complete rectal prolapse: a multicenter pooled analysis of 643 individual patient data. Dis Colon

Rectum 2005;48(6):1200–1206.

30. Brown HW, Wexner SD, Segall MM, et al. Accidental bowel leakage in the mature women’s health

study: prevalence and predictors. Int J Clin Pract 2012;66(11):1101–1108.

31. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum

1993;36(1):77–97.

32. Hayden DM, Weiss EG. Fecal incontinence: etiology, evaluation, and treatment. Clin Colon Rectal

Surg 2011;24(1):64–70.

33. Berho M, Wexner SD, Botero-Anug AM, et al. Histopathologic advantages of compression ring

anastomosis healing as compared with stapled anastomosis in a porcine model: a blinded

comparative study. Dis Colon Rectum 2014;57(4):506–513.

34. Frascio M1, Mandolfino F, Imperatore M, et al. The SECCA procedure for faecal incontinence: a

review. Colorectal Dis 2014;16(3):167–172.

35. Takahashi-Monroy T, Morales M, Garcia-Osogobio S, et al. SECCA procedure for the treatment of

fecal incontinence: results of five-year follow-up. Dis Colon Rectum 2008;51(3):355–359.

36. Bravo Gutierrez A, Madoff RD, Lowry AC, et al. Long-term results of anterior sphincteroplasty. Dis

Colon Rectum 2004;47(5):727–731; discussion 731–732.

37. Wong MT, Meurette G, Wyart V, et al. The artificial bowel sphincter: a single institution experience

over a decade. Ann Surg 2011;254(6):951–956.

38. Hull T, Giese C, Wexner SD, et al. Long-term durability of sacral nerve stimulation therapy for

chronic fecal incontinence. Dis Colon Rectum 2013;56(2):234–245.

39. Knowles CH, Horrocks EJ, Bremner SA, et al; CONFIDeNT study group. Percutaneous tibial nerve

stimulation versus sham electrical stimulation for the treatment of faecal incontinence in adults

(CONFIDeNT): a double-blind, multicentre, pragmatic, parallel-group, randomised controlled trial.

Lancet 2015;386(10004):1640–1648.

40. Viazis N, Vlachogiannakos J, Vasiliadis K, et al. Earlier eradication of intra-anal warts with argon

plasma coagulator combined with imiquimod cream compared with argon plasma coagulator alone:

a prospective, randomized trial. Dis Colon Rectum 2007;50(12):2173–2179.

41. Frisch M, Biggar RJ, Goedert JJ. Human papillomavirus-associated cancers in patients with human

immunodeficiency virus infection and acquired immunodeficiency syndrome. J Natl Cancer Inst

2000;92(18):1500–1510.

42. Trombetta LJ, Place RJ. Giant condyloma acuminatum of the anorectum: trends in epidemiology

and management: report of a case and review of the literature. Dis Colon Rectum

2001;44(12):1878–1886.

43. Sarmiento JM, Wolff BG, Burgart LJ, et al. Perianal Bowen’s disease: associated tumors, human

papillomavirus, surgery, and other controversies. Dis Colon Rectum 1997;40(8):912–918.

44. Möller C, Saksela E. Cancer of the anus and anal canal. Acta Chir Scand 1970;136(4):340–348.

45. Fuchshuber PR, Rodriguez-Bigas M, Weber T, et al. Anal canal and perianal epidermoid cancers. J

Am Coll Surg 1997;185(5):494–505.

46. Beck DE. Paget’s disease and Bowen’s disease of the anus. Semin Colon Rectal Surg 1995;6:143–149.

47. Hassan I, Horgan AF, Nivatvongs S. V-Y island flaps for repair of large perianal defects. Am J Surg

2001;181(4):363–365.

48. Skinner PP, Ogunbiyi OA, Scholefield JH, et al. Skin appendage involvement in anal intraepithelial

neoplasia. Br J Surg 1997;84(5):675–678.

49. Paterson CA, Young-Fadok TM, Dozois RR. Basal cell carcinoma of the perianal region: 20-year

experience. Dis Colon Rectum 1999;42(9):1200–1202.

50. Rousseau DL Jr, Petrelli NJ, Kahlenberg MS. Overview of anal cancer for the surgeon. Surg Oncol

Clin N Am 2004;13(2):249–262.

51. Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus

radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Coordinating Committee on Cancer Research. Lancet 1996;348(9034):1049–1054.

52. Bartelink H, Roelofsen F, Eschwege F, et al. Concomitant radiotherapy and chemotherapy is

superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase

III randomized trial of the European Organization for Research and Treatment of Cancer

1886

Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol 1997;15(5):2040-2049.

53. Mariani P, Ghanneme A, De la Rochefordière A, et al. Abdominoperineal resection for anal cancer.

Dis Colon Rectum 2008;51(10):1495–1501.

54. Nguyen WD, Mitchell KM, Beck DE. Risk factors associated with requiring a stoma for the

management of anal cancer. Dis Colon Rectum 2004;47(6):843–846.

55. Christian CK, Kwaan MR, Betensky RA, et al. Risk factors for perineal wound complications

following abdominoperineal resection. Dis Colon Rectum 2005;48(1):43–48.

56. Tarazi R, Nelson RL. Adenocarcinoma of the anus. Semin Colon Rectal Surg 1995;6:169–173.

57. Beal KP, Wong D, Guillem JG, et al. Primary adenocarcinoma of the anus treated with combined

modality therapy. Dis Colon Rectum 2003;46(10):1320–1324.

58. Weyandt GH, Eggert AO, Houf M, et al. Anorectal melanoma: surgical management guidelines

according to tumour thickness. Br J Cancer 2003; 89(11):2019–2022.

59. Bullard KM, Tuttle TM, Rothenberger DA, et al. Surgical therapy for anorectal melanoma. J Am Coll

Surg 2003;196(2):206–211.

60. Pessaux P, Pocard M, Elias D, et al. Surgical management of primary anorectal melanoma. Br J Surg

2004;91(9):1183–1187.

1887

Chapter 71

Diseases of Appendix

Edward A. Levine and Nathan Mowery

Key Points

1 The anatomy of the appendix tells the story of the epidemiology of appendicitis and can serve as a

road map for its intra-abdominal location.

2 Despite advances in diagnostic tests, appendicitis remains a clinical diagnosis.

3 When indicated helical CT with IV contrast is the test of choice when imaging is indicated in patients

with suspected appendicitis.

4 In selected patients with acute, uncomplicated appendicitis, antibiotic treatment is an appropriate

alternative to appendectomy.

5 The decision to perform an interval appendectomy following successful nonoperative management

with antibiotics and percutaneous drainage remains controversial.

6 Laparoscopic appendectomy confers many benefits over open appendectomy, and should be strongly

considered as the preferred approach where surgical expertise is appropriate and equipment is

available and affordable.

7 Outpatient appendectomy should be considered in cases of uncomplicated appendicitis.

8 Appendiceal cancer represents approximately 1% of colon malignancies.

9 Appendiceal cancer typically presents as unexpected finding on final pathology after appendectomy

for presumed acute appendicitis.

10 Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is a standard

approach for appendiceal cancer with peritoneal dissemination.

APPENDICITIS

The first description of appendicitis in the literature was by Lorenz Heister in 1711.1 He described a

perforated appendix with associated abscess in the autopsy report of a prisoner. Unfortunately, autopsy

was the most common operation done for appendicitis until 1827, when a French surgeon, Francois

Melier, suggested removing the appendix during episodes of right lower-quadrant pain.1 It was not until

advances in anesthesia and antisepsis developed in the late 1800s that appendectomy became more

common.

Perhaps the most famous case of appendicitis is that of King Edward VII, the first son of Queen

Victoria. After a prolonged period waiting to inherit the crown from his mother, Edward, was set to

become King of England. Less than 2 weeks before the coronation, the future king developed abdominal

discomfort. A staff of physicians attended to Edward including two prominent British surgeons, Lord

Joseph Lister and Sir Frederic Treves. They observed right lower-quadrant swelling, tenderness, and

fever in the future king. The medical staff was unanimous in recommending an operation, but Edward

was hesitant on the eve of his coronation. It fell to Lister to persuade Edward that an urgent operation

was necessary. Westminster Abbey not only hosted coronations but also funerals of British royalty.

Edward responded to his medical staff, “I must keep faith with my people and go to the [Westminster]

Abbey for the coronation.” Edward was adamant, and after hearing him repeat “I must go to the

Abbey,” Treves replied, “Then, Sir, you will go as a corpse.”

Edward finally consented to surgery, and on June 24, 1902, Treves operated on Edward at

Buckingham Palace. He opened a large periappendiceal abscess, evacuated pus, and left two large drains

in place. He did not remove the appendix. The wound was packed open and the entire procedure took

approximately 40 minutes. Edward recovered successfully and underwent coronation approximately 7

weeks after surgery. He served as king for the remaining eight years of his life without ever undergoing

an interval appendectomy.

1888