Review
Intussusception of the appendix: comprehensive review of the literature

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Abstract

Background

Intussusception of the appendix is a rare disease that constitutes a diagnostic challenge to the surgeon. The literature on this condition is limited to case reports. The demographics, presentation, and treatment remain debatable in the absence of a comprehensive review of the literature.

Data sources

This article reports a case of a 40-year-old woman who presented with intussusception of the appendix caused by endometriosis. A comprehensive review of the English literature in PubMed was performed. The trends in incidence, sex predilection, presentation, and treatment of appendiceal intussusception were derived based on the reports of 191 patients.

Comments

The incidence was more common in adults (76%) than in children (24%). Female patients (72%) were 2 times more affected in adults than in children, whereas male patients (58%) seem to be more affected in the pediatric population. Intussusception of the appendix has most commonly a chronic presentation (63%). Endometriosis (33%) and inflammation (76%) were the most common pathologic findings in adults and children, respectively. Only 49% of patients were treated by simple appendectomy; 49% patients underwent partial colectomy; and 2% of patients had their appendixes endoscopically removed.

Section snippets

Methods

The medical records of a 40-year-old woman with history of endometriosis who presented with RLQ pain and was found to have intussusception of the appendix were reviewed and presented in the case report.

A PubMed search using the following key word combinations was performed: “appendix and intussusception,” “appendiceal and intussusception,” “intussuscepted and appendix,” and “appendiceal and intussuscepted.” The search resulted in 346 articles, which were reviewed individually. Only 147 papers

Case report

A 40-year-old woman presented to the emergency department with a history of 4 days of intermittent abdominal pain. The pain was progressively worsening. She complained of nausea and chills but no vomiting or diarrhea. The physical examination was notable for RLQ pain more than left with guarding. She was afebrile and had a borderline white blood cell count of 10.7.

Her past medical history was notable for uterine fibroids and endometriosis. She had a remote history of a uterine myomectomy for a

Results

Intussusception of the appendix is more common in adults (76%) than in children (24%). Female patients (72%) are >2 times more affected than men (28%) in the adult population, whereas male patients (58%) may be slightly more affected in the pediatric population (Table 2). Patient age varies from 5 months to 85 years, and the average age of presentation is 7 years in pediatric patients and 46 years in adult patients.

Intussusception can be reversed, especially if it is not associated with a lead

Comments

McKidd first reported intussusception of the appendix in 1858.23 Since the first report, the literature on appendiceal intussusception has been limited to case reports and small case series. Forshall24 and Bachman and Clement25 wrote the largest case series, presenting 7 patients each. The incidence, demographics, and characteristics of appendiceal intussusception are almost impossible to determine because of the rarity of the condition. Some investigators attempted limited reviews of the

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