A signed informed consent was obtained for the surgical procedure.A separate consent for the video was not obtained because the patient's identification has not been revealed or included in any of the material submitted for publication.
A 33-year-old man presented to our outpatient department after a large appendicolith was incidentally found on lumbar computed tomography (CT) for unrelated lower back pain. Follow-up dedicated CT of the abdomen and pelvis revealed a dilated appendix containing moderate-sized appendicoliths with associated calcification. Despite a soft and non-tender abdomen on examination, on further history the patient described concurrent and vague rightsided abdominal pain. Given the tubular and suspicious appearance of the appendix, the patient underwent an elective laparoscopic appendicectomy. Intra-operative examination demonstrated the proximal appendix intussuscepting into the caecum of the large bowel ( Fig. 1). Caecectomy was also subsequently performed. The appendix was successfully removed and the operation was uneventful. The patient progressed well post-operatively and made an uncomplicated recovery. Histopathology was benign, merely revealing an early inflammatory process.Intussusception of the appendix is extremely rare, with an incidence of 0.01% in all appendectomy procedures. 1 There are a variety of causes; however, the underlying abnormality involves irregular peristalsis of the appendix secondary to local irritation. 2 The causes of intussusception should be classified into anatomical and pathological. 2 Predisposing anatomical factors include increasing mobility of the appendicular wall, capable of active peristalsis, and a large appendicular lumen, with the diameter of the proximal lumen larger than the distal portion. 1 Similarly, there are many pathological causes, ranging from inflammatory (endometriosis, fibroma and follicular lymphoid hyperplasia), benign (faecaliths, polyps and mucocoele) and malignant (carcinoid, adenocarcinoma and metastases). [3][4][5] McSwain describes an anatomical classification based on the region of appendix that undergoes intussusception. 2 There are five anatomical classifications of appendiceal intussusception:
Background Colorectal surgical procedures can have a significant impact on quality‐of‐life (QoL), functional and symptom outcomes. This retrospective study conducted in a tertiary care center evaluated the influence of four colorectal surgical procedures on patient‐reported outcome measures (PROMs). Methods 512 patients undergoing colorectal neoplasia surgery between June 2015 and December 2017 were identified via the Cabrini Monash Colorectal Neoplasia database. Primary outcomes measured were the mean changes in PROMs following surgery utilizing the International Consortium of Health Outcome Measures colorectal cancer (CRC) PROMs. Results 242 patients from 483 eligible patients responded (50% participation rate). Responders and non‐responders were comparable in median age (72 vs. 70 years), gender (48% vs. 52% male), time from surgery (<1 and >1 year), overall stage at diagnosis and type of surgery. Respondents underwent either a right hemicolectomy, ultra‐low anterior resection, abdominoperineal resection or a transanal endoscopic microsurgery/transanal minimally invasive surgery. Right hemicolectomy patients reported the best post‐operative function and reduced symptoms, significantly better (P < 0.01) than ultra‐low anterior resection patients who reported the worst outcomes in multiple areas (body image, embarrassment, flatulence, diarrhoea, stool frequency). Furthermore, patients undergoing an abdominoperineal resection reported the worst scores for body image, urinary frequency, urinary incontinence, buttock pain, faecal incontinence and male impotence. Conclusions The differences in PROMs in CRC surgical procedures is demonstrable. The worst post‐operative functional and symptom scores were reported after either an ultra‐low anterior resection or an abdominoperineal resection. Implementation of PROMs will identify and aid early patient referral to allied health and support services.
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