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Appendectomy in familial Mediterranean fever: clinical, genetic and pathological findings

M Lidar1, A Doron, R Kedem

  • 1Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Israel. merav.lidar@sheba.health.gov.il

Clinical and Experimental Rheumatology
|September 19, 2008
PubMed
Abstract

Insights

Familial Mediterranean Fever (FMF) abdominal attacks often mimic appendicitis, leading to high rates of unnecessary appendectomies. Severe FMF phenotype and M694V homozygosity increase appendectomy risk.

Area of Science:

  • Medical research
  • Clinical diagnostics
  • Genetics

Background:

  • Familial Mediterranean Fever (FMF) presents with abdominal attacks that can be mistaken for acute appendicitis.
  • This diagnostic challenge frequently results in unnecessary appendectomies for FMF patients.

Purpose of the Study:

  • To investigate the diagnostic accuracy of appendicitis in patients with Familial Mediterranean Fever (FMF).
  • To identify risk factors associated with appendectomy in FMF patients.

Main Methods:

  • Retrospective review of 182 consecutive FMF patients.
  • Comparison of clinical and genetic data between patients who underwent appendectomy and those who did not.

Main Results:

  • Appendectomy rates in FMF patients (40%) significantly exceed general population rates (12-25%).
  • A high rate of non-inflamed appendectomies (80%) was observed, with no reduction over time despite improved medical care.
  • Severe FMF phenotype and M694V homozygosity are risk factors for appendectomy; localized right lower quadrant pain predicts inflamed appendix.

Conclusions:

  • Diagnostic accuracy for acute appendicitis in FMF patients can be improved by relying more on clinical parameters.
  • Targeted clinical assessment is crucial to reduce misdiagnosis and unnecessary surgeries in FMF.

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