Date of Award

7-9-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Walter Longo

Abstract

INTUSSUSCEPTION OF THE APPENDIX: NEW TRENDS AND COMPREHENSIVE ANALYSIS OF 140 PUBLISHED CASE REPORTS. Barbara A. Wexelman, Cassius Ochoa Chaar, and Walter Longo. Section of Colorectal Surgery, Department of Surgery, Yale University, School of Medicine, New Haven, CT. Statement of Purpose: This paper uses 139 published case reports to understand the demographic, diagnostic, and treatment trends of intussusception of the appendix. Methods: Using the PubMed literature search engine to find all English references of intussusception and appendix, and reviewing those that contained actual case reports of intussusception of the appendix, we analyzed the demographics, presentation, diagnostic methods, surgical treatment, and histology from 140 articles representing data from 181 patients. Results: There were 41 (22.5%) pediatric cases and 141 (77.5%) adult cases. The average age was 37.3 years. There were more males in the pediatric set (23 males to 18 females) while there were more females in the adult set (38 males to 101 females). The most prevalent symptoms in children were abdominal pain (87.8%), vomiting (53.7%), and nausea (26.8%). The adults presented with abdominal pain (75.4%), bloody stools (26.1%), and vomiting (18.1%). Most of the patients reported chronic symptoms (62.6% chronic, 30.8% acute). Barium enema was the most prevalent method for both pediatrics (43.9%) and adults (49.3%). The most common surgical procedure for both the children and the adults was appendectomy (43.9%), followed by right hemicolectomy (20.6%). Prior to 1990 the majority of IA cases were diagnosed intra-operatively (64.8%), but since 2000 over half of the patients (56.8%) were given the correct diagnosis pre-operatively, and less than one third (29.6%) of patients were diagnosed intra-operatively. Endometriosis was the most common histopathology in adult women (37.6%). Conclusions: Adults, especially middle-aged women, make up the majority of patients with intussusception of the appendix. IA should be considered in the workup of chronic abdominal pain in women, and may likely be linked with gastrointestinal endometriosis. Increasingly IA is a pre-operative diagnosis, aided by colonoscopy and CT imaging.

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