Appendicular Diseases; Spectrum in Surgical Pathology

Abstract

Acute appendicitis is a common cause of acute surgical abdomen and many appendectomies are performed daily. All disease processes involving appendix will present as acute appendicitis. Clinically diagnosed acute appendicitis is treated by urgent appendectomy. As most of the removed appendices will reveal acute suppurative inflammation, therefore, appendectomy specimens are not usually submitted for histopathological examination unless the surgeon notices advanced disease or grossly recognizable abnormalities. Objectives: The purpose of this study is; 1, to explore the spectrum of diseases affecting the appendix in the community; 2, to find the age and gender association of appendicular diseases; and 3, to see if all the surgically removed appendices should be submitted for histopathological examination as a routine procedure. Study Design: Retrospective study. Setting: Charsada Teaching Hospital affiliated with Jinnah Medical College Peshawar. Period: January 2013 to January 2016. Methods: The histology slides and diagnoses of all the retrieved cases were reviewed with regards to morphology, patient's age, gender and presence or absence of any associated disease. Results: Nine disease entities were identified affecting the appendix, which from most to least common were acute suppurative appendicitis, lymphoid hyperplasia, fecalith, fibrous luminal obliteration, oxyuriasis, carcinoid tumor, submucosal fibrosis, acquired diverticulosis, and inflammatory mucocele. The first three commonest diseases were most frequent in the second decade of life; fibrous luminal obliteration in the fourth decade, carcinoid tumors in the third decade, and oxyuriasis in the first decade. Moreover, acute suppurative appendicitis, fecalith, oxyuriasis, and submucosal fibrosis were more frequent in males; whereas, lymphoid hyperplasia and fibrous luminal obliteration were more common in females. Conclusions: Acute suppurative appendicitis was the most common histological diagnosis. Acute suppurative appendicitis, fecalith, oxyuriasis, and submucosal fibrosis were more common in males; whereas, lymphoid hyperplasia and fibrous luminal atresia were more common in females. Acute suppurative appendicitis, lymphoid hyperplasia, and fecalith were most common in the second decade of life. In view of the nine different histological disease entities identified in this study under one clinical diagnosis of acute appendicitis, it is highly recommended to submit all appendectomy specimens for histopathological examination.

Impact of Endemicity of Ascariasis on Diagnosis of Acute Appendicitis

“…It can result from faecolith, lymphoid hyperplasia and foreign bodies. 5 Parasitic infestation leading to obstruction of appendicular lumen resulting in edema, super added bacterial infection and necrosis is another rare but known cause of right iliac fossa pain in people living in endemic areas. 6,7 The parasitic infestation of appendicular lumen can be asymptomatic most of the times.…”