2004 were used to identify trends in the number of cases of appendicitis and imaging studies performed in EDs. We also evaluated age distri- bution of appendicitis cases and frequency of antibiotic use. Descriptive statistics were used to present proportions and a chi square test was used to evaluate trends. Results: The number of cases of appendicitis over the ten-year study period increased from 199,359 in 1996 to 360, 387 in 2005 (p value for trend=0.025). Children under age 18 and under accounted for 30.6% of all ED visits for appendicitis, with 50.6% of cases between ages 19-44 and 18.8% were 45 or older. Males made up 55% of cases annually. CT scan usage increased over the time period of the study from 6% in 1997 to 61.7% in 2005. The percentage of cases given antibiotics in the ED also increased from 19.7% to 40.3%. Conclusion: Contrary to previous reports, we found that the incidence of appendi- citis presenting to Emergency Departments increased over the ten-year period. The use of CT scan for diagnosis and the use of antibiotics in the ED have also increased. QS59. ACUTE APPENDICITIS: THE GREAT MASQUER- ADER. Dawn A. Hardy, Thomas J. Schroeppel, Louis J. Magnotti, Peter Edmund Fischer, Martin A. Croce, Timothy C. Fabian; University of Tennessee Health Science Center, Memphis, TN Background: Acute appendicitis classically presents with the gradual onset of periumbilical pain that migrates to the lower right quadrant of the abdomen. The ability to mimic any intra-abdominal process can make appendicitis a formidable diagnostic challenge, as illustrated in the following case. Case Report: A 36-year-old African-American man presented to the emergency department with a four-day history of crampy, intermittent lower abdominal pain accompanied by two days of diarrhea. On examination, the patient was afebrile, diaphoretic, had right and left lower quadrant tenderness, distension, and decreased bowel sounds with tinkles and rushes. Laboratory values were remark- able for an elevated white blood cell count. Plain roentgenogram of the abdomen showed dilated loops of small intestine with a foreign body in the pelvis. A preoperative diagnosis of mechanical small bowel obstruc- tion due to a foreign body was made and exploratory laparotomy was performed. Intraoperative findings were that of adhesive small bowel obstruction caused by a perforated appendicitis secondary to a large fecalith and an accompanying pelvic abscess. After appendectomy, the patient had a delayed return of bowel function and was discharged after ten days. Conclusion: Acute appendicitis is a common disease that can have many unusual manifestations including those in which the primary disease process is completely obscured. It is necessary to em- phasize the consideration of acute appendicitis in the differential diag- nosis of acute abdomen, as early recognition is critical to the institution of appropriate and prompt therapy to avoid impending complications and mortality. QS60. EFFECTS OF EXTRINSIC DENERVATION ON INNER- VATION WITH VASOACTIVE INTESTINAL POLYPEP- TIDE AND SUBSTANCE P IN CIRCULAR MUSCLE OF RAT JEJUNUM. Michael S. Kasparek, Javairiah Fatima, Corey W. Iqbal, Judith A. Duenes, Michael G. Sarr; Mayo Clinic College of Medicine, Rochester, MN Intestinal denervation contributes to enteric motor dysfunction after small bowel transplantation (SBT). Aim: To determine effects of ex- trinsic denervation on functional motor innervation with the nonadren- ergic, noncholinergic (NANC) neurotransmitters vasoactive intestinal polypeptide (VIP) and substance P (Sub P). Hypothesis: Extrinsic denervation by SBT changes the innervation with VIP and Sub P. Methods: 6 groups of rats (n6 per group) were studied: naïve controls (NC); 1 wk after anesthesia/sham celiotomy (SC-1); 1 and 8 wk after jejunal and ileal transection/reanastomosis (TA-1, TA-8), or syngeneic (no immune phenomena) orthotopic SBT (SBT-1, SBT-8). Dose- response of jejunal circular muscle strips to exogenous VIP and Sub P (3x10 -9 -3x10 -7 M) was studied without/with the VIP antagonist [D-p- Cl-Phe 6 ,Leu 17 ]-VIP, the Sub P antagonist [D-Pro 2 ,D-Trp 7,9 ]-Sub P, and the nitric oxide-synthase