Although the main cause of appendicitis is unclear, infection with Enterobius vermicularis is suggested as a neglected risk factor. Since, there is no comprehensive analysis to estimate the prevalence of E. vermicularis in appendicitis; therefore, we conducted a global-scale systematic review and meta-analysis study to estimate the prevalence of E. vermicularis infection in appendicitis cases. PubMed, Scopus, Web of Science and Google Scholar databases were systematically searched for relevant studies published until 15 August 2019. Pooled prevalence of E. vermicularis infection was estimated using the random effects model. Data were classified based on the continents and countries. Moreover, subgroup analyses regarding the gender, the human development index (HDI), and income level of countries were also performed. Fifty-nine studies involving 103195 appendix tissue samples belonging to the individuals of appendicitis were included. The pooled prevalence of E. vermicularis infection was (4%, 95%CI, 2-6%), with the highest prevalence (8%, 95% CI: 0-36%) and lowest prevalence (2%, 95% CI: 1-4%) in Africa and Americas continents, respectively. With respect to countries, the lowest and highest prevalence rates were reported from Venezuela (<1%, 95% CI: 0-1%) and Nigeria (33%, 95% CI: 17-52%), respectively. Indeed, a higher prevalence was observed in females, as well as in countries with lower levels of income and HDI. Our findings indicate the relatively high burden of E. vermicularis infection in appendicitis cases. However, our findings suggest the great need for more epidemiological studies to depth understand overlaps between E. vermicularis infection and appendicitis in countries with lower HDI and income levels.

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The neglected role of Enterobius vermicularis in appendicitis: A systematic review and meta-analysis

Background: Abdominal pain is a common cause for emergency admission. While some patients have serious abdominal pathology, a significant group of those patients have no specific cause for the pain. This study was conducted to identify those who have non-specific abdominal pain who can be either admitted short term for observation or reassured and discharged for outpatient management. Patients and methods: A prospective documentation of clinical and laboratory data was obtained on a consecutive cohort of 286 patients who were admitted to a surgical unit over a nine month period with symptoms of abdominal pain regarded severe enough for full assessment in the casualty department and admission to a surgical ward. The patients were followed until a definite diagnosis was made or the patient's condition and abdominal pain improved and the patient discharged. The hospital where the study took place is a small peripheral general hospital draining a population of 120,000 people in a rural area in New Zealand. Results: There were 286 admissions to the emergency department. Logistic regression multivariate statistical analysis showed that guarding raised white cells count, tachycardia and vomiting were the only variables associated with significant pathology. Conclusion: Patients with no vomiting, no guarding, who have normal pulse rates and normal white cell counts are unlikely to have significant pathology requiring further active intervention either medical or surgical.

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What clinical and laboratory parameters determine significant intra abdominal pathology for patients assessed in hospital with acute abdominal pain

Neuroendocrine tumours (NETs) are a heterogenous group of tumours arising from neuroendocrine cells in several sites around the body They include tumours of the gastroenteropancreatic system, phaeochromocytoma and paraganglioma and medullary thyroid cancer In recent years, it has become increasingly apparent that a number of these tumours arise as a result of germline genetic mutations and are inherited in an autosomal dominant pattern The number of genes implicated is increasing rapidly Identifying which patients are likely to have a germline mutation enables clinicians to counsel patients adequately about their future disease risk, and allows for earlier detection of at-risk patients through family screening The institution of screening and surveillance programmes may in turn lead to a major shift in presentation patterns for some of these tumours In this review, we examine the features which may lead a clinician to suspect that a patient may have an inherited cause of a NET and we outline which underlying conditions should be suspected We also discuss what type of screening may be appropriate in a variety of situations

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When should genetic testing be performed in patients with neuroendocrine tumours

Abdominal pain is the most common reason for consultation in the emergency department, and most of the times, its cause is an episode of acute appendicitis. However, the misdiagnosis rate of acute appendicitis is high due to the unusual presentation of the symptoms. Therefore, the clinician has to be very alert in order to establish a correct diagnosis.

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Clinical Approach in the Diagnosis of Acute Appendicitis

A rare case of subacute appendicitis, actinomycosis as the final pathology reports: A case report and literature review

Pathologic evaluation of the appendix after appendectomy is routine and can occasionally identify unexpected findings The aim of the present study was to determine the incidence and type of pathologic diagnoses found in appendectomy specimens at our institution The clinicopathological data of 1627 patients who underwent appendectomies for presumed acute appendicitis from January 2008 to October 2014 were reviewed retrospectively There were 986 men and 641 women (sex ratio M/F = 15) aged between 16 months and 90 years (mean = 30 years) All patients underwent appendectomy (either open or laparoscopic) Histological examination of the surgical specimen showed acute inflammation of the appendix in 1455 cases (8942 %), fibrosed appendix in 37 cases (227 %), and Enterobius vermicularis (n = 23) In 101 cases (62 %), the appendix was histologically normal Incidental unexpected pathological diagnoses were noted in 57 appendectomy specimens They included pinworm (n = 23), mucinous neoplasms (n = 12), neuroendocrine tumors (NET) (n = 8), adenocarcinoma (n = 2), granulomatous inflammation (n = 5), tuberculosis (n = 2), hyperplastic polyp (n = 1), tubular adenoma (n = 1), diverticulitis (n = 1), endometriosis (n = 1), and actinomycosis (n = 1) The routine histopathological examination of the appendix is of value for identifying unsuspected conditions requiring further postoperative management Gross examination alone does not appear to be a good indicator of an unexpected finding on microscopic exam It is recommended that in order to avoid misdiagnoses, all appendices should be histopathologically examined

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Unexpected Histopathological Findings in Appendectomy Specimens: a Retrospective Study of 1627 Cases.

