cated acute appendicitis and the risk factors associated with conservative treat-ment.treatment.The significant and independent predictors of resistance to conservative treatment were body temperature≥37.3℃,appendicolith and Douglas sinus fluid visible on computed tomography(CT).The rate of resistance to conservative treatment was 66.7%(6/9)for patients with the above three factors,22.9%(8/35)for patients with two factors(appendicolith and body temperature≥37.3℃),16.7%(2/12)for patients with two factors(Douglas sinus fluid and appendicolith)and 11.1%(1/9)for patients with two factors(Douglas sinus fluid and body temperature≥37.3℃).CONCLUSION A temperature≥37.3℃,appendicolith and Douglas sinus fluid on CT might be clinical risk factors of resistance to conservative treatment for acute appendicitis.

Added value of ratio of cross diameters of the appendix in ultrasound diagnosis of acute appendicitis

BACKGROUND The maximum outer diameter(MOD)of the appendix is an essential parameter for diagnosing acute appendicitis,but there is space for improvement in ultrasound(US)diagnostic performance.AIM To investigate whether combining the ratio of the cross diameters(RATIO)of the appendix with MOD of the appendix can enhance the diagnostic performance of acute appendicitis.METHODS A retrospective study was conducted,and medical records of 233 patients with acute appendicitis and 112 patients with a normal appendix were reviewed.The MOD and RATIO of the appendix were calculated and tested for their diagnostic performance of acute appendicitis,both individually and in combination.RESULTS The RATIO for a normal appendix was 1.32±0.16,while for acute appendicitis it was 1.09±0.07.The cut-off value for RATIO was determined to be≤1.18.The area under the receiver operating characteristic curve(AUC)for diagnosing acute appendicitis using RATIO≤1.18 and MOD>6 mm was 0.870 and 0.652,respectively.There was a significant difference in AUC between RATIO≤1.18 and MOD>6 mm(P<0.0001).When comparing the combination of RATIO≤1.18 and MOD>6 mm with MOD>6 mm alone,the combination showed increased specificity,positive predictive value(PPV),and AUC.However,the sensitivity and negative predictive value decreased.CONCLUSION Combining RATIO of the appendix≤1.18 and MOD>6 mm can significantly improve the specificity,PPV,and AUC in the US diagnosis of acute appendicitis.

Is endoscopic retrograde appendicitis therapy a better modality for acute uncomplicated appendicitis? A systematic review and metaanalysis

BACKGROUND Previous studies had shown endoscopic retrograde appendicitis therapy(ERAT)is an effective treatment for acute appendicitis.However,different studies reported conflicting outcomes regarding the effectiveness of ERAT in comparison with laparoscopic appendectomy(LA).AIM To compare the effectiveness of ERAT with LA.METHODS Randomized controlled trials(RCTs)and retrospective studies of ERAT for acute uncomplicated appendicitis were searched in PubMed,Cochrane Library,Web of Science,Embase database,China National Knowledge Infrastructure(CNKI),the WanFang Database,and Chinese Scientific Journals Database(VIP)from the establishment date to March 12021.Heterogeneity was assessed using the Isquared statistic.Pooled odds ratios(OR),weighted mean difference(WMD),and standard mean difference(SMD),with 95%confidence intervals(CI)were calculated through either fixed-effects or random-effects model.Sensitivity analysis was also performed.Publication bias was tested by Egger's test,and Begg’s test.The quality of included RCT were evaluated by the Jadad scale,while Newcastle-Ottawa scale is adopted for assessing the methodological quality of case-control studies.All statistical analysis was performed using Stata 15.1 statistical software.All statistical analysis was performed using Stata 15.1 statistical software.This study is registered with PROSPERO,CRD42021243955.RESULTS After screening,10 RCTs and 2 case-control studies were included in the current systematic review.Firstly,the length of hospitalizations[WMD=-1.15,95%CI:-1.99,-0.31;P=0.007]was shorter than LA group.Secondly,the level of postoperative CRP[WMD=-10.06,95%CI:(-17.39,-2.73);P=0.007],TNF-α[WMD=-7.70,95%CI:(-8.47,-6.93);P<0.001],and IL-6 Levels[WMD=-9.78,95%CI:(-10.69,-8.88);P<0.001;P<0.001]in ERAT group was significantly lower than LA group.Thirdly,ERAT group had a lower incidence of intestinal obstruction than LA group.[OR=0.19,95%CI:(0.05,0.79);P=0.020].Moreover,the quality of 10 RCTs were low with 0-3 Jadad scores,while the methodological quality of two case-control studies were fair with a score of 2(each).CONCLUSION Compared with LA,ERAT reduces operation time,the level of postoperative inflammation,and results in fewer complications and shorter recovery time,with preserving the appendix and its immune and biological functions.

