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The pathology of acute appendicitis
1Department of Histopathology, Royal Hospital Haslar, Gosport, Hampshire, UK.
Abstract:
Although acute appendicitis is frequent, it is subject to common misconceptions. Furthermore, there is little good evidence to support some of our beliefs. This report reviews the role of the anatomic pathologist in diagnosis when acute appendicitis is suspected clinically and discusses what is known of its pathology. The conclusions that can be legitimately drawn from the literature are emphasized. A classification is proposed that incorporates intraluminal inflammation, acute mucosal inflammation, acute mucosal and submucosal inflammation, suppurative (phlegmonous) appendicitis, gangrenous appendicitis, and periappendicitis, and the significance of each of these diagnoses is discussed. The etiology and pathogenesis of acute appendicitis is reviewed. Contrary to popular belief, the best evidence indicates that obstruction is unlikely to be the primary cause, at least in the majority of cases. Ancillary techniques in the diagnosis of appendicitis, including laparoscopy and peritoneal aspiration cytology, are discussed.
Insights
Acute appendicitis is common but often misunderstood. New evidence suggests obstruction is not the primary cause in most cases, challenging popular beliefs about this condition.
Area of Science:
- Pathology
- Gastroenterology
Background:
- Acute appendicitis is a frequent clinical diagnosis with prevalent misconceptions.
- Limited evidence supports some common beliefs regarding its etiology and pathology.
Purpose of the Study:
- To review the role of anatomic pathology in diagnosing suspected acute appendicitis.
- To discuss the known pathology, etiology, and pathogenesis of acute appendicitis.
- To propose a classification for appendicitis based on inflammation.
Main Methods:
- Literature review focusing on evidence-based conclusions.
- Pathological classification of appendicitis stages.
- Review of etiology and pathogenesis, including obstruction.
Main Results:
- Obstruction is unlikely to be the primary cause of acute appendicitis in the majority of cases, contrary to popular belief.
- A proposed classification includes intraluminal inflammation, mucosal inflammation, mucosal and submucosal inflammation, suppurative appendicitis, gangrenous appendicitis, and periappendicitis.
- Ancillary diagnostic techniques such as laparoscopy and peritoneal aspiration cytology are discussed.
Conclusions:
- The diagnosis and understanding of acute appendicitis require critical evaluation of existing evidence.
- A refined pathological classification aids in understanding disease progression.
- Challenging the traditional view of obstruction as the primary cause is supported by current evidence.