Clinical Significance of Variable Histomorphologic Findings Related to Mucosal Inflammation in Negative Appendectomy

Abstract

The aim of the study was to investigate the clinical significance of various histomorphologic findings related to mucosal inflammation in negative appendectomy. We reviewed histopathologic findings of 118 negative appendectomies and correlated them with the appendicitis inflammatory response (AIR) score and appendiceal diameter. Among 118 patients with negative appendectomy, 94 (80%), 73 (78%) and 89 (75%) patients displayed mucosal inflammation, high neutrophil score (neutrophil count ≥10/5 high power field and surface epithelial flattening, respectively. Out of 118 patients with negative appendectomy, mucosal inflammation, high neutrophil score and surface epithelial flattening were associated with higher risk group according to the appendicitis inflammatory response (AIR) score (p < 0.05, respectively). In addition, mucosal inflammation, high neutrophil score and surface epithelial flattening were frequently detected in 118 negative appendectomies, compared with 24 incidental appendectomies (p < 0.05, respectively). In an analysis of 77 negative appendectomy patients with appendiceal diameter data available, increased appendiceal diameter was positively correlated with luminal inflammation, high neutrophil score and surface epithelial flattening (p < 0.05, respectively). In conclusion, mucosal inflammation, high neutrophil score and surface epithelial flattening in negative appendectomy may be relevant to patients’ signs and symptoms, especially in cases with no other cause of the abdominal pain.

Comparison of Appendicitis Inflammatory Response (AIR) and Lintula scoring systems in diagnosing acute appendicitis among children

“…Therefore, timely treatment through surgical resection has been considered the gold standard in treating acute appendicitis for decades [ 2 , 3 ]. Although many efforts were made to acquire an early and accurate diagnosis in patients suspected of acute appendicitis, the histopathological evaluation of the post-appendectomy specimen remains the only reliable test to confirm the diagnosis [ 4 , 5 ]. Accordingly, the rates of complicated acute appendicitis are still far from ideal, and even significant advancements in the diagnostic evaluation of children with suspected appendicitis have not changed the management of this condition.…”

Comment on ‘Is it necessary to block an entire appendix to exclude acute appendicitis?’, a previously published article by Newton ACS Wong

“…Minimal mucosal inflammation, defined as neutrophils confined to the mucosa only, was excluded from the study as its clinical significance is contentious. 1,2 The 55 appendicectomies included 42 females (76%) and 13 males (24%). Four cases revealed clinically significant changes (7%), and these included acute appendicitis, Enterobius vermicularis, sessile serrated lesion without dysplasia and endometriosis.It was difficult to estimate the additional cost incurred for embedding the rest of appendices, but we used a schedule of charges used in our institution for external requests for research purposes; the additional cost amounted to $8830 for the above 55 cases (approximately $160 for a case).…”

“…Minimal mucosal inflammation, defined as neutrophils confined to the mucosa only, was excluded from the study as its clinical significance is contentious. 1,2 The 55 appendicectomies included 42 females (76%) and 13 males (24%). Four cases revealed clinically significant changes (7%), and these included acute appendicitis, Enterobius vermicularis, sessile serrated lesion without dysplasia and endometriosis.…”