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Acute appendicitis in patients with sickle cell disease
Mona A Al-Nazer1, Hussain H Al-Saeed, Ahmed H Al-Salem
1Department of Pathology, Qatif Central Hospital, Qatif, Kingdom of Saudi Arabia.
Saudi Medical Journal
|September 16, 2003
Summary
Acute appendicitis in sickle cell disease (SCD) is rare but severe, often leading to perforation. Sickled red blood cells (RBCs) block vessels, causing ischemia and ulceration in SCD patients.
Area of Science:
- Medicine
- Hematology
- Surgery
Background:
- Abdominal pain in sickle cell disease (SCD) is often misdiagnosed as vaso-occlusive crisis.
- Acute appendicitis is an uncommon surgical emergency in SCD patients, characterized by rapid progression and high perforation rates.
Purpose of the Study:
- To investigate the clinical and pathological characteristics of acute appendicitis in patients with sickle cell disease.
- To compare appendiceal changes in SCD patients with those in sickle cell trait and control groups.
Main Methods:
- A retrospective review of 8 SCD patients with acute appendicitis from 1995-2001.
- Histological examination of appendiceal tissues.
- Comparison with 9 sickle cell trait patients and 28 controls.
Main Results:
- SCD patients exhibited severe inflammation and vessels packed with sickled red blood cells (RBCs).
- Mucosal ulcerations were significantly more common in SCD patients (87.5%) compared to sickle cell trait (44.4%) and controls (64.3%).
- One SCD patient presented with transmural hemorrhage and sickled RBCs without inflammatory infiltrate.
Conclusions:
- Acute appendicitis in SCD is rare and characterized by appendiceal vascular blockage due to sickled RBCs.
- This blockage leads to ischemia, edema, and subsequent mucosal ulceration with significant inflammation.
- Prompt diagnosis and surgical intervention are crucial for managing appendicitis in SCD patients.