Emergency combined surgery for acute appendicitis and cystic lesions of small pelvis

Makhovsky V.Z.

Stavropol State Medical University

Aksenenko V.A.

Stavropol State Medical University

Makhovsky V.V.

Polyclinic No. 1 of the Presidential Administration

Aksenenko D.V.

Stavropol State Medical University

Kuyumcheva K.K.

Stavropol State Medical University

Yurin S.V.

Stavropol Regional Clinical Hospital

Emergency combined surgery for acute appendicitis and cystic lesions of small pelvis

Authors:

Makhovsky V.Z., Aksenenko V.A., Makhovsky V.V., Aksenenko D.V., Kuyumcheva K.K., Yurin S.V.

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Journal: Pirogov Russian Journal of Surgery. 2022;(2): 30‑37

DOI: 10.17116/hirurgia202202130

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To cite this article:

Makhovsky VZ, Aksenenko VA, Makhovsky VV, Aksenenko DV, Kuyumcheva KK, Yurin SV. Emergency combined surgery for acute appendicitis and cystic lesions of small pelvis. Pirogov Russian Journal of Surgery. 2022;(2):30‑37. (In Russ.)
https://doi.org/10.17116/hirurgia202202130

Подписка 2025-2 (Pirogov Russian Journal of Surgery)

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OBJECTIVE

To determine the optimal surgical approach for acute appendicitis and concomitant cystic lesions of small pelvis.

MATERIAL AND METHODS

The authors report the results of emergency combined surgery on abdominal and pelvic organs in 995 patients for the period from 1990 to 2020 (30 years). Acute appendicitis was diagnosed in 698 (70.15%) patients. Cystic lesions of small pelvis were observed in 286 (28.7%) patients: follicular cyst — 133 (46.5%), serous cyst — 91 (31.8%), corpus luteum cyst — 42 (46.4%), dermoid cyst — 20 (7.0%), endometrioid cyst — 3 (1.0%) cases. Catarrhal appendicitis was diagnosed in 10 (1.4%) patients, phlegmonous appendicitis — 685 (98.1%), gangrenous appendicitis — 3 (0.4%) patients. All patients with pyoinflammatory diseases of small pelvis had long-term history of gynecological diseases.

RESULTS

Cystic lesions of small pelvis can undergo malignant transformation. Therefore, surgical intervention is determined by surgeon together with gynecologist. Tree large endometrioid cysts (20—25 cm) were malignant. These patients also had adenocarcinoma of sigmoid colon. Malignant neoplasm resulted acute ileus, and the cysts were incorporated into pyogenic membrane. Extensive adhesive process was also observed. These aspects caused significant technical difficulties during resection of these cysts. Postoperative complications occurred in 2.31% of patients.

CONCLUSION

Prolonged therapy and follow-up of patients with urgent concomitant inflammatory diseases of abdominal cavity and small pelvis (chronic nonspecific salpingitis, diffuse pelvic endometriosis, ovarian cysts, etc.) can lead to development and growth of cystic lesions of small pelvis. These cysts may be complicated by subsequent malignant transformation.

Keywords:

acute appendicitis

purulent salpingitis

endometriosis and ovarian cysts

urgent simultaneous combined surgical and gynecological surgeries

Authors:

Makhovsky V.Z.

Stavropol State Medical University

Aksenenko V.A.

Stavropol State Medical University

Makhovsky V.V.

Polyclinic No. 1 of the Presidential Administration

Aksenenko D.V.

Stavropol State Medical University

Kuyumcheva K.K.

Stavropol State Medical University

Yurin S.V.

Stavropol Regional Clinical Hospital

Received:

08.04.2021

Accepted:

15.05.2021

List of references:

