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Periappendicitis is a significant clinical finding
A S Fink1, C A Kosakowski, J R Hiatt
1Department of Surgery, University of Cincinnati Medical Center, Ohio 45267-0558.
Abstract:
Periappendicitis has heretofore been regarded as a pathologic curiosity with little clinical significance. In this report, we have reviewed the UCLA experience with periappendicitis. Between 1955 and 1985, resected appendices of 353 patients showed periappendicitis on pathologic examination. Sixty-one of these patients, in whom exploratory surgery was performed for reasons other than acute appendicitis, underwent incidental appendectomy. In 251 of the remaining 292 patients, appendectomy was performed either for pathologically confirmed acute appendicitis or concomitant with treatment of other unsuspected abnormalities discovered intraoperatively. Although the remaining 41 patients were also believed to have acute appendicitis, their resected specimens revealed only periappendicitis. The latter group was composed of 9 males and 32 females, with a mean age of 29 years (range: 6 to 76 years). Twenty-four complications occurred in 18 of these patients (44%). Seven additional operative procedures were required in 5 of the 41 patients (12%). One patient died (2%). We conclude that identification of periappendicitis in the patient presumed to have acute appendicitis is of definite clinical significance and may merit further clinical investigation.
Insights
Periappendicitis, inflammation of the appendix outer layer, is often overlooked. This study reveals it has significant clinical implications, with a high complication rate in patients initially suspected of acute appendicitis.
Area of Science:
- Medicine
- Pathology
- Surgery
Background:
- Periappendicitis, inflammation of the serosal layer of the appendix, has historically been considered a minor pathological finding.
- Its clinical significance has been largely underestimated in medical literature.
Purpose of the Study:
- To evaluate the clinical significance and outcomes of periappendicitis.
- To determine the incidence and complications associated with periappendicitis in patients undergoing appendectomy.
Main Methods:
- Retrospective review of appendectomy specimens at UCLA between 1955 and 1985.
- Analysis of 353 cases with pathologically confirmed periappendicitis, focusing on a subgroup of 41 patients initially suspected of acute appendicitis.
Main Results:
- Of 353 patients with periappendicitis, 41 were initially suspected of acute appendicitis but had only periappendicitis on examination.
- This group (9 males, 32 females, mean age 29) experienced a 44% complication rate (24 complications in 18 patients).
- Five patients (12%) required additional surgery, and one patient (2%) died.
Conclusions:
- Periappendicitis is not merely a pathological curiosity and carries significant clinical implications.
- Patients presenting with symptoms suggestive of acute appendicitis but found to have periappendicitis require careful management due to potential complications.
- Further clinical investigation into periappendicitis is warranted.