Granulomatous Appendicitis in the Pediatric Population
Hao Wu1, Maren Y Fuller1, Jennifer Pogoriler2
1Department of Pathology and Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
Insights
Pediatric granulomatous appendicitis (GA) is rare, often linked to interval appendectomy. Crohn's disease is an uncommon association, and special stains for infections offer little clinical value in diagnosing GA.
Area of Science:
- Pediatric pathology
- Gastrointestinal surgery
- Histopathology
Background:
- The clinical significance of granulomatous appendicitis (GA) in children is not well understood.
- Pediatric GA is a rare condition requiring further investigation into its causes and implications.
Purpose of the Study:
- To investigate the etiology and histopathology of pediatric granulomatous appendicitis.
- To determine the association between GA and other gastrointestinal conditions like Crohn's disease.
- To evaluate the diagnostic yield of special stains in pediatric GA cases.
Main Methods:
- Retrospective review of pediatric patients diagnosed with GA at two major pediatric institutions.
- Analysis of etiological factors and histopathological findings in appendectomy specimens.
- Review of clinical data, including follow-up for inflammatory bowel disease and the use of special stains.
Main Results:
- Forty-three cases of pediatric GA were identified (0.4% of appendectomies), with a median age of 12.1 years.
- Interval appendectomy was the most common scenario (51% perforated appendicitis managed medically prior to surgery).
- GA was rarely associated with Crohn's disease (1 of 21 non-interval appendectomies) and special stains showed low diagnostic utility.
Conclusions:
- Granulomatous appendicitis is a rare finding in pediatric patients, most frequently associated with interval appendectomies.
- The association of pediatric GA with Crohn's disease is infrequent, and serosal granulomas are more common in interval appendectomies.
- Special stains for microorganisms in pediatric GA have limited diagnostic value and minimal impact on clinical management.
Background:
The clinical significance of a diagnosis of granulomatous appendicitis (GA) is not well established in the pediatric population.
Methods:
Retrospective review of the etiology and histopathology of pediatric GA at 2 large pediatric institutions.
Results:
Forty-three (0.4%) patients had GA at a median age of 12.1 years. Twenty-two (51%) had perforated appendicitis that was medically managed prior to interval appendectomy. Sixteen of 21 noninterval appendectomies were performed for clinically suspected acute appendicitis. Among them, 1 had Crohn's disease identified during surgery. None of the other patients had a subsequent diagnosis of inflammatory bowel disease (median follow-up of 4 weeks). There were significantly more cases with mucosal-only granulomas as well as fewer serosal granulomas in the noninterval appendectomy specimens than the interval specimens (P = .014). When performed, special stains for microorganisms did not contribute to clinical care. In the same time period, GA was seen in 6 (6%) of 94 bowel resections for Crohn's disease.
Conclusion:
GA is rare in pediatric patients, with interval appendectomy being the most common etiology and only rarely associated with Crohn's disease. Granulomas in interval appendectomies tend to be serosal-based. Special stains for infectious organisms in GA are of low diagnostic yield and have little impact on clinical management.
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