Ileocecal resection was performed through extension of the Mc-Burney incision in 28 patients, but 4 patients had required a separate midline incision because of difficulty of exposure. Right hemicolectomy was performed through conversion to a midline incision in all 16

patients. Primary PCI-34051 manufacturer end-to-side ileocolic anastomosis was performed in all cases. Figure 4 An unexpected ileocecal mass (red arrow). Final pathology of the specimen is malign mesenquimal tumor. During surgery, the surgeons examined the specimens macroscopically and in 16 patients malignancy was suspected. The histopathologic diagnoses of these patients were tuberculosis in 4, appendiceal phlegmon in 4, non-spesific granulomatous in 2, appendecular endometriosis in 2

and malign mesenquimal neoplasm Sapanisertib in 4 patients. Totally the histopathologic diagnosises were as follows, appendiceal phlegmon in 18, perforated cecal diverticulitis in 12, tuberculosis in 6, appendiceal and cecal rupture in 4 patients, malign mesenquimal neoplasm in 4 patients, non-spesific granulomatous in 2 and appendecular endometriosis in 2 patients (Table 6) (Figure 5). Figure 5 Ileocecal Tuberculosis. Tuberculous granulomatous lesions showing caseous necrosis in the centre, and a prominent cuff of lymphocytes and plasma cells at the periphery. Table 6 The final pathology Findings Number of cases % Appendiceal phlegmon 18 37,5 Perforated cecal Staurosporine purchase diverticulitis 12 25,0 Tuberculosis 6 12,5 Appendiceal-cecal rupture 4 8,3 Malign mesenquimal neoplasm 4 8,3 Non-spesific granulomatous 2 4,2 Appendecular endometriosis check details 2 4,2 There was no mortality and all of the patients were discharged in good health. There was only one complication of wound infection. The postoperative hospital stay duration was between 1 to 7 days, especially depending on the co-morbidity of the patients. Discussion Appendicitis is the most common cause of acute abdomen requiring emergency surgery. Only half of the patients present classical clinical diagnosis of appendix infection [1]. Sometimes inflammatory

cecal masses or cancers mimick acute appendicitis and during the operation the surgeons can not distinguish the pathology. Inflammation and cancer frequently form masses which are hardly distinguishable, and surgeons are often challenged to determine the pathologic origin of an inflammatory mass. Such masses involving the cecum are relatively uncommon when one excludes those resulting from appendicitis. Because such lesions are rare they are often reported, many are found unexpectedly at emergency operations as lesions simulating appendicitis [9]. Although most of the appendicular masses are benign and can be solved simplistically, a number of other conditions, some of them sinister, can be a dilemma for the surgeons.