CASE REPORT: We report a 37-year-old woman with recurrent right iliac fossa pain. Computed tomography scan revealed a caecal mass suggesting complete inversion or intussusception of the appendix, which was confirmed by pathologic microscopic examination. This case report discusses appendiceal intussusception with emphasis on diagnosis and treatment options.
DISCUSSION: Appendiceal intussusception is a rare entity and the complete type typically presents as a polypoid lesion located at the appendiceal orifice in the caecum. It is imperative to include this entity in the differential diagnosis of caecal mass, especially during colonoscopy, as the removal of this polypoid lesion can result in a devastating caecal perforation or haemorrhage.
METHODS: We retrospectively reviewed data of all adult patients with intussusception admitted to our hospital between 2007 and 2017. The patients' characteristics, presentation, operation details, postoperative outcomes and pathology were analyzed. Comparisons were made between the laparoscopic and open surgery procedures performed during the study period.
RESULTS: Seventeen open and 20 laparoscopic-assisted resections were performed. No significant differences were found between the two groups for the following parameters: age (45.3 ± 16.8 vs. 54.9 ± 19.1, p = 0.160); gender (41 vs. 60% males, p = 0.330); American Society of Anesthesiologists score (p = 0.609); history of cardiovascular disease (5.9% vs. 5.6%, p = 0.950), COPD/asthma (0% vs. 5.6%, p = 0.950), diabetes (11.8% vs. 11.1%, p = 0.950), and renal impairment (5.9% vs. 0%, p = 0.486); body mass index (20.6 vs. 21.9, p = 0.433); timing of presentation (p = 1.000); type of intussusception (p = 0.658); type of procedures (p = 0.446); operative time (173.7 ± 45.4 vs. 191.5 ± 43.9, p = 0.329); and length of postoperative stay (6.7 ± 5.4 vs. 4.5 ± 1.1 days, p = 0.153). However, the open surgery group had fewer patients with hypertension (17.6% vs. 61.1%, p = 0.009) and demonstrated a delayed oral intake (4.0 ± 1.7 days vs. 2.5 ± 0.7 days, p = 0.010) and a higher comprehensive complication index (11.5 ± 27.1 vs. 0, p = 0.038).
CONCLUSIONS: The laparoscopic approach was associated with earlier oral intake and a lower comprehensive complication index. It is a safe and feasible technique that confers the advantages of minimally invasive surgery. It can be considered the preferred surgical option when the surgical expertise is available.