Clinical significance of peri-appendiceal abscess and phlegmon in acute complicated appendicitis patients undergoing emergency appendectomy

BACKGROUND Although antibiotic therapy has become the primary treatment for acute unco-mplicated appendicitis,the management of acute complicated appendicitis nece-ssitates careful consideration of various treatment options.AIM To analyze the clinical data of patients who underwent emergency appendectomy for acute complicated appendicitis with peri-appendiceal abscess or phlegmon,identify factors influencing the postoperative length of hospital stay(LOS),and improve treatment strategies.METHODS The clinical data of acute complicated appendicitis patients with peri-appendiceal abscess or phlegmon who underwent emergency appendectomy at The Depart-ment of Emergency Surgery,Zhongshan Hospital,Fudan University from January 2016 to March 2023 were retrospectively analyzed.RESULTS A total of 234 patients were included in our study.The duration of symptoms and the presence of an appendicolith were significantly correlated with the occurrence of peri-appendiceal abscess in patients with acute complicated appendicitis(P<0.001 and P=0.015,respectively).Patients with symptoms lasting longer than 72 h had a significantly longer postoperative LOS compared to those with symptoms lasting 72 h or less[hazard ratio(HR),1.208;95%CI:1.107-1.319;P<0.001].Additionally,patients with peri-appendiceal abscesses had a significantly longer postoperative LOS compared to those with phlegmon(HR,1.217;95%CI:1.095-1.352;P<0.001).The patients with peri-appendiceal abscesses were divided into two groups based on the median size of the abscess:Those with abscesses smaller than 5.0 cm(n=69)and those with abscesses 5.0 cm or larger(n=82).Patients with peri-appendiceal abscesses measuring 5.0 cm or larger had a significantly longer postoperative LOS than those with abscesses smaller than 5.0 cm(P=0.038).CONCLUSION The duration of symptoms and the presence of an appendicolith are significant risk factors for the formation of peri-appendiceal abscesses in patients with acute complicated appendicitis.Patients with peri-appendiceal abscesses experience a significantly longer postoperative LOS compared to those with peri-appendiceal phlegmon.

Evaluation of the clinical effects of atropine in combination with remifentanil in children undergoing surgery for acute appendicitis

BACKGROUND Acute appendicitis(AA)is the most common cause of acute abdomen in children.Anesthesia significantly influences the surgical treatment of AA in children,making the scientific and effective selection of anesthetics crucial.AIM To assess the clinical effect of atropine(ATR)in combination with remifentanil(REMI)in children undergoing surgery for AA.METHODS In total,108 cases of pediatric AA treated between May 2020 and May 2023 were selected,58 of which received ATR+REMI[research group(RG)]and 50 who received REMI[control group(CG)].Comparative analyses were conducted on the time to loss of eyelash reflex,pain resolution time,recovery time from anesthesia,incidence of adverse events(AEs;respiratory depression,hypoxemia,bradycardia,nausea and vomiting,and hypotension),intraoperative responses(head shaking,limb activity,orientation recovery,safe departure time from the operating room),hemodynamic parameters[oxygen saturation(SPO2),mean arterial pressure,heart rate,and respiratory rate],postoperative sedation score(Ramsay score),and pain level[the Face,Legs,Activity,Cry,Consolability(FLACC)Behavioral Scale].RESULTS Compared with the CG,the RG showed significantly shorter time to loss of eyelash reflex,pain resolution,recovery from anesthesia,and safe departure from the operating room.Furthermore,the incidence rates of overall AEs(head shaking,limb activity,etc.)were lower,and influences on intraoperative hemodynamic parameters and stress response indexes were fewer.The Ramsay score at 30 min after extubation and the FLACC score at 60 min after extubation were significantly lower in the RG than in the CG.CONCLUSION ATR+REMI is superior to REMI alone in children undergoing AA surgery,with a lower incidence of AEs,fewer influences on hemodynamics and stress responses,and better post-anesthesia recovery.

