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Incidence and outcomes of unexpected pathology findings after appendectomy

Hanna Alemayehu1, Charles L Snyder1, Shawn D St Peter1

  • 1The Children's Mercy Hospital, Kansas City, MO.

Journal of Pediatric Surgery
|August 24, 2014
PubMed

Insights

Unexpected findings in pediatric appendectomies are rare but can include carcinoid tumors, pinworms, granulomas, and eosinophilia. Most cases resolve without intervention, though some eosinophilia may become symptomatic.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Pathology

Background:

  • Appendectomy is a common pediatric surgical procedure.
  • Pathologic examination of the appendix can reveal unexpected findings beyond acute appendicitis.
  • Understanding the clinical course of these unexpected findings is crucial for patient management.

Purpose of the Study:

  • To review the clinical outcomes of children with unexpected appendiceal pathology identified after appendectomy.
  • To analyze the incidence and management of various non-appendicitis findings in pediatric appendectomy specimens.

Main Methods:

  • Retrospective review of pediatric appendectomy cases from 1995 to 2011.
  • Data collection focused on patients with abnormal appendiceal pathology.
  • Analysis included demographics, diagnosis, pathology, outcomes, and treatment.

Main Results:

  • Of 3602 appendectomies, 86 patients had unexpected findings.
  • These included carcinoid tumors (n=9), pinworms (n=34), granulomas (n=14), and eosinophilic infiltrates (n=18).
  • Carcinoid tumors were fully resected; pinworm treatment was effective; one granuloma case progressed to Crohn's disease; some eosinophilia cases became symptomatic.

Conclusions:

  • Pediatric appendiceal carcinoid tumors are often incidental and require no further treatment.
  • Appendiceal granulomas have a low short-term association with Crohn's disease.
  • Antimicrobial therapy is sufficient for pinworm infestations.
  • Appendiceal eosinophilia may indicate a risk for symptomatic intestinal eosinophilia.
Abstract

Keywords:
AppendectomyOutcomesPathologyTreatment

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