Granulomatous appendicitis in children: a single institutional experience

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Pathology

Background:

• Granulomatous appendicitis (GA) is an uncommon condition, with limited pediatric case reports.
• This study investigates the incidence and characteristics of GA in children at a tertiary care hospital.

Purpose of the Study:

• To determine the incidence of granulomatous appendicitis in pediatric appendectomies.
• To describe the clinical presentation, etiology, and outcomes of pediatric GA.

Main Methods:

• Retrospective analysis of pediatric appendectomy cases (children <13 years) with biopsy-proven granulomatous appendicitis from 1991-2011.
• Data collected included demographics, clinical and radiological findings, intra-operative details, histology, diagnosis, and follow-up.

Main Results:

• Twelve of 1150 appendectomies (1.04%) showed biopsy-proven GA, with a male predominance (8:4).
• Etiologies included Yersinia enterocolitis (4 cases), Crohn's disease (2 cases), and idiopathic (5 cases). One idiopathic case later developed Crohn's disease.
• Inflammatory bowel disease (IBD) was more common in older children, while Yersinia was seen in younger children. Most patients (10/12) were asymptomatic at 5-year follow-up, with two experiencing recurrent symptoms.

Conclusions:

• Granulomatous appendicitis is rare in children (1.04% incidence) with a male predilection.
• Idiopathic causes are most frequent, followed by Yersinia enterocolitis and Crohn's disease.
• Long-term follow-up is recommended for idiopathic GA in children, and IBD should be considered in recurrent cases.