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      Absence of the appendix discovered during childhood.

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          Abstract

          Absence of the appendix is rare. Isolated cases are usually discovered in adult patients or cadavers. We report the case of a 14 year old boy who was found to have no appendix on laparotomy for assumed acute appendicitis and use this opportunity to highlight the growing surgical uses of this vestigial structure.

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          Preliminary report: the antegrade continence enema.

          B. E. Kiely, P. Colm Malone, P. G. Ransley (1990)
          The principles of antegrade colonic washout and the Mitrofanoff non-refluxing catheterisable channel were combined to produce a continent catheterisable colonic stoma. The intention was that antegrade washouts delivered by this route would produce complete colonic emptying and thereby prevent soiling. The procedure has been successfully carried out in five patients with intractable faecal incontinence.
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            [Trans-appendicular continent cystostomy in the management of the neurogenic bladder].

            P Mitrofanoff (1979)
            The comfort obtained in some cases of neurogenic bladder of the girl, thanks to unsterile self catheterization, and usual absence of septic complications, incite to search for a process which could be used for the boys as well as girls in those cases where urethral catheterization cannot be done. What's more, if the catheterization is easy to achieve even by young children and if the process brings complete dryness, almost perfect conditions of comfort would be achieved. A cystostomy with a continent opening easy to catheterize and associated with a closure of the vesical neck, was the objective. We had the idea to use the appendix in order to create a passage between the skin and the bladder, the tip of the appendix opening into the bladder at the end of an anti-reflux submucosal tunnel and the other end hemmed to the skin. The bladder neck is usually closed in the course of the same operation. From October 1976 to January 1979, 16 children have gone through such a vesicostomy. In two more cases a trans-ureteral cystostomy was created. Five cases were a failure owing to a too small bladder and required a cutaneous diversion. The continence of the vesicostomy is total and the comfort obtained is excellent for the other 13 cases. Some complications result directly from this technique. It concerns more particularly cutaneous fistula (1 case) or with urethral repermeation (2 cases). Other problems, common to all conservative treatments of a neurogenic bladder, are discussed:vesico-renal reflux, dilatation of the upper urinary tract, urinary infections and of course, risk for the renal function. They appear to be related with a small and hypertonic bladder. Obviously these problems must be kept in mind and require a strict selection for the vesicostomy and a strict followup.
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              The appendix as ureteral substitute: a report of 10 cases.

              Haitham Dagash, Sudipta Sen, Jacob Chacko … (2008)
              Ureteric replacement in part or in total is rarely needed in children. We present our experience in using the appendix to replace the ureter. A retrospective case note review was carried out at Sheffield Children's Hospital (UK), Ekta Institute of Child Health (Raipur, Chhattisgarh, India) and Christian Medical College Hospital (Vellore, India) of all cases of ureteric substitution using the appendix. Ten patients were identified, operated in 2002-2007: seven males and three females with a median age of 2.5 years (range 2.5 months to 12 years). The reasons for ureteric replacement were traumatic ureteric avulsion (n=1), congenital ureteric stenosis (n=5), non-drainage following previous pyeloplasty for pelvi-ureteric junction obstruction (n=3) and ureteric stricture following reimplantation for vesico-ureteric reflux (n=1). The appendix was used in an anti-peristaltic manner in all cases, and in one case a transureteroureterostomy was performed. At a median follow up of 16months (1-72 months), all the patients were well except one whose kidney function had deteriorated. Total or partial replacement of the ureter using the appendix, even in the first year of life, preserved renal function in nine cases. Ureteric continuity can be successfully restored in children using the appendix.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Springerplus
                Title: SpringerPlus
                Publisher: Springer Science and Business Media LLC
                ISSN: 2193-1801
                ISSN (Print): 2193-1801
                Publication date (Electronic): 2014
                Volume: 3
                Affiliations
                [1 ] Department of Surgery, Queen Elizabeth Hospital, Martindales Road, St Michael, BB1115 Barbados.
                Article
                Publisher Item ID: 1211
                DOI: 10.1186/2193-1801-3-522
                PMC ID: 4166596
                PubMed ID: 25279313
                SO-VID: 68430ece-0c27-472c-8dae-c4560440601d
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