Skip to main content
Erschienen in: World Journal of Surgical Oncology 1/2012

Open Access 01.12.2012 | Case report

Schwannoma of ascending colon treated by laparoscopic right hemicolectomy

verfasst von: Hun Jin Kim, Chang Hyung Kim, Sang Woo Lim, Jung Wook Huh, Young Jin Kim, Hyeong Rok Kim

Erschienen in: World Journal of Surgical Oncology | Ausgabe 1/2012

download
DOWNLOAD
print
DRUCKEN
insite
SUCHEN

Abstract

Schwannomas of the colon are rare and are difficult to diagnose preoperatively, since they often defy endoscopic and radiographic detection. Immunohistochemical stains are useful postoperatively to confirm this tumor, but more reliable diagnostic techniques (such as colonoscopic biopsy with immunohistochemistry) have emerged to enhance preoperative diagnostic accuracy. Here we report an instance of schwannoma arising in the ascending colon, where immunohistochemical staining of a preoperative biopsy facilitated diagnosis. After laparoscopic resection, histologic examination was confirmatory.
Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1477-7819-10-81) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

HJK wrote the main manuscript and HRK performed the operation, revised, the manuscript for important intellectual content, and gave the final, approval for the version to be submitted for publication. All authors read and approve the final manuscript.

Background

Schwannomas of the gastrointestinal tract are relatively uncommon and rarely involve the large intestine [13]. Although considered benign, they may recur locally (if incompletely excised), and malignant transformation is occasionally observed [4, 5]. Radical surgery is, therefore, the accepted standard of treatment.
While accurate diagnosis prior to surgical intervention can aid in therapeutic planning, limitations of conventional imaging and lack of sufficient biopsy material usually make this difficult. Recent improvements in colonoscopic techniques have led to use of endoscopic biopsy and immunohistochemistry in combination as a more reliable method for accurate preoperative assessment. We report here an instance of schwannoma of the ascending colon, confirmed by immunohistochemistry, for which laparoscopic right hemicolectomy was performed.

Case report

A 61-year-old male was referred to his local hospital for a routine health examination. On screening colonoscopy, a polypoid lesion of the ascending colon was discovered (Figure 1). A subsequent biopsy showed only signs of chronic ulceration (fibrinoid necrosis and neutrophils), so he was transferred to our hospital for further evaluation and treatment.
The patient’s physical examination was noncontributory, but we obtained multiple colonic biopsies. The mass was composed of benign spindle cells (Figure 2) strongly positive for S-100 protein and negative for smooth muscle actin, CD117 and CD34 (Figure 3). This histochemical profile was compatible with schwannoma.
Abdominopelvic computed tomography (CT) indicated that the lesion of the ascending colon protruded intraluminally, exhibiting homogenous enhancement (Figure 4). A well- circumscribed, fungating mass (1.7 cm × 1.8 cm) was ultimately resected via laparoscopic-enabled right hemicolectomy with side-to-side ileocolic anastomosis (Figure 5). Histologic evaluation, including immunohistochemistry, confirmed the tumor as schwannoma. Postoperatively, the patient recovered and has done well with no recurrence.