Aleksandrov LS, Ishhenko AI, Vedernikova NV. Sochetannye operacii v ginekologii (obzor). Akusherstvo i ginekologija. 2003;4:11-14. (In Russ.).
Baskakov VP. Klinika i lechenie jendometrioza. SPb. 1990. (In Russ.).
Bashilov VP, Savinova EB, Neshitov SP, Snigur NV. Gigantskaja fibromioma matki. Hirurgija. 2007;1:63-64. (In Russ.).
Belov JuV, Komarov RN. Abdominal’nye katastrofy v hirurgii aorty i serdca. Hirurgija. 2010;4:4-10. (In Russ.).
Bucenko VN. Ostryj appendicit i zabolevanija genitalij. Klinicheskaja hirurgija. 1984;4:42-44. (In Russ.).
Bjalik JaR, Podkopaeva VV. Hirurgicheskaja taktika pri ginekologicheskih zabolevanijah, simulirujushhih ostryj appendicit. Sov. medicina. 1981;5:101-102. (In Russ.).
Ishhenko AI, Aleksandrov LS, Vetshev PS. Laparoskopicheskaja appendjektomija v akusherstve i ginekologii. Jendoskop. hirurgija. 2001;2:30. (In Russ.).
Mahovskij VZ. Diagnostika hirurgicheskih zabolevanij i taktika vedenija bol’nyh v klinike fakul’tetskoj hirurgii. Stavropol’: StGMU; 2008. (In Russ.).
Mahovskij VZ. Odnomomentnye sochetannye operacii v neotlozhnoj i planovoj hirurgii. Stavropol’: StGMU; 2006. (In Russ.).
Mahovskij VZ, Aksenenko VA. Sochetannaja operacija pri brjushnoj donoshennoj beremennosti. Hirurgija. 2011;8:89-91. (In Russ.).
Mahovskij VZ, Mahovskij VV. Ostraja obturacionnaja kishechnaja neprohodimost’ pri diffuznom infil’trativnom jendometrioze. Hirurgija. 2016;3:72-75. (In Russ.). https://doi.org/10.17116/hirurgia2016372-75
Mahovskij VZ, Jurin SV, Mahovskij VV. Sinhronnoe pervichno mnozhestvennoe zlokachestvennoe porazhenie tolstoj kishki i jaichnika s ishodom v ostruju kishechnuju neprohodimost’. Hirurgija. 2016;4:67-69. (In Russ.). https://doi.org/10.17116/hirurgia2016467-69
Audebert AJ. External endometriosis: histogenesis, etiology and natural course. Rev Prat. 1990;40(12):1077-1081.
Anaf VE, Nakadi I, Simon P, et al. Preferential infiltration of large bowel endometriosis along the nerves of the colon. Hum Reprod. 2004;19(4):996-1002.
Abrao MS, Podgaec S, Dias JA, Jr, et al. Endometriosis lesions that compromise the rectum deeper than the inner muscularis layer have more than 40% of the circumference of the rectum affected by the disease. J Minim Invasive Gynecol. 2008;15(3):280-285.
Agarwal N, Subramanian A. Endometriosis — morphology, clinical presentations and molecular pathology. J Lab Physicians. 2010;2(1):1-9.
Bozdech JM. Endoscopic diagnosis of colonic endometriosis. Gastrointest Endosc. 1992;38(5):568-570.
Bergqvist A. Different types of extragenital endometriosis: a review. Gynecol Endocrinol. 1993;7(3):207-221.
Balachandran I, Gerber M. Presentation of endometriosis of the cervix in cervical smear: a case report and review of literature. J Low Genit Tract Dis. 2002;6(3):162-166.
Bazot M, Darai E, Hourani R, et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology. 2004;232(2):379-389.
Benagiano G, Brosens I, Lippi D. The history of endometriosis. Gynecol Obstet Invest. 2014;78(1):1-9.
Cohen J. Clinical forms of genital endometriosis (excluding sterility). Rev Prat. 1990;40(12):1085-1008.
Cornillie FJ, Oosterlynck D, Lauweryns JM, Koninckx PR. Deeply infiltrating pelvic endometriosis: histology and clinical significance. Fertil Steril. 1990;53(6):978-983.
Chen KT. Endometrioid adenocarcinoma arising from colonic endometriosis mimicking primary colonic carcinoma. Int J Gynecol Pathol. 2002;21(3):285-288.
Chapron C, Fauconnier A, Vieira M, et al. Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod. 2003;18(1):157-161.
Dmowski WP, Gebel HM, Rawlins R.G. Immunologic aspects of endometriosis. Obstet Gynecol Clin North Am. 1989;16(1):93-103.
de Bree E, Schoretsanitis G, Melissas J, et al. Acute intestinal obstruction caused by endometriosis mimicking sigmoid carcinoma. Acta Gastroenterol Belg. 1998;61(3):376-378.
Donnez J, Spada F, Squifflet J, Nisolle M. Bladder endometriosis must be considered as bladder adenomyosis. Fertil Steril. 2000;74(6):1175-1181.
Dimoulios P, Koutroubakis IE, Tzardi M, et al. A case of sigmoid endometriosis difficult to differentiate from colon cancer. BMC Gastroenterol. 2003;7(3):18.
Del Frate C, Girometti R, Pittino M, et al. Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. Radiographics. 2006;26(6):1705-1718.

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