Isolate the mesoappendix
and cauterize and divide it using 5-mm ultrasonic shears inserted through the RLQ trocar (FIGURE 2).
Patients suffering from appendicitis and USG suggestive of acute appendicitis in patients with long mesoappendix
Not uncommonly, surgical pathologists encounter appendiceal resection specimens with mucin deposits on the appendiceal serosa, within the mesoappendix
, or limited to the right lower quadrant (Figure 3, A and B).
The remnant of the mesoappendix
was also identified and the appendicular artery was isolated (Figure 2).
Arterial supply and extent of mesoappendix
They are characterized histologically by wide invasion of the mesoappendix
, and clinically by delayed local recurrence and distant metastases.
34) For this reason, many surgeons elect to proceed with right-sided hemicolectomy after initial appendectomy with tumors that are larger than 2 cm, with subserosa or mesoappendix
invasion, with lymphovascular invasion by tumor, or with identification of increased mitotic activity (>2 mitoses per 50 high-power fields) in rare cases.
The obstruction of the mesoappendix
may occur because of the elevation of intraabdominal pressure due to abdominal muscle spasms or the adhesions in chronic hernia.
According to the WHO classification, endocrine tumors of the appendix are defined as (1) a well-differentiated endocrine tumor with benign behavior (confined to the appendiceal wall, with a diameter [less than or equal to] 2 cm and without angioinvasion) or uncertain behavior (confined to the subserosa or with a maximal diameter >2 cm or angioinvasion); (2) a well-differentiated endocrine carcinoma (invading the mesoappendix
or beyond and/ or with metastases); or (3) goblet cell carcinoma (Table).
With bipolar diathermy, mesoappendix
is cauterized and the cut (fig.
Nonfunctioning cytologically bland tumors measuring not more than 1 cm in greatest dimension, without extension into mesoappendix
5) The fat of the mesoappendix
apparently migrates along the course of the perforating blood vessels as they ramify from the mesoappendix
to the sub mucosa.