Discussion

Schwannomas are uncommon neoplasms arising from Schwann cells of the neural sheath [2, 6]. They may occur anywhere in the body, but gastrointestinal sites are rare, especially the colon [13, 712]. Depending on tumor size and location, schwannomas of the colon may occasionally produce symptoms, such as constipation, bleeding, abdominal pain or discomfort, and anal pain [2, 10]. Intussuception is unusual [12]. Most patients, however, have no symptoms, because these are inherently slow-growing neoplasms [9, 13]. In our patient, tumor discovery was incidental.
Preoperative diagnosis of schwannoma is difficult due to its tissue density and the tendency for ulceration [2]. Biopsies are often nondiagnostic, and information gained by other means is limited. Colonoscopy, abdominal ultrasound (US), abdominal CT and abdominal magnetic resonance imaging (MRI) may aid in evaluating the contours of colorectal schwannomas and their relationship with surrounding organs, as well as tumor multiplicity or metastasis. Levy, et al. [14] described gastrointestinal schwannomas as homogeneously attenuated and well-defined mural masses on CT, noting that they were indistinguishable from gastrointestinal stromal tumors. Low-attenuation hemorrhage, necrosis and internal degeneration constituted shared CT features. Attributes signifying benign vs malignant behavior were not addressed [15, 16]. More recently, endoscopic ultrasonography (EUS) surpassed other imaging modalities in diagnostic accuracy but still will not differentiate a schwannoma from other gastrointestinal stromal tumors. EUS-guided fine needle aspiration or biopsy of submucosal tumors has been attempted [1720].
Schwannoma of the colon usually is not diagnosable solely by routine histology. A newer, more reliable approach incorporates immunohistochemistry [2, 7]. Characteristically, these tumors are composed of spindle cells (much like neurofibromas, gastrointestinal stromal tumors and leiomyomas) [7, 21] that are 100% immunoreactive for S-100 protein. Cells of neurofibroma show less S-100 positivity (30% to 40%), while gastrointestinal stromal tumors are generally positive for CD117(c-kit) and CD34 (70%) and negative for S-100 protein. Leiomyomas similarly are devoid of S-100 protein, expressing smooth muscle actin and desmin instead [22, 23].
Because the prognosis for schwannoma differs from other gastrointestinal stromal tumors, a correct diagnosis is critical. Schwannomas overall are considered benign, but they may recur locally if excision is incomplete and in rare instances are capable of malignant transformation [4, 5]. Tozbikian et al. [5] found that gastric schwannomas on occasion could be aggressive, progressing rapidly and responding poorly to chemotherapy.
Standard treatment for schwannomas is complete surgical resection [4, 24]. The role of radiotherapy or chemotherapy to date remains unclear [4, 25]. Lymph node resection is not recommended, because the risk of malignant change is low [24, 26]. A minimally invasive procedure (in our case, laparoscopic surgery) is acceptable for schwannoma of the colon and rectum [8, 13, 27]. Our patient resumed oral feeding on the second postoperative day and after an uneventful stay, was discharged on the sixth postoperative day. In clinical follow-up, he has been well and problem-free.

Conclusion

In conclusion, schwannomas of the ascending colon are rare tumors dependent upon immunohistochemistry for definitive classification. Accurate preoperative diagnosis is essential for appropriate surgical management. While radical resection affords optimal outcomes, a laparoscopic approach may be used.
Written informed consent was obtained from the patient for publication of this report and any accompanying images.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

