The Histopathology of the Appendix in Children at Interval Appendectomy

Abstract

Whilst most surgeons agree that conservative treatment of appendiceal abscess in children is an adequate treatment, the need for subsequent interval appendectomy is still controversial. We analyzed the histopathology in interval appendectomy in search of signs of inflammation. All patients admitted between 2010 and 2017 with appendiceal abscess and scheduled for interval appendectomy were reviewed. The specimens were evaluated for grade of inflammation, type and distribution of cellular infiltrate, presence of necrosis or hemorrhage and infiltrate in the serosa. Forty-two patients had appendiceal abscess and were treated conservatively. Seven underwent emergent appendectomy. Thirty-three out of 35 patients underwent elective interval appendectomy. Thirty-two specimens were revised. Carcinoid tumor or other malignant lesions were not found. All of them presented some amount of inflammation, grade 1 to 2 in 53%, grade 3 to 4 in 47%. Twenty-five percent of the specimens had signs of necrosis accompanied by hemorrhage and in more than the half (53%) the infiltrate extended to the serosa. Conclusions: Although the appendix was mostly found not macroscopically inflamed intraoperatively, histology confirmed a certain grade of inflammation even months after the conservative treatment. No correlation was found between histopathologic findings and lapse of time between abscess treatment and interval appendectomy.

Case report: Histological findings of peri-appendicitis in three children with SARS-CoV-2 – related multisystem inflammatory syndrome: A mark for systemic inflammation?

“…Indeed, perivisceral inflammation is described in more than half of cases of acute pediatric appendicitis, mostly with moderate-to-severe inflammation ( 20 ). In our cases, inflammation of the serosa was present even if mucosal inflammation was none-to-mild, in line with previous observations on the extra-pulmonary manifestations of SARS-CoV-2 disease ( 21 , 22 ).…”

“…Of note, neither viral particles nor viral cytopathic effect was detected in any of the histopathological reports published so far (15,21), highly suggesting an immune-mediated mechanism rather than a direct viral injury. Furthermore, the pathological findings from the three cases show that inflammatory infiltrate primarily affects the perivisceral fat and vessels, in contrast with other forms of acute appendicitis in which inflammation extends from the mucosal surface to the perivisceral fat.…”

Benefit for non-operative treatment of pediatric appendicitis with intra-abdominal abscess. A single-center report

“…In our series, more than half of the patients presented acute inflammatory infiltration of the appendix after surgery. Nevertheless, this rate decreased after waiting for a longer interval before surgery [15]. Recently, Farr et al found that acute inflammation was associated with longer operative time for delayed appendectomy, reducing the potential benefits of NOT.…”

Complicated Appendicitis-Shifting towards Early Appendectomy-A Comprehensive Review

“…24 The histopathology of the appendix specimen of patients who underwent interval appendectomy and the results showed that all specimens had various grades of inflammation and there were no neoplasms. 25 These studies concluded that interval appendectomy need not be routinely done after completion of conservative treatment. As patients can be followed up with computerized tomography and colonoscopy, Interval appendectomy is only indicated for patients who present with recurrent symptoms.…”