RARE CLINICAL CASES OF ACUTE APPENDICITIS. A REVIEW
Keywords:acute appendicitis, atypical acute appendicitis, appendix anomalies
Objectives. The purpose of the article was to analyze data from existing literature sources, with reference to the rare and extremely rare clinical cases of acute appendicitis.
Material and methods. A number of 66 scientific publications presenting information about the topographic anatomy of the vermicular appendix, the clinical picture and surgical treatment tactics based on the atypical topography of the appendix have been studied. International publications through the online platforms Google Scholar and PubMed have been used as sources. The keywords used in the search were: “rare atypical clinical cases of acute appendicitis”, “rare atypical topographic forms of the appendix and cecum”, “congenital anomalies of appendix”, “ectopia of appendix”, “treatment features of the rare clinical-anatomical cases of acute appendicitis”, “situs inversus”.
Results. We identified 66 scientific publications that reveal current information about the rare topographic anatomy of the vermicular appendix in acute appendicitis, the particularities of the clinical picture and the tactics of treatment of unusual and rare cases of acute appendicitis.
Conclusions. There is no single opinion about the incidence of appendix position, some authors consider that the most common position is the descending position, followed by the lateral or retrocecal position, other authors consider the retrocecal position more frequent, followed by the descending position. When on the background of a clinical picture of acute appendicitis the vermicular appendix is "missing" during operation at the place of convergence of the cecum tenia it is necessary to exclude: acute appendicitis with appendix located completely below the serosa of the cecum, stump appendicitis, invagination of the appendix, completed retroperitoneal position of the appendix. The treatment of acute appendicitis in case of Amyand or De Garengeot hernia consists of appendicectomy with or without hernioplasty with own tissues, also the use of hernioplasts with synthetic meshes is contraindicated. In case of suspicion of acute left appendicitis it is necessary to confirm clinically and instrumentally the reversal of organs. In case of development of acute appendicitis on a pre-existing pathological background of appendix cancer, Crohn's disease, Yersineosis, etc, the definitive clinical diagnosis is based on histological examination, which denotes the presence of atypical cells, or granulomatous inflammation.
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