Modified technical protocol for single-port laparoscopic appendectomy using needle-type grasping forceps for acute simple appendicitis:A case report

BACKGROUND Because of the mild inflammatory status in acute uncomplicated appendicitis,our team developed a novel technical protocol for single-port laparoscopic appendec-tomy using needle-type grasping forceps(SLAN)and achieved positive clinical outcomes.However,the intraoperative procedure lacked stability and fluency due to a series of problems highlighted by the small incision design of the proto-col(only 1 cm long).Therefore,there is a growing clinical demand to further opti-mize the SLAN protocol.CASE SUMMARY An adult male patient was admitted for persistent right lower abdominal pain with preoperative computed tomography findings suggestive of appendicitis accompanied by localized peritonitis.A modified technical protocol for SLAN based on minimally invasive surgical principles was used,and the patient was confirmed to have acute simple appendicitis by postoperative pathological ana-lysis.Postoperative recovery was uneventful,and no postoperative complications,such as incision infection or severe incision pain,were observed.The patient was discharged successfully on postoperative day 2.CONCLUSION The modified technical protocol of SLAN may be a new minimally invasive surgical alternative for patients with acute simple appendicitis.

Analysis of the Clinical Value of Surgical Treatment and Postoperative Anti-Infection Treatment of Acute Suppurative Appendicitis

Objective: To explore the clinical value of surgical treatment and postoperative anti-infection treatment for acute suppurative appendicitis. Methods: A total of 116 patients with acute suppurative appendicitis were enrolled in this study. The collection period was from December 2021 to December 2023. The patients were randomly grouped into a control group (surgical treatment) and an observation group (surgical treatment and postoperative anti-infection treatment), of 58 patients each. At the end of the treatment, the results of each index of the two groups were compared. Results: The length of hospitalization time, exhaust time, and incidence of complications in the observation group were shorter than those of the control group (P < 0.05). The total effective rate of the observation group was higher than that of the control group (P < 0.05). Conclusion: It is crucial to perform anti-infective treatment promptly after surgical treatment in patients with acute suppurative appendicitis. It can effectively prevent the occurrence of complications and improve the clinical efficacy. Hence, it is worthy of research and promotion.

Acute appendicitis: Epidemiology, treatment and outcomesanalysis of 16544 consecutive cases

AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA) in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system(more than 1 million inhabitants) from 1997 to 2013.Data about treatment,surgery,length of stay were collected.Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.RESULTS From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA,with a crude incidence rate of 89/100000 inhabitants per year; mean age was 24.51 ± 16.17,54.7% were male and the mean Charlson's comorbidity index was 0.32 ± 0.92.Mortality was < 0.0001%.Appendectomy was performed in 94.7% of the patients and the mean length of stay was 5.08 ± 2.88 d; the cumulative hospital stay was 5.19 ± 3.36 d and 1.2% of patients had at least one further hospitalization due intestinal occlusion.Laparoscopic appendectomy was performed in 48% of cases.Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98 ± 3.96 d; the relapse rate was 23.1% and the cumulative hospital stay during the study period was 5.46 ± 6.05 d.CONCLUSION The treatment of acute appendicitis in Northern Italy is slowly changing,with the large diffusion of laparoscopic approach; conservative treatment of non-complicated appendicitis is still a neglected option,but rich of promising results.

