Chul Nam Kim

Clinical Characteristics of Primary Epiploic Appendagitis

Purpose Primary epiploic appendagitis (PEA) is a rare cause of an acute abdomen. It can be clinically misdiagnosed as either diverticulitis or appendicitis on clinical examination because the clinical symptoms and signs of PEA are non-specific. The present study was performed to describe the clinical characteristics of PEA and to assess the differences between PEA and diverticulitis. Methods We reviewed the clinical records and radiologic findings of 31 consecutive patients with PEA and compared them with those of patients with diverticulitis without complications. Results In most cases, abdominal pain was localized to the right (13 cases, 41.9%) or left (13 cases, 41.9%) lower quadrants. Gastrointestinal symptoms such as nausea and vomiting were infrequent, and localized tenderness without peritoneal irritation was common. All patients were afebrile, and only 4 patients (12.9%) showed leukocytosis. In all cases except one, a pericolic fatty mass with a hyperattenuated ring was observed on computed tomography. Patients with left PEA were younger than those with diverticulitis (41.4 ± 11.9 vs. 69.7 ± 13.3, P < 0.001), and the mean body mass index was higher in patients with left PEA (26.4 ± 2.9 vs. 22.6 ± 3.4, P = 0.01). Whereas one patient (6.7%) with left PEA showed leukocytosis, the incidence of leukocytosis in patients with diverticulitis was 80% (8/10) (P < 0.001). Conclusion In patients with an acute abdomen showing localized tenderness without associated symptoms or leukocytosis, a high index of suspicion for PEA is necessary. For correct diagnosis and proper management, it would useful for surgeons to be aware of the computed tomographic findings and the natural course of the disease.

Duodenal Somatostatinoma: A Case Report and Review

Somatostatinomas are rare functioning carcinoid tumors that usually arise in the pancreas and duodenum. They are seldom associated with typical clinical symptoms; their diagnosis is confirmed only by histological and immunohistochemical studies and the presence of specific hormones. Two distinct clinicopathological forms of somatostatinoma exist: duodenal and pancreatic somatostatinomas. Clinically, compared to pancreatic somatostatinomas, duodenal somatostatinomas are more often associated with nonspecific symptoms and neurofibromatosis, but less often with somatostatinoma syndrome or metastasis. Histologically, duodenal somatostatinomas frequently have psammoma bodies in the tumor cells. We report a case of duodenal somatostatinoma in 58-year-old man with vague epigastric pain and nausea. He did not have diabetes, steatorrhea, or cholelithiasis. Abdominal computed tomography showed a 25-mm mass in the duodenum and 25-mm nodule in the liver. Endoscopic retrograde cholangiopancreatography showed a duodenal submucosal tumor. Although the endoscopic biopsies were free of malignancy, the patient subsequently underwent Whipples operation for the duodenal mass. Examination revealed as a somatostatinoma using a special stain for somatostatin.

Comparison of clinical outcomes and hospital cost between open appendectomy and laparoscopic appendectomy.

Purpose Laparoscopic appendectomy has been recognized to have many advantages such as greater cosmetic results, less postoperative pain and shorter hospital stays. On the other hand, the cost of laparoscopic procedures is still more expensive than that of open procedures in Korea. The aim of this study is to compare clinical outcomes and hospital costs between open appendectomy and laparoscopic appendectomy. Methods Between January 1, 2010 and December 31, 2010, 471 patients were diagnosed with acute appendicitis. Of these, 418 patients met the inclusion criteria and were divided into two groups of open appendectomy (OA) group and laparoscopic appendectomy (LA) group. We analyzed the clinical data and hospital costs. Results The mean operation time for laparoscopic appendectomy (72.17 minutes) was significantly longer than that of open appendectomy (46.26 minutes) (P = 0.0004). The mean amounts of intravenous analgesics for OA group (2.00 times) was greater than that of LA group (1.86 times) (P < 0.0001). The complication rate was similar between the two groups (OA, 6.99% vs. LA, 10.87%; P = 0.3662). The mean length of postoperative hospital stay was shorter in LA group (OA, 4.55 days vs. LA, 3.60 days; P = 0.0002). The mean total cost covered by the National Health Insurance was more expensive in LA group (OA, 1,259,842 won [Korean monetary unit] vs. LA, 1,664,367 won; P = 0.0057). Conclusion Clinical outcomes of laparoscopic appendectomy were superior to that of open appendectomy even though the cost of laparoscopic appendectomy was more expensive than that of open appendectomy. Whenever surgeons manage a patient with appendicitis, laparoscopic appendectomy should be considered as the procedure of choice.