HJK wrote the main manuscript and HRK performed the operation, revised, the manuscript for important intellectual content, and gave the final, approval for the version to be submitted for publication. All authors read and approve the final manuscript.
Literatur
1.
Zurück zum Zitat Abraham SC: Distinguishing gastrointestinal stromal tumors from their mimics: an update. Adv Anat Pathol. 2007, 14: 178-188. 10.1097/PAP.0b013e318050aa66.CrossRefPubMed Abraham SC: Distinguishing gastrointestinal stromal tumors from their mimics: an update. Adv Anat Pathol. 2007, 14: 178-188. 10.1097/PAP.0b013e318050aa66.CrossRefPubMed
2.
Zurück zum Zitat Inagawa S, Hori M, Shimazaki J, Matsumoto S, Ishii H, Itabashi M, Adachi S, Kawamoto T, Fukao K: Solitary schwannoma of the colon: report of two cases. Surg Today. 2001, 31: 833-838. 10.1007/s005950170060.CrossRefPubMed Inagawa S, Hori M, Shimazaki J, Matsumoto S, Ishii H, Itabashi M, Adachi S, Kawamoto T, Fukao K: Solitary schwannoma of the colon: report of two cases. Surg Today. 2001, 31: 833-838. 10.1007/s005950170060.CrossRefPubMed
3.
Zurück zum Zitat Chetty R, Vajpeyi R, Penwick JL: Psammomatous melanotic schwannoma presenting as colonic polyps. Virchows Archiv. 2007, 451: 717-720. 10.1007/s00428-007-0453-0.CrossRefPubMed Chetty R, Vajpeyi R, Penwick JL: Psammomatous melanotic schwannoma presenting as colonic polyps. Virchows Archiv. 2007, 451: 717-720. 10.1007/s00428-007-0453-0.CrossRefPubMed
4.
5.
Zurück zum Zitat Tozbikian G, Shen R, Suster S: Signet ring cell gastric schwannoma: report of a new distinctive morphological variant. Ann Diagn Pathol. 2008, 12: 146-152. 10.1016/j.anndiagpath.2006.12.004.CrossRefPubMed Tozbikian G, Shen R, Suster S: Signet ring cell gastric schwannoma: report of a new distinctive morphological variant. Ann Diagn Pathol. 2008, 12: 146-152. 10.1016/j.anndiagpath.2006.12.004.CrossRefPubMed
6.
Zurück zum Zitat Matsuki A, Kosugi S, Kanda T, Komukai S, Ohashi M, Umezu H, Mashima Y, Suzuki T, Hatakeyama K: Schwannoma of the esophagus: a case exhibiting high 18 F-fluorodeoxyglucose uptake in positron emission tomography imaging. Dis Esophagus. 2009, 22: E6-E10. 10.1111/j.1442-2050.2007.00712.x.CrossRefPubMed Matsuki A, Kosugi S, Kanda T, Komukai S, Ohashi M, Umezu H, Mashima Y, Suzuki T, Hatakeyama K: Schwannoma of the esophagus: a case exhibiting high 18 F-fluorodeoxyglucose uptake in positron emission tomography imaging. Dis Esophagus. 2009, 22: E6-E10. 10.1111/j.1442-2050.2007.00712.x.CrossRefPubMed
7.
Zurück zum Zitat Hou YY, Tan YS, Xu JF, Wang XN, Lu SH, Ji Y, Wang J, Zhu XZ: Schwannoma of the gastrointestinal tract: a clinicopathological, immunohistochemical and ultrastructural study of 33 cases. Histopathology. 2006, 48: 536-545. 10.1111/j.1365-2559.2006.02370.x.CrossRefPubMed Hou YY, Tan YS, Xu JF, Wang XN, Lu SH, Ji Y, Wang J, Zhu XZ: Schwannoma of the gastrointestinal tract: a clinicopathological, immunohistochemical and ultrastructural study of 33 cases. Histopathology. 2006, 48: 536-545. 10.1111/j.1365-2559.2006.02370.x.CrossRefPubMed
8.
Zurück zum Zitat Park KJ, Kim KH, Roh YH, Kim SH, Lee JH, Rha SH, Choi HJ: Isolated primary schwannoma arising on the colon: report of two cases and review of the literature. J Korean Surg Soc. 2011, 80: 367-372. 10.4174/jkss.2011.80.5.367.PubMedCentralCrossRefPubMed Park KJ, Kim KH, Roh YH, Kim SH, Lee JH, Rha SH, Choi HJ: Isolated primary schwannoma arising on the colon: report of two cases and review of the literature. J Korean Surg Soc. 2011, 80: 367-372. 10.4174/jkss.2011.80.5.367.PubMedCentralCrossRefPubMed
9.
Zurück zum Zitat Mysorekar VV, Rao SG, Jalihal U, Sridhar M: Schwannoma of the ascending colon. Indian J Pathol Microbiol. 2010, 53: 198-200. 10.4103/0377-4929.59241.CrossRefPubMed Mysorekar VV, Rao SG, Jalihal U, Sridhar M: Schwannoma of the ascending colon. Indian J Pathol Microbiol. 2010, 53: 198-200. 10.4103/0377-4929.59241.CrossRefPubMed
10.
