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Appendicular colic and the non-inflamed appendix: fact or fiction?
N Fraser1, C Gannon, M D Stringer
1Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Summary
Appendicoliths, or fecaliths, can cause acute abdominal pain that mimics appendicitis. This study found appendicoliths in non-inflamed appendices, suggesting they can cause pain without inflammation.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pathology
Background:
- Appendicoliths are a known cause of acute appendicitis and perforation.
- The role of appendicoliths in causing abdominal pain without appendicitis is less understood.
Purpose of the Study:
- To investigate whether appendicoliths can cause acute abdominal pain in the absence of acute appendicitis.
- To analyze the prevalence of appendicoliths in different categories of appendectomy specimens.
Main Methods:
- Retrospective observational study of 601 pediatric appendectomy specimens (age < 16) from 1995-2001.
- Histology reports categorized specimens as perforated appendicitis, uncomplicated appendicitis, non-inflamed, or incidental.
- Presence of appendicoliths and clinical data were reviewed.
Main Results:
- Appendicoliths were found in 26% of perforated appendicitis, 17% of uncomplicated appendicitis, and 20% of non-inflamed appendices.
- All patients with appendicoliths in non-inflamed appendices presented with acute abdominal pain mimicking appendicitis.
- Appendicoliths were rarely found in incidental appendectomies (1%), but their frequency in non-inflamed appendices was higher than expected.
Conclusions:
- Appendicoliths can cause acute abdominal pain that mimics acute appendicitis.
- The presence of appendicoliths in non-inflamed appendices suggests a direct causal link to pain, independent of inflammation.