The CT criteria for the diagnosis of AA included a dilated appendix with distended lumen (> 6 mm), and at least one of following findings: wall thickening and enhancement; periappendiceal inflammation, including adjacent fat stranding and thickening of the lateroconal fascia or
mesoappendix; extraluminal fluid or abscess formation; or the presence of appendicoliths (10-15).
Reasons for increased operative time were transition from open to laparoscopic approach, initial learning curve and use of unipolar diathermy for cauterization of
mesoappendix. Wound infection is one of the postoperative complications that affect outcome.
Following separation of the
mesoappendix, a single endoloop was placed in the base of the appendix, and the appendix was transected 3-4 mm above the suture by means of a thermal cauterizing device.
A window was created behind the AMC, and the
mesoappendix was stapled.
First, the
mesoappendix was divided with 3/0 silk knots, and the base of the appendix was then ligated with 2/0 silk before the appendectomy specimen was removed from the abdominal cavity (Figure 2a).
The
mesoappendix was cut with ultrasonically activated coagulating shears (Fig.2).
Gonzalez-Moreno and colleagues advocate removing the
mesoappendix en bloc with the appendix, and if gross pathology suggests malignancy, then performing frozen-section would be warranted.
Pathology confirmed metastatic carcinoid tumor in the distal ileum,
mesoappendix, and liver.
Bipolar cautery was used to burn the
mesoappendix before skeletonization, using monopolar hook cautery.
About 100 cc fresh blood was sucked, the appendix was dissected from the
mesoappendix, and small bowel mesoplasty was performed.
With prolongation of duration of symptoms, in some patients appendicular lump developed which is an inflammatory mass composed of inflamed appendix, caecum, omentum, terminal ileum and
mesoappendix at times sigmoid, right tubes and overies in females.