Zurück zum Zitat Min YW, Kim YH, Yun HS, Kil JS, Kim YC, Yun SH, Kim KM, Kim JJ: A case of benign schwannoma in the ascending colon. Korean J Gastroenterol. 2007, 50: 398-401.PubMed Min YW, Kim YH, Yun HS, Kil JS, Kim YC, Yun SH, Kim KM, Kim JJ: A case of benign schwannoma in the ascending colon. Korean J Gastroenterol. 2007, 50: 398-401.PubMed
11.
Zurück zum Zitat Ozawa T, Watanabe H, Okuyama Y, Okumura K, Tsuchiya T, Tanji N, Anzai Y, Unakami M: [A case of schwannoma of ascending colon.]. Nihon Shokakibyo Gakkai Zasshi. 2001, 98: 167-173.PubMed Ozawa T, Watanabe H, Okuyama Y, Okumura K, Tsuchiya T, Tanji N, Anzai Y, Unakami M: [A case of schwannoma of ascending colon.]. Nihon Shokakibyo Gakkai Zasshi. 2001, 98: 167-173.PubMed
12.
Zurück zum Zitat Wani HU, Al Omair A, Al Shakweer W, Ahmed B: Schwannoma of the ascending colon with ileocolic intussusception. Trop Gastroenterol. 2010, 31: 337-339.PubMed Wani HU, Al Omair A, Al Shakweer W, Ahmed B: Schwannoma of the ascending colon with ileocolic intussusception. Trop Gastroenterol. 2010, 31: 337-339.PubMed
13.
Zurück zum Zitat Suh SW, Park JM, Choi YS, Cha SJ, Chang IT, Kim BG: Laparoscopic approach to a case of appendicular schwannoma. J Korean Soc Coloproctol. 2010, 26: 302-306. 10.3393/jksc.2010.26.4.302.PubMedCentralCrossRefPubMed Suh SW, Park JM, Choi YS, Cha SJ, Chang IT, Kim BG: Laparoscopic approach to a case of appendicular schwannoma. J Korean Soc Coloproctol. 2010, 26: 302-306. 10.3393/jksc.2010.26.4.302.PubMedCentralCrossRefPubMed
14.
Zurück zum Zitat Levy AD, Quiles AM, Miettinen M, Sobin LH: Gastrointestinal schwannomas: CT features with clinicopathologic correlation. AJR Am J Roentgenol. 2005, 184: 797-802.CrossRefPubMed Levy AD, Quiles AM, Miettinen M, Sobin LH: Gastrointestinal schwannomas: CT features with clinicopathologic correlation. AJR Am J Roentgenol. 2005, 184: 797-802.CrossRefPubMed
15.
Zurück zum Zitat Quiroga S, Alvarez-Castells A, Pallisa E, Sebastia MC: Duodenal schwannoma causing gastrointestinal bleeding: helical CT findings. Abdom Imaging. 1997, 22: 154-155. 10.1007/s002619900160.CrossRefPubMed Quiroga S, Alvarez-Castells A, Pallisa E, Sebastia MC: Duodenal schwannoma causing gastrointestinal bleeding: helical CT findings. Abdom Imaging. 1997, 22: 154-155. 10.1007/s002619900160.CrossRefPubMed
16.
Zurück zum Zitat Rueda O, Escribano J, Vicente JM, Garcia F, Villeta R: Gastrointestinal autonomic nerve tumors (plexosarcomas). Is a radiological diagnosis possible?. Eur Radiol. 1998, 8: 458-460. 10.1007/s003300050413.CrossRefPubMed Rueda O, Escribano J, Vicente JM, Garcia F, Villeta R: Gastrointestinal autonomic nerve tumors (plexosarcomas). Is a radiological diagnosis possible?. Eur Radiol. 1998, 8: 458-460. 10.1007/s003300050413.CrossRefPubMed
17.
Zurück zum Zitat Okada N, Hirooka Y, Itoh A, Hashimoto S, Niwa K, Ishikawa H, Itoh T, Kawashima H, Goto H: Retroperitoneal neurilemoma diagnosed by EUS-guided FNA. Gastrointest Endosc. 2003, 57: 790-792. 10.1067/mge.2003.216.CrossRefPubMed Okada N, Hirooka Y, Itoh A, Hashimoto S, Niwa K, Ishikawa H, Itoh T, Kawashima H, Goto H: Retroperitoneal neurilemoma diagnosed by EUS-guided FNA. Gastrointest Endosc. 2003, 57: 790-792. 10.1067/mge.2003.216.CrossRefPubMed
18.
Zurück zum Zitat Stelow EB, Lai R, Bardales RH, Linzie BM, Mallery S, Stanley MW: Endoscopic ultrasound-guided fine-needle aspiration cytology of peripheral nerve-sheath tumors. Diagn Cytopathol. 2004, 30: 172-177. 10.1002/dc.10274.CrossRefPubMed Stelow EB, Lai R, Bardales RH, Linzie BM, Mallery S, Stanley MW: Endoscopic ultrasound-guided fine-needle aspiration cytology of peripheral nerve-sheath tumors. Diagn Cytopathol. 2004, 30: 172-177. 10.1002/dc.10274.CrossRefPubMed
19.
Zurück zum Zitat Larghi A, Noffsinger A, Dye CE, Hart J, Waxman I: EUS-guided fine needle tissue acquisition by using high negative pressure suction for the evaluation of solid masses: a pilot study. Gastrointest Endosc. 2005, 62: 768-774. 10.1016/j.gie.2005.05.014.CrossRefPubMed Larghi A, Noffsinger A, Dye CE, Hart J, Waxman I: EUS-guided fine needle tissue acquisition by using high negative pressure suction for the evaluation of solid masses: a pilot study. Gastrointest Endosc. 2005, 62: 768-774. 10.1016/j.gie.2005.05.014.CrossRefPubMed