Acute appendicitis following endoscopic mucosal resection of cecal adenoma

Endoscopic mucosal resection(EMR) allows the removal of flat or sessile lesions, laterally spreading tumors, and carcinoma of the colon or the rectum limited to the mucosa or the superficial submucosa. Acute appendicitis is the most common abdominal emergency requiring emergency surgery, and it is also a rare complication of diagnostic colonoscopy and therapeutic endoscopy, including EMR. In the case presented here, a 53-year-old female underwent colonoscopy due to a positive fecal occult blood test and was diagnosed with cecal adenoma. She was referred to our hospital and admitted for treatment. The patient had no other symptoms. EMR was performed, and 7 h after the surgery, the patient experienced right-lower abdominal pain. Laboratory tests performed the following day revealed a WBC count of 16000/mm3, a neutrophil count of 14144/mm3, and a C-reactive protein level of 2.20 mg/d L, indicating an inflammatory response. Computed tomography also revealed appendiceal wall thickening and swelling, so acute appendicitis following EMR was diagnosed. Antibiotics were initiated leading to total resolution of the symptoms, and the patient was discharged on the sixth post-operative day. Pathological analysis revealed a high-grade cecal tubular adenoma. Such acute appendicitis following EMR is extremely rare, and EMR of the cecum may be a rare cause of acute appendicitis.

Acute appendicitis: What is the gold standard of treatment?

McBurney’s procedure represented the gold-standard for acute appendicitis until 1981,but nowadays the number of laparoscopic appendectomies has progressively increased since it has been demonstrated to be a safe procedure,with excellent cosmetic results and it also allows a shorter hospitalization,a quicker and less painful postoperative recovery.The aim of this editorial was to perform a review of the literature in order to address controversial issues in the treatment of acute appendicitis.

Seasonal variations of acute appendicitis and nonspecific abdominal pain in Finland

AIM: To investigate whether seasonal changes had an effect on the incidence of acute appendicitis (AA) or nonspecific abdominal pain (NSAP).

Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy

Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy(LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Nonoperative management of AA may be tolerated only in children. Postoperative complications increase according to the patient's factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon's skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner(i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.

Septic thrombophlebitis of the porto-mesenteric veins as a complication of acute appendicitis

Pylephlebitis, a rare complication of acute appendicitis, is defined as thrombophlebitis of the portal venous system. Pylephlebitis usually occurs due to secondary infection in the region drained into the portal system. We report a case of pylephlebitis caused by acute appendicitis. The patient was transferred from a private clinic 1 wk after appendectomy with the chief complaints of high fever and abdominal pain. He was diagnosed with pylephlebitis of the portal vein and superior mesenteric vein by CT-scan. The patient was treated with antibiotics and anticoagulation therapy, and discharged on the 25th day and follow-up CT scan showed a cavernous transformation of portal thrombosis.

Clinical and computed tomography findings of appendiceal diverticulitis vs acute appendicitis

AIM: To study the clinical features and computed tomography(CT) findings of appendiceal diverticulitis vs acute appendicitis.METHODS: We retrospectively reviewed the records of 451 patients who had undergone appendectomy inour in stitution from January 2007 to September 2012. Patient demographics, clinical features, pathological findings, and surgical outcomes were analyzed. We also compared preoperative CT images of 25 patients with appendiceal diverticulitis with those of 25 patients with acute appendicitis.RESULTS: Among 451 patients, 44(9.7%) were diagnosed to have appendiceal diverticulitis and 398(86.9%) to have acute appendicitis. Patients with appendiceal diverticulitis were older(59 vs 37 years, P < 0.001) and had a longer duration of the illness(4.0 d vs 1.0 d, P < 0.001). Perforation rates in patients with appendiceal diverticulitis were higher(68% vs 27%, P < 0.001). The appendix could be visualized in only 13 patients(52%) among the appendiceal diverticulitis cases, but in all acute appendicitis cases. CT findings suggestive of appendiceal diverticulitis included the absence of fluid collection in the appendix(84% vs 12%, P < 0.001), absence of appendicolith(92% vs 52%, P = 0.005), and formation of abscess(68% vs 16%, P < 0.001). Appendiceal diverticula were identified in 6 patients(24%).CONCLUSION: Among patients who had undergone appendectomy, 9.7% had appendiceal diverticulitis. Patients with appendiceal diverticulitis had different clinical features and CT findings from patients with acute appendicitis.

Evaluation of modifi ed Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis

BACKGROUND: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%–10%. The Raja Isteri Pengiran Anak Saleha Appendicitis(RIPASA) scoring system was established in 2008 specif ically for Asian populations. The aim of this study was to compare the modif ied Alvarado with the RIPASA scoring system in Kuwait population.METHODS: This study included 180 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre logbook(unit B) from November 2014 to March 2016. The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic(ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software.RESULTS: A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modif ied Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specif icity of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specif icity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modif ied Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased significantly, from 18.4% to 10.7% for the modified Alvarado, and to 2.2% for the RIPASA scoring system, which was a signif icant difference(P<0.001) for both scoring systems.CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specif icity than the modif ied Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modif ied Alvarado scoring system for Kuwait population.

Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis scores for diagnosis of acute appendicitis

AIM:To assess the reliability and practical applicability of the widely used Alvarado,Eskelinen,Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis(RIPASA)scoring systems in patients with suspected acute appendicitis.METHODS:Patients admitted to our tertiary center due to suspected acute appendicitis constituted the study group.Patients were divided into two groups.appendicitis group(Group A)consisted of patients who underwent appendectomy and were histopathologically diagnosed with acute appendicitis,and non-appendicitis group(Group N-A)consisted of patients who underwent negative appendectomy and were diagnosed with pathologies other than appendicitis and patients that were followed non-operatively.The operative findings for the patients,the additional analyses from follow up of the patients and the results of those analyses were recorded using the follow-up forms.RESULTS:One hundred and thirteen patients with suspected acute appendicitis were included in the study.Of the 113 patients(62 males,51 females),the mean age was 30.2±10.1(range 18-67)years.Of the 113patients,94 patients underwent surgery,while the rest were followed non-operatively.Of the 94 patients,77patients were histopathologically diagnosed with acute appendicitis.Our study showed a sensitivity level of81%for the Alvarado system when a cut-off value of 6.5was used,a sensitivity level of 83.1%for the Ohmann system when a cut-off value of 13.75 was used,a sensitivity level of 80.5%for the Eskelinen system when a cut-off value of 63.72 was used,and a sensitivity level of 83.1%for the RIPASA system when a cut-off value of 10.25 was used.CONCLUSION:The Ohmann and RIPASA scoring systems had the highest specificity for the diagnosis of acute appendicitis.

Can fruit seeds and undigested plant residuals cause acute appendicitis

Objective:To investigate the relation between fruit seeds,plants residuals and appendicitis. Methods:Among cases that underwent appendectomy,the appendicitis cases having fruit seeds and undigested plant residuals in their etiology were examined retrospectively.Also, histopathological features,age,sex,and parameters of morbidity and mortality were used. Results:Fruit seed was found in one case(0.05%) with presence of pus in appendix lumen, undigested plant residuals in 7 cases(0.35%).It was determined that there were appendix inflammation in 2 of the plant residuals cases,while there were obstruction and lymphoid hyperplasia in the appendix lumen of 5 cases.No mortality was observed.Conclusions:The ratio of acute appendicitis caused by plants is minimal among all appendectomised patients, but avoidence of eating undigested fruit seeds and chewing plants well may help to prevent appendicitis.

Acute myelogenous leukemia and acute leukemic appendicitis:A case report

Acute myelogenous leukemia(AML)can involve the gastrointestinal tract but rarely involves the appendix. We report a male patient who had 1 year partial remission from AML and who presented with apparent acute appendicitis as the initial manifestation of leu-kemia relapse.Pathological findings of the appendix revealed transmural infiltrates of myeloblasts,which indicated a diagnosis of leukemia.Unfortunately,the patient died from progression of the disease on the 19th d after admission.Although leukemic cell infiltration of the appendix is uncommon,patients with leu-kemia relapse can present with symptoms mimicking acute appendicitis.