Resume Introduction La possibilite evolutive grave de l’appendicite aigue a conduit pendant plusieurs decennies a poser des indications tres larges a la chirurgie en urgence. Dans ce cas 15 a 20 % des appendicectomies sont inutiles. Nous avons evalue une attitude consistant a reunir plus d’arguments en faveur du diagnostic d’appendicite par des examens cliniques et paracliniques chez les patients ayant une douleur aigue de la fosse iliaque droite. Methodes De mars 2002 a fevrier 2003, nous avons inclus prospectivement des patients consecutifs ayant une douleur aigue de la fosse iliaque droite. En fonction du traitement propose, nous avons divise notre effectif en 3 groupes: un groupe de malades operes en urgence dans un delai moyen de 6 heures, un groupe de malades mis sous surveillance et operes secondairement, et un groupe de patients non operes. Resultats Deux cent cinq patients ont ete inclus. Il s’agissait de 120 femmes et de 85 hommes ( sex ratio = 0,7), âges en moyenne de 27 ans (extremes 11-69). Cent dix patients ont ete operes en urgence (54%) dans un delai moyen de 6 heures. Ces patients avaient une temperature38C dans 63% des cas, une defense de la fosse iliaque droite dans 44% et une hyperleucocytose >10000/mm 3 dans 87,2% des cas. Il s’agissait d’une appendicite aigue dans 92% des cas. Quatre-vingt-quinze patients etaient mis sous surveillance (46%), 50 patients etait operes secondairement dans un delai moyen de 36 heures. Dans ce groupe, la temperature etait38C dans 44% des cas, il y avait une defense de la fosse iliaque droite dans 8% et une hyperleucocytose >10000 dans 74% des cas. Il s’agissait d’une appendicite aigue dans 94% des cas. Les autres patients (45 cas), qui n’ont pas ete operes, ont quitte le service au bout d’une surveillance hospitaliere de 36 heures en moyenne. La morbidite globale dans cette serie etait de 0,9% et la mortalite etait nulle. Conclusion Devant une douleur de la fosse iliaque droite, la presence d’une temperature38C, d’une defense de la fosse iliaque droite et d’une hyperleucocytose >10000/mm 3 sont des signes predictifs d’une appendicite aigue dans 96% des cas. Devant un syndrome clinique atypique, la surveillance clinique intra-hospitaliere n’augmente ni le taux de complications peri-operatoires ni le sejour hospitalier et permet d’eviter dans 22% des cas une intervention inutile. Voir aussi dans ce numero l’editorial de Karem Slim, Surveiller ou non les appendicites incertaines, p. 373-4 ;l’editorial de Boyan Christoforov, Appendicites aigues : peut-on reduire les interventions inutiles et diminuer le nombre des investigations ? p. 375-6.

Douleurs aiguës de la fosse iliaque droite:intérêt de la surveillance clinique hospitalière : Étude prospective de 205 cas

Adult intussusception is a relatively rare clinical entity. Almost 90% of cases of intussusception in adults are secondary to a pathologic condition that serves as a lead point. Lymphangioma of the small bowel is an unusual tumour that has been rarely reported to cause intussusception. In this paper, we present a rare case of adult intussusception due to jejunal lymphangioma. A 22-year-old female patient with a medical history significant for anaemia presented with intermittent colicky abdominal pain, diarrhoea and oedema of the inferior limbs for the past three months. Ultrasonography and CT scan revealed a typical target sign with dilated intestinal loops. At laparotomy, a jejuno-jejunal intussusception was found. Partial resection of the jejunum was performed. Macroscopic examination of the surgical specimen revealed a pedunculated polyp measuring 2 cm in diameter. Histological sections of the polyp revealed in the lamina propria and submucosal layer of the jejunum several markedly dilated thin-walled lymphatic spaces lined with single layers of flat endothelial cells. The final pathologic diagnosis was submucosal lymphangioma. This case report indicates that intussusception, although rare in adults, should be considered in the differential diagnosis of abdominal pain. Moreover, it should be taken into consideration that lymphangioma is one of the possible lesions that can cause intussusception.

Lobna Marsaoui

Papers

Unexpected Histopathological Findings in Appendectomy Specimens: a Retrospective Study of 1627 Cases.

Douleurs aiguës de la fosse iliaque droite:intérêt de la surveillance clinique hospitalière : Étude prospective de 205 cas

Jejunal lymphangioma: an unusual cause of intussusception in an adult patient.