20.
Zurück zum Zitat Larghi A, Verna EC, Ricci R, Seerden TC, Galasso D, Carnuccio A, Uchida N, Rindi G, Costamagna G: EUS-guided fine-needle tissue acquisition by using a 19-gauge needle in a selected patient population: a prospective study. Gastrointest Endosc. 2011, 74: 504-510. 10.1016/j.gie.2011.05.014.CrossRefPubMed Larghi A, Verna EC, Ricci R, Seerden TC, Galasso D, Carnuccio A, Uchida N, Rindi G, Costamagna G: EUS-guided fine-needle tissue acquisition by using a 19-gauge needle in a selected patient population: a prospective study. Gastrointest Endosc. 2011, 74: 504-510. 10.1016/j.gie.2011.05.014.CrossRefPubMed
21.
Zurück zum Zitat Skopelitou AS, Mylonakis EP, Charchanti AV, Kappas AM: Cellular neurilemoma (schwannoma) of the descending colon mimicking carcinoma: report of a case. Dis Colon Rectum. 1998, 41: 1193-1196. 10.1007/BF02239444.CrossRefPubMed Skopelitou AS, Mylonakis EP, Charchanti AV, Kappas AM: Cellular neurilemoma (schwannoma) of the descending colon mimicking carcinoma: report of a case. Dis Colon Rectum. 1998, 41: 1193-1196. 10.1007/BF02239444.CrossRefPubMed
22.
Zurück zum Zitat Miettinen M, Lasota J: Gastrointestinal stromal tumors–definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Archiv. 2001, 438: 1-12. 10.1007/s004280000338.CrossRefPubMed Miettinen M, Lasota J: Gastrointestinal stromal tumors–definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Archiv. 2001, 438: 1-12. 10.1007/s004280000338.CrossRefPubMed
23.
Zurück zum Zitat Miettinen M, Shekitka KM, Sobin LH: Schwannomas in the colon and rectum: a clinicopathologic and immunohistochemical study of 20 cases. Am J Surg Pathol. 2001, 25: 846-855. 10.1097/00000478-200107000-00002.CrossRefPubMed Miettinen M, Shekitka KM, Sobin LH: Schwannomas in the colon and rectum: a clinicopathologic and immunohistochemical study of 20 cases. Am J Surg Pathol. 2001, 25: 846-855. 10.1097/00000478-200107000-00002.CrossRefPubMed
24.
Zurück zum Zitat Maciejewski A, Lange D, Wloch J: Case report of schwannoma of the rectum–clinical and pathological contribution. Med Sci Monit. 2000, 6: 779-782.PubMed Maciejewski A, Lange D, Wloch J: Case report of schwannoma of the rectum–clinical and pathological contribution. Med Sci Monit. 2000, 6: 779-782.PubMed
25.
Zurück zum Zitat Pollock J, Morgan D, Denobile J, Williams J: Adjuvant radiotherapy for gastrointestinal stromal tumor of the rectum. Dig Dis Sci. 2001, 46: 268-272. 10.1023/A:1005581000712.CrossRefPubMed Pollock J, Morgan D, Denobile J, Williams J: Adjuvant radiotherapy for gastrointestinal stromal tumor of the rectum. Dig Dis Sci. 2001, 46: 268-272. 10.1023/A:1005581000712.CrossRefPubMed
26.
Zurück zum Zitat Wilhelm D, von Delius S, Weber L, Meining A, Schneider A, Friess H, Schmid RM, Frimberger E, Feussner H: Combined laparoscopic-endoscopic resections of colorectal polyps: 10-year experience and follow-up. Surg Endosc. 2009, 23: 688-693. 10.1007/s00464-008-0282-5.CrossRefPubMed Wilhelm D, von Delius S, Weber L, Meining A, Schneider A, Friess H, Schmid RM, Frimberger E, Feussner H: Combined laparoscopic-endoscopic resections of colorectal polyps: 10-year experience and follow-up. Surg Endosc. 2009, 23: 688-693. 10.1007/s00464-008-0282-5.CrossRefPubMed
27.
Zurück zum Zitat Teitelbaum EN, Nguyen SQ, Zhu H, Salky BA: Laparoscopic resection of a schwannoma of the ascending colon. Am Surg. 2010, 76: E97-E99.PubMed Teitelbaum EN, Nguyen SQ, Zhu H, Salky BA: Laparoscopic resection of a schwannoma of the ascending colon. Am Surg. 2010, 76: E97-E99.PubMed
Metadaten
Titel
Schwannoma of ascending colon treated by laparoscopic right hemicolectomy
verfasst von
Hun Jin Kim
Chang Hyung Kim
Sang Woo Lim
Jung Wook Huh
Young Jin Kim
Hyeong Rok Kim
Publikationsdatum
01.12.2012
Verlag
BioMed Central
Erschienen in
World Journal of Surgical Oncology / Ausgabe 1/2012
Elektronische ISSN: 1477-7819
DOI
https://doi.org/10.1186/1477-7819-10-81

Weitere Artikel der Ausgabe 1/2012

World Journal of Surgical Oncology 1/2012 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.