inhibitor L-N G -nitro arginine (L-NNA). Elec- trical field stimulation (EFS) at 6 and 20 Hz was applied without/with antagonists to study endogenous release of neurotransmitters. Data are xSEM. Drug responses are change from baseline contractile activity in % (increase: positive values; decrease: negative values). Results: VIP inhibited contractile activity dose-dependently, more pronounced in NC compared to all other groups (NC: −876 vs. others: -4012 to -6412%; p0.05; ANOVA). Sub P increased contractile activity dose-dependently in all groups but most pronounced in NC (NC: 14019 vs. others: 2919 to 7923%; p0.05; ANOVA). The VIP antagonist ([D-p-Cl-Phe 6 ,Leu 17 ]-VIP) failed to prevent the inhibitory effect of exogenous VIP in any group, while the Sub P antagonist ([D-Pro 2 ,D-Trp 7,9 ]-Sub P) prevented the excitatory effect of exogenous Sub P partially in TA-8 and SBT-8, and completely in NC (p0.05; ANOVA). The VIP antagonist, L-NNA, and Sub P antagonist did not affect the EFS response at 6 and 20 Hz in any group 1 wk postopera- tively. In contrast, in NC, TA-8, and SBT-8, after blocking the release of the dominant inhibitory NANC neurotransmitter nitric oxide, the en- dogenous release of VIP was uncovered by the VIP antagonist with a net increase in contractile activity to EFS at 6 Hz (p0.05; ANOVA). The excitatory response to EFS at 20 Hz was prevented by the Sub P antagonist partially in TA-8 and SBT-8 and completely in NC (p0.05; ANOVA). Conclusion: Changes in functional innervation with VIP and Sub P in rat jejunal circular muscle persist up to 8 wk postopera- tively. Endogenous release of VIP and Sub P is preserved after SBT. Changes in the innervation of the circular muscle of the jejunum with VIP and Sub P might contribute to enteric motor dysfunction after SBT, but appear related more to the bowel transection (disruption of enteric neural continuity) than to extrinsic denervation after SBT. QS61. IL-6 IS AN ESSENTIAL INHIBITOR OF APOPTOSIS FOLLOWING INTESTINAL INJURY. Xiaoling Jin, Teresa A. Zimmers, Pochi R. Subbarayan, Zongxiu Zhang, Bach Ardlan, Leonidas G. Koniaris; University of Miami, Miami, FL Background and Aims: IL-6 is a well-recognized mediator of liver disease. We sought to determine the in vitro and in vivo effects of IL-6 on small intestinal enterocytes. Methods: Cell lines and murine mod- els were examined. Results: Intestinal cell lines demonstrated ex- pression of gp80 and gp130 the two receptors for IL-6. Cell lines phosphorylated STAT3 in response to IL-6. Mice exposed to high- dose IL-6 developed intestinal hyperplasia with a 30% increases in bowel mass and increase in intestinal overall length and villus length. Pulse labeling of enterocytes demonstrated equivalent crypt proliferation following 2h or BrdU labeling but a dramatic prolonga- tion of enterocyte life-span. By Western analysis, no increase in enterocyte proliferation rate, or PCNA expression was noted; induc- tion of a number of anti-apoptotic proteins including Bcl-2, ref-1 and FLIP along with decreased executor caspase activity and cleavage of PARP was observed. IL-6 pretreated mice demonstrated less intes- tinal injury following ischemia reperfusion of the small bowel as well as less caspase-3 activation following single-dose exposure to the commonly used chemotherapy 5-FU. Examination of IL-6 null mice demonstrated impaired recovery following massive enterectomy and increased apoptosis in IL-6 null animals relative to wild type controls following 5-FU chemotherapy. Conclusions: IL-6 has important in vivo anti-apoptotic and anti-necrotic effects on enterocytes. Loss of IL-6 results in increased activation of pro-apoptotic and death pathways and increased injury in models of intestinal injury. Therapies that augment IL-6 or its signaling pathways may be beneficial in the management of intestinal disorders associated with increased apoptosis and gut injury. QS62. CHEMICALLY INDUCED COLONIC INFLAMMATION STIMULATES SMALL INTESTINAL GLUTAMINE AB- SORPTION. Brynn S. Wolff 1 , Wiley W. Souba 2 , Qinghe Meng 1 , Leonard R. Fitzpatrick 1 , Katia Meirelles 1 , Robert